Doctor to detail new health fee model
A new approach to healthcare that could save money and prevent more people becoming sick is to be presented tonight at a dinner for doctors.
Henry Dowling, who said he could be the island’s only physician to adopt the direct primary care model, billed his talk as offering “a solution to our healthcare dilemmas”.
He said: “We want to go back to taking care of the whole patient, and not waiting for people to get sick, or referring them to somebody else because we can’t take the time they need. I didn’t go into medicine to mop up problems. I want to fix the problems.”
Dr Dowling is to speak on direct primary care at the Bermuda Healthcare Services and Brown-Darrell Clinic’s quarterly Docs for Dinner event.
The Paget-based doctor said that direct primary care involved payment of a flat monthly rate to cover visits to the practice.
He explained: “Direct primary care is considered membership-based care. Patients play a flat fee per month, and get unlimited visits per month and access to their doctor.”
Dr Dowling added: “It’s grown in popularity in the States, where there are around 800 practitioners involved. Five years ago there were maybe half that.
“It was borne out of the frustration of primary care doctors that were ending up with more paperwork and seeing more patients just to keep their doors open.”
Dr Dowling said the island’s model was a fee for service system based on patients “coming to us with a problem”.
He added he started to explore direct primary care after he became “frustrated with everyone talking about the cost of healthcare, but with no meaningful change”.
The Bermuda Health Council’s annual reports have tracked the ever-rising expense of healthcare.
The BHeC earlier this year tallied healthcare spending at more than $700 million from April 1, 2015 to March 31, 2016.
The watchdog warned at the time that the island’s healthcare system was “at a breaking point”.
Dr Dowling, who returned to the island in 2002 after working at a family practice in New Jersey, said he had grown disenchanted with the business of medicine in Bermuda.
He said: “I started looking for alternatives. Direct primary care meant, more or less, going back to the old family doctor who did everything for the family.
“It goes back to what I trained for. Patients don’t just go to the doctor because they’re sick, but to stay healthy.”
A general physician at Associates in Integrated Health and Bermuda Chiropractic Health Centre, Dr Dowling said he had switched to the new model in May.
He added: “A patient’s fee is anything from $20 a month to the most expensive of $105.
“It’s not going to cover things that happen at the hospital, lab work or X-rays. It covers you seeing the doctor, seldom for less than half an hour or 45 minutes.
“I guarantee same-day access and access to me after hours. That potentially can offset some of these emergency room visits.”
He added the most “basic” visit to the emergency room at the hospital costs “$450, minimum”.
Dr Dowling said: “Direct primary care has been shown to save money to the healthcare system. It’s not about making money but about establishing relationships.”
He added the move also cut out dealing with insurance companies.
He said: “I leave that for patients to use elsewhere. I have approached some insurance companies and they are not with the idea, which is surprising.
“In the States, there are some insurers that will reimburse patients monthly because it benefits them if patients are not having to access high-cost healthcare.”
The talk, open to invited guests only, will be held from 7pm at the St George Room at Café Lido at Elbow Beach.