Q&A: For Dr. Matt Bain, direct primary care is a matter of simple economics

For Dr. Matt Bain of Mid-Valley DPC in Albany, Oregon, the idea of direct primary care is a matter of simple economics.

“It makes sense to purchase insurance for catastrophic events, but it’s a very expensive way to pay for routine care,” he says.

Enter the DPC model, where his patients pay a monthly membership fee of $70 for an individual with a maximum of $160 for a family (and no limit on the number of children through age 24). A membership to his clinic gives them access to him by phone, office visits, and text messaging and significant savings on services like MRIs, X-rays, and lab work.

Dr. Bain answers a few questions for us about his practice and understanding of the medical world in general.

How is your practice different from a typical one?

Members pay a simple monthly fee of $70 per individual, with a maximum of $160 for a family (no limit on number of children). From there, I just simply take care of the patients, like an old-fashioned doctor. There’s no additional charge for an office visit, phone call, or text, and there’s much improved communication, no hassles. I work directly for the patient, no insurance involved.

What are some of the advantages to your practice that patients most appreciate?

In this model, we are BOTH much more efficient, with fewer trips to an urgent care. Many simple problems we can deal with over the phone. In fact, I have managed several more complex problems initially over the phone. Perhaps ordering imaging, then having the patient follow up in one to two days with the results of testing. This is another completely different aspect of the DPC model: We have access to $40 X-rays, $150 ultrasounds, $200 CTs, $300 MRIs, all done without the delay and hassle of trying to navigate through the barriers and costs associated with an insurance company. So the care is much faster, much cheaper, and I spend more time with the patient because I am not spending it with an insurance company trying to justify things the patient and I decided. I have witnessed firsthand how this translates into significantly better quality than what I used to deliver. The reason for this is simple: In the old model, the true client is the third-party payer. In this model, the client role shifts back to the patient, where it belongs. I have never met a patient who had a primary concern about an ICD or CPT code.

What are some of the problems with regulation of health care that you are able to avoid by having a DPC?

There is WAY too much regulation in health care today in the U.S. Again, the fundamental reason is very simple. In order to insure anything, it must meet three criteria: 1. The event must be rare (e.g., house fire, or lightning strike, or brain tumor, etc.). 2. Should the event occur, it must be catastrophic. 3. The thing you are insuring must NOT be desired. This is actually a key point. Many people will actually desire routine healthcare—such as monitoring blood pressure, diabetes, back pain, etc. None of these typical things fit ANY of the three criteria to insure.

What then happens, is because people are trying to insure routine health care that is common and actually desired, then the third party (insurance company) must play the role of rationing your care. Someone must ration everything. It is my belief that you are capable of rationing your entertainment, education, travel, housing, and, of course, your health care as well.

Now the DPC model works WITH basic laws of economics rather than against them as health insurance does. Most people soon realize that they should plan for the unforeseen catastrophe (that is undesired) such as heart attack, cancer, surgery, or tumor, etc.—that is bucket No. 1 shared by something like SMI. However, they also realize that funds going into bucket No. 1 have nothing whatsoever to do with routine care that they desire on a regular basis. That is the domain of Bucket No. 2, which is routine care. This makes much more sense to purchase via DPC than insurance. Then combine the monthly cost of buckets 1 and 2 and compare that to traditional insurance. Most people can see that there is no comparison with the quality and cost of their care. Better quality, obtained faster, and for markedly less cost.

We at Mid-Valley DPC strive to give the best quality primary care for an affordable price. The reasons above spell out part of the ways in which we do that.

Why did you join Samaritan Ministries?

I first learned of SMI from patients several years ago. I joined because it is a straightforward, simple concept that makes sense Biblically. For anything to work, it must be based on Biblical concepts. That’s why the insurance model doesn't work. Very simply, the Lord detests unequal weights and measures in business transactions. However, in the insurance model, no two patients actually pay the same for the same service. In the DPC model, all of my patients are on equal footing. Patients now pay the same for the same membership, imaging, lab test, etc. This comes much closer to a true free-market approach, rather than a distorted market.

What has your experience been with having a need?

I have personally used SMI to pay for a knee surgery that worked out smoothly.