回到自費醫療市場？

U.S.|THE TEXAS TRIBUNE

Doctors Shun Insurance, Offering Care for Cash

By ALEXA URAAPRIL 10, 2014

from New York Times



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At his office in Laredo, Tex., Dr. Gustavo Villarreal treated Sebastian Acosta on Wednesday. His practice, which follows a “direct primary care” model, does not accept insurance, but rather charges a flat $50 fee for most visits.CreditEddie Seal for The Texas Tribune

在德州一個城市，Laredo, Texas，有1/3的居民活在貧窮的邊緣，一位醫生Dr. Villarreal，他選擇不加入醫療保險，改收自費現金，每次美金$50元。

這位醫師不加入醫療保險給付的原因有許多，其中有我想最重要的是，「Texas’ sky-high rate of residents without health coverage」，因此，跳出保險給付是有道理的。

但這文中也列舉了醫療保險的問題，看到以下這段話，我心裡感到心有戚戚焉：

Doctors who use the model, which they call “direct primary care,” say they can keep their costs down by avoiding the bureaucracy of the health insurance system and the high processing costs — including additional staff — associated with accepting coverage.

這些自費基層診所醫療大致是做basic or preventive care，例如：看感冒，輕微感染，外傷，或是DM，骨鬆的長期照顧。當患者需要做進一步檢查時，就會給予轉診給有醫療保險給付的院所。

當然站在公衛專家的角度，太多的自費院所，這樣Obama的Affordable Care Act推行起來，困難就會高許多了。 然而，站在這些做自費醫療的醫師們角度，因為保險給付的複雜，惱人的文書行政作業（沒特別說明，是像我們的抽審或是核刪嗎？或是，點值下降？）甚至規定醫師們看診的時間，或是日期，讓醫師們想要退出保險給付。

文中這位醫師，
In Laredo, Dr. Villarreal has had a different experience. His business model frees up time for him to see more patients, he said, without the added costs that come from filing insurance claims. He still sees 40 to 60 patients a day, he said, 20 of whom tend to be new to his practice.

“To me, there’s no other way I would practice medicine,” he said. “You feel like you’re a doctor again.”

後記：

1) 這文章很有趣，讓我們看一下，也許不久將來即將全面進入醫療保險時代的美國，和我們之前成立全民健保，這過程是否有不同？

2) 高雄復興路一家皮膚科，蔡皮，只看自費，每次約收費NT$150，就和健保差不多，晚上也是人聲鼎沸。