Nov-Dec 2001 Table of Contents


An alternative financing model

FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.

FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Fam Pract Manag. 2001 Nov-Dec;8(10):12-13.

To the Editor:

Is It Time to Re-examine Family Practice?” notes that “comprehensive, continuing patient care – the hallmark of family practice – is becoming increasingly difficult to provide in a fragmented health care system where productivity pressures, increasing rules and regulations and concern for short-term profits threaten to compromise the physician-patient relationship.” In fact, the article goes on to quote others who state that the physician-patient relationship is already compromised.

It is evident that managed care is incompatible with this hallmark of family practice. For our specialty to survive, we must devise a palatable, efficient and safe alternative health care financing and delivery system.

The answer is a primary care retainer plan, in which patients would pay a low single annual fee to their primary care physician of choice. In return, patients would receive comprehensive primary care. The annual fee could variably come from patients, their employers or the government.

Financing of “extra primary” services (i.e., lab, X-ray, specialty referral care, ancillary services, drugs, emergency department and hospitalization) would be handled by various combinations of personal savings, medical savings accounts, defined contribution plans, low-cost, high-deductible insurance and intermediate benefit insurance. A government safety net would remain for those least able to afford coverage. Notably, managed care would have no role.

New market-driven relationships would arise among these extra primary entities and primary care physicians, based on quality as well as cost. We would be free from most, if not all, of the current administrative and bureaucratic hassles impeding the practice of medicine.

A primary care retainer plan would make primary care the cornerstone of health care, offer affordable primary medical care to many more individuals and smaller employers, restore the focus on the doctor-patient relationship and vastly reduce administrative costs and burdens.

A full treatment of this plan is beyond the scope of this letter, but can be found on the Web at


Send your comments to Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.

Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

Article Tools

  • Print page
  • Share this page

CME Quiz

Information From Industry