The Influence of Health Reform on "Direct Pay" Medicine




Srinivasan, Divya

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This dissertation focuses on "direct pay," which is a new business model that revolutionizes the practice of traditional medicine, by delivering individualized, patient-centered care (with services, such as house calls, 24/7 access to the physician, and same-day appointments) in return for a recurring membership fee, which is not covered by health insurance plans. The purpose of the study is to analyze how two characteristics of direct pay practices -- 1) organizational identity of "pure practices" (direct pay-only practices) and "hybrid practices" (practices with the direct pay services, as well as managed care services for patients with health insurance) and 2) the presence of Fee-for-Care or Fee-for-Service payment models in the practice -- impact the perception and utility of health reform policies, health information technologies, and organizational culture. Direct pay may produce a public policy solution to the administrative, financial, and regulatory troubles faced by traditional, private medical practices in the U.S, while also demonstrating that new government policies need to be devised to aid and incorporate direct pay practices in the political economy.



Public policy, Health care management, Concierge medicine, Direct pay, Direct primary care, Health information technology, Public policy, Retainer medicine