TX physicians create cash-only practices for uninsured

In Texas, which has millions of uninsured residents, doctors and patients increasingly rely on a cash-based finance model--a system that appears to work for both parties, according to the Texas Tribune.

Many doctors practicing in down-on-the-heels communities, such as Laredo, decide to forego the bureaucracy of insurance altogether and only accept cash from their patients, according to the article.

The doctors say they adopted the "direct primary care" model as a matter of necessity. "It had always been affordable and possible to maintain a practice with what insurance and patients paid, but about 10 or 15 years ago, you started seeing a decline" in revenue, Laredo family practice physician Gustavo Villareal, M.D., told the Tribune. He surrendered his insurance contracts in 2012.

Such a model is more likely to evolve in Texas than many other states. The Lone Star state has the highest uninsured rate in the nation--more than a quarter of its residents lack coverage. And the state's lawmakers refuse to consider expanding Medicaid eligibility as part of the Affordable Care Act.

Patients' economic strictures limit the services physicians offer in a direct primary care practice. Most offer little more than prescribing medicines for colds or other mild conditions, treating minor injuries or managing chronic conditions such as diabetes. Some physicians use the model to limit the number of patients they see or to make house calls. But Villareal sees 40 to 60 patients per day, according to the Tribune.

And despite getting some access to healthcare services, patients without insurance still require insurance if they are hospitalized, or charity care if they lack coverage.

"Consumers should anticipate their medical needs," David Gonzales, executive director of the Texas Association of Health Plans, told the Tribune. "However, when that is not possible, consumers should have financial protection from the unexpected." Only 295,000 residents purchased coverage through Texas state health insurance exchange--a quarter of the number of Californians who did so, likely because the state did no outreach.Gonzales did not offer any alternatives.

To learn more:
- read the Texas Tribune article

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