In July, the University of Houston Medical School announced a bold new program—it will open a direct primary care clinic on the campus of Memorial Herman Southwest Hospital. The new DPC facility—aimed at low-income Houston residents—is to be the first in a network of such clinics.
Low-income and uninsured Texans stand to benefit from this first foray of the public sector into the DPC world. But success here could and should lead to an expansion of the principle: Let’s provide care to those who don’t have access to it by actually providing care—not by merely expanding Medicaid, a failing program that proves coverage doesn’t equal care.
Direct primary care is very simple. For a modest monthly subscription fee, a patient has full (often 24/7) access to a physician and that practitioner’s support staff. That fee is often $80 or less (and additional family members often get a discount). Other costs of care—a lab test, for example, or an x-ray—are billed to the patient, but at a much-reduced price. The patient will pay the actual cost of a service rather than what the ER or even a hospital clinic might have otherwise billed them. In the case of the program proposed in Houston, a charitable trust has donated $1 million dollars so these services may be offered at no or low cost to the patients who need care.
Access to the doctors and nurses can be through a smartphone app, through phone calls or text messages, or even by email.
Most of the health care Texans need, and most of the time, can readily be handled by DPC practices—everything from seasonal allergies and colds to sports medicine for our young athletes to women’s care and hormone replacement therapies, for example.
What’s more, DPC practices are uniquely suited to many of the ailments that drive too many Texans to emergency rooms—regardless of whether they’re insured. Diabetes is on the rise in Texas, particularly among low-income individuals. In 2020, the CDC reported more than 2.3 million Texans, or 11.2% of our population, have been diagnosed with diabetes—and another 621,000 have it but don’t yet know it.
The key to diabetes care is staying on top of it. Routine care is vital—yet Medicaid patients, the uninsured and even the insured with high deductibles often let treatment lapse. One study published by the American Journal of Preventive Medicine noted that “There are likely many steps between having health insurance and successfully getting treatment for diabetes—including providers needing to recognize the importance of screening and patients needing to implement rigorous lifestyle changes.”
That’s where DPC comes in. With easy access to health care providers, regular check-ins (from home or work, no waiting room), and nutrition and lifestyle advice at their fingertips, diabetes patients can receive much more attention and support with DPC. Outcomes would be better, and the cost—compared to a single ER visit due to diabetic ketoacidosis or hypo- or hyperglycemia, would be miniscule.
That’s just one example, but it shows how direct primary care, a model driven by private sector efforts so far, can also benefit the public sector. Right now, Medicaid patients have great difficulty finding physicians who accept their insurance, and they often see long wait times to get appointments. So in desperation, they end up in the (far more expensive) ER. Medicaid dollars now wastefully spent there could be redirected for better outcomes and happier patients if a portion could fund a Medicaid family’s DPC subscription fees.
The same goes for the still-failing VA health system. Giving our veterans access to care—including mental health care—at their fingertips could save many lives. Congressman Chip Roy, R-Texas, has offered a bill establishing a five-year pilot program doing just this.
For those physicians (and physicians-in-training) at the University of Houston Medical School, the new DPC clinic is a dream come true. This is the kind of medicine they worked for years to be able to practice—real doctor/patient relationships, making decisions without having to consult insurance companies or bureaucrats.
Direct primary care has proven itself both popular and effective in the private sector. Let’s allow the public sector—including Medicaid and the VA system—to enjoy its benefits, as well.