In your January 4, 2018 article about the new Accountable Care Organization (One Care) and the All Payer Model, both statewide initiatives that are also being implemented in Addison County, the goals of “better care, better access to care, and cost savings” are correctly articulated.
But, will an Accountable Care Organization and a new way of paying providers other than fee for service really achieve these goals? Whatever else these new initiative accomplish, universal access can only happen if health care is a public good. Paying the provider a capitated payment versus a fee for service, whatever the possible merits, won’t impact the patient who has high out-of-pocket costs and avoids going to the doctor in the first place.
Legislation currently being considered in Montpelier, on the other hand, would actually increase access markedly if implemented. That legislation is S53/H248. These bills would make primary care a publicly financed, public good in Vermont, with no out-of-pocket costs to patients. Since primary care is inexpensive (less than 6 percent of total health care costs), implementing universal primary care is not a big ticket item. Yet, making primary care universally accessible with no financial barriers to care would markedly improve public health in our state.
All studies show that access to primary care is the single most significant step that can be taken which can improve overall public health. Better still, a universally accessible primary care system will contain overall system costs, as patients who do not delay care can be treated before their symptoms are more serious, and therefore more costly.
While it might be a good thing to experiment with different payment systems for providers (other than fee for service), we need to be aware that this is not the main issue as far as access is concerned. Indeed, there are some countries that have universal national health care systems that still use fee for service. Despite this, their per capita health care costs are much lower than the United States.
Their lower costs are due to several factors. First comes universal access. Health care problems are treated earlier before they are more expensive. Also, such public systems have much lower administrative costs, since they do not have multiple private insurers. These public systems also have stricter controls over prices of services and drugs.
We can take a step in the direction of better health and cost control by making primary care a universal public good in Vermont.
Ellen Oxfeld
Middlebury