Identifying DPC nonsense does not require a law degree.
Watch out. Near you is a direct primary care advocate begging a legislator or regulator to make his medical practice less accountable. He is stomping his feet very, very hard and he’s shouting “This is not insurance”, “There is no risk being transferred”, or “My practice is not a ‘risk-bearing’ entity”.
This is not rocket science.
Question Set #1:
A. The day before I enter into a direct primary care contract, am I at risk of falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
B. The day after I enter into a direct primary care contract, am I at risk of falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
Answer Set #1
A. Yes.
B. Yes.
Question Set #2
The day before I enter into a direct primary care contract, am I at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
The day before I enter into a direct primary care contract, is any direct primary care physician at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
Answer Set #2
A. Yes.
B. No.
Question Set #3
A. The day after I enter into a direct primary care contract, am I at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
B. The day after I enter into a direct primary care contract, is my direct primary care physician at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object?
Answer Set #3
A. No.
B. Yes.
Question Set #4
A. If on the day before I entered into a direct primary care contract, I was the one at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object and on the day after I entered into a direct primary care contract, my direct primary care physician was the one at financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object, had there been a transfer of the financial risk of having to bear the costs of primary care services needed to treat the consequences of my falling while out on a walk, spraining my ankle, and wounding myself by falling on a sharp object from me to my direct primary care physician?
B. How many heads of direct primary care advocates just exploded?
Answer Set #4
A. Yes.
B. Many.
The State of New York has the financial capital of the world, has the most insurance companies in the country, and was the biggest state for the longest time. For these reasons is generally looked to for leadership in the law on financial subjects primarily governed by state law. Here’s how they define an insurance contract.
(a) In this article: (1) “Insurance contract” means any agreement or other transaction whereby one party, the “insurer”, is obligated to confer benefit of pecuniary value upon another party, the “insured” or “beneficiary”, dependent upon the happening of a fortuitous event in which the insured or beneficiary has, or is expected to have at the time of such happening, a material interest which will be adversely affected by the happening of such event.
(2) “Fortuitous event” means any occurrence or failure to occur which is, or is assumed by the parties to be, to a substantial extent beyond the control of either party.
Every other state has the same core idea of an obligation dependent on a fortuity.
Bonus round (advanced players only).
A. A municipality in the western corner of South Carolina self-insures to cover the costs of its employees’ health care. To meet part of its commitment to its employees it engages a group of primary care physicians who call themselves Western South Carolina Capitated Access MD. The employer pays them a fixed monthly fee for each employee who wishes to be a clinic patient in exchange for as much primary care as each such employee may need during the covered period. Is that capitation?
B. A municipality in the western corner of South Carolina self-insures to cover the costs of its employees’ health care. To meet part of its commitment to its employees it engages a group of primary care physicians who call themselves Western South Carolina Direct Access MD). The employer pays them a fixed monthly fee for each employee who wishes to be a clinic patient in exchange for as much primary care as each such employee may need during the covered period. Is that capitation?
Answers:
A. Yes.
B. Yes.
For pretzel lovers: For DPC advocates’ views on risk, capitation, and direct primary care, see this tweet thread and this one. For more DPC advocate double talk in this genre, extended to address adverse selection, try this masterpiece. See discussion here.
DPC Referee 