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Fam Pract Manag. 2001;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


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Copyright © 2001 by the American Academy of Family Physicians.

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