Compensating Providers for ‘Free’ (Primary) Healthcare
‘free’ primary care; insurance covering specialized services
In this proposal there would be ‘free’ (free-at-point-of-service) primary healthcare. General practitioners and internists would provide the services, along with physician assistants (PA’s), registered nurses (RN’s), and licensed practical nurses (LPN’s). It would be where people would go for regular check-ups and initial medical care for non-emergency ‘complaints’ (as medical professionals refer to patients’ specific reasons for seeking medical attention). It would be for those doctors to decide whether specialized services were needed.
Here we’ll focus on pay for those medical professionals. The object is to provide sufficient income without requiring so many patients that care would be jeopardized, yet creating disincentives for those professionals from overcommitting themselves in terms of the number of patients they would see in a day, to avoid mere perfunctory service. To that end, the U.S., where this author has always lived, will be used for supplying numbers.
We’ll focus specifically on doctors, under the assumption that a suitable algorithm for their compensation could serve as a template for the other providers. As I am not a medical professional, the specific numbers I suggest might not be realistic, but even if they are unrealistic that would not in itself invalidate the structure of the proposal.
The general idea would be that a doctor would accrue pay on a daily basis, based on the number of patients seen, with more pay for more patients up to a point — and a change in the scale of increase in pay per patient at some point. There could also be a possible bonus based on the average number of patients seen over four weeks. Other providers would receive some ratio of the pay that doctors received.
Let’s start with proposing an ‘ideal’ annual income for a primary care physician. Let’s say that would be $240,000/yr.
Let’s assume a doctor would work 240 days a year (5 days/wk.; 48wks.). To obtain that ideal income the doctor would make $1,000/day.
Now let’s suggest an ideal number of patients. I’ll put that at 20/day. That’s roughly an average of 20 mins./patient for seven hours (leaving a decent amount of slack time in a day for the ‘known unknowns’).
Here’s one possible approach to their compensation. Each day, the doctor would earn $7 for the first patient seen. Up to a point, with each additional patient the compensation per patient would increase. Up through 14 patients it would increase by $1/additional patient. So a doctor seeing 14 patients would earn $20/patient, $280 for the day: a rate for an annual pay of $67,200. Up through 20 patients the increase in compensation would rise $5/additional patient. On that scale a doctor seeing 20 patients on one day would earn $50/patient: $1,000 for the day.
For any additional patient(s) seen that day the doctor would be paid singly (no effect on the pay for other patients). It could be $50/patient; with some number of additional patients — including 1 — that number could decrease, say, $5/patient, down to some minimum.
Other pay could take the form of a bonus paid every four weeks based on the average number of patients seen each day, say, starting at 10 and ending at 20 (say, $1,000 for 10 and $100 for each additional number of patients averaged/day). That could particularly help new doctors just getting started, so it might at least be the case for the first year of a doctor’s career. If applied to all doctors, however, it might also decrease the jump in compensation for a day after (in this example) 14 patients.
Alternatively, all doctors could be paid a guaranteed minimum income that would equal, say, 15 patients/day for 240 days ($90,000), receiving more pay (as per the above scale) for days they did exceed that number of patients plus the bonus for the average number of patients seen per day in a month. In that case the bonus might be restructured.
In any event, one way to compensate the other providers would be to base their pay on the pay a doctor would receive. A PA might get 2/3 of what a doctor would get, an RN 2/3 of the pay of a PA, and and LPN 2/3 of the pay of an RN. Based on the above “ideal” pay that would be an annual income of, respectively, $160,000, $106,667, and $71,111.