Q&A: Self-pay health care options are growing
By Mike Miller · Aug 27, 2013
Public policy consultant Sean Parnell‘s new blog, The Self-Pay Patient, and his upcoming book on the same topic might be of value to Samaritan Ministries members. Besides his own consulting firm in Virginia, which has a focus on health care policy, Sean is also Adjunct Scholar in Health Care for the Rhode Island Center for Freedom & Prosperity and a policy adviser to The Heartland Institute. He graciously took some time recently while recovering from minor surgery to answer our questions.
Q: What’s the current environment for self-pay patients in the U.S.? What are the attitudes of health care providers toward self-pays?
The current environment remains difficult, as health care is still largely dominated by third-party payment. That said, there are a growing number of primary care options that cater to self-pay patients and offer them fair value and real prices, including cash-only doctors, direct primary care practices, convenient care clinics, and urgent care clinics. Many pharmacies are also catering to self-pay patients with $4 generics, coupons, and other policies that are beneficial to the uninsured and those with high-deductible insurance. There are generally fewer options for self-pay patients when it comes to hospital care and surgeries, though, where “chargemaster” policies can financially devastate self-pay patients. There are a few glimmers of hope, through online sites where patients needing surgical or hospital care can be matched with facilities that are friendly to self-pay patients, including overseas options. But self-pay patients looking for hospital or surgical care can still have a rough time.
As for attitudes, I think there is growing interest among primary care providers in opting out of insurance altogether. Among hospitals there doesn’t seem to be as much interest, as self-pay and no-pay appear to often be used interchangeably by many facilities. There are exceptions such as the Surgery Center of Oklahoma, though, and I am hopeful that physician-owned facilities including surgical centers, specialty hospitals, and stand-alone emergency rooms may be able to become innovators in facilities treating self-pay patients fairly.
Q: What challenges do you think they will face once the Affordable Care Act is in effect? Will self-pay patients actually see any benefits from the ACA?
The Affordable Care Act is often cited by doctors as a reason they are considering going to cash-only practices, so to the extent the law pushes more into that market I think self-pay patients will benefit by having more provider options. In addition, the Affordable Care Act also limits what hospitals can charge self-pay patients, although it’s unclear how this will implemented. But it could help to end some of the worst “chargemaster” abuses.
Q: What are good resources for self-pay patients that you’re aware of?
Lots! Right now there are literally scores of resources available, mostly online. Unfortunately they’re scattered across dozens of different web sites, with no single source for self-pay patients to go to looking for information on where they can go. The Self-Pay Patient blog is intended to fill that gap, as a one-stop source for the self-pay patient to find information on getting the healthcare they need at affordable prices. Some of my top sites are:
Q: When is your book expected to be available? What will be in it?
The book will basically provide information and resources for self-pay patients in every major area of healthcare, including insurance alternatives (like Samaritan Ministries, but also critical illness policies, short-term insurance, and other options), primary care, hospital and surgical care, mental health, prescription drugs, oral and dental, and others. I’m still seeking a publisher for the book, or I might self-publish, I’m aiming to get it to the market this fall or winter.