From the Guidelines
Balancing private practice in healthcare with the need for a comprehensive and equitable system requires a mixed model approach that prioritizes universal access and quality of care, as evidenced by the most recent study on value-based payment for clinicians treating cardiovascular disease 1. This approach can be achieved by implementing tiered coverage systems, where basic healthcare is guaranteed to all citizens through public funding, while allowing private options for supplementary services. Key considerations include:
- Regulated fee structures to prevent exploitation and ensure affordability
- Public-private partnerships to enhance access to care in underserved areas
- Incentive programs that encourage private practitioners to serve diverse patient populations
- Clear quality standards and oversight mechanisms to ensure equity and excellence in care
- Sliding scale payment systems based on income levels to make services accessible to all population segments
The success of such systems in countries like Australia, Germany, and France demonstrates that private practice can coexist with universal coverage when properly regulated and integrated within a cohesive national healthcare strategy. As noted in the American College of Physicians' policy position paper on direct patient contracting practices 1, there is a need for high-quality, independent research on the effect of private practice models on quality and access. However, the most recent guidance from the American Heart Association on value-based payment for clinicians treating cardiovascular disease 1 emphasizes the importance of designing payment systems that promote equity and improve patient outcomes, particularly for high-risk groups. By prioritizing these principles and leveraging the strengths of both private and public sectors, it is possible to create a balanced and equitable healthcare system that meets the needs of all patients.
From the Research
Balancing Private Practice in Healthcare with Comprehensive and Equitable Systems
- The resurgence of private practice in healthcare raises concerns about balancing individualized care with the need for a comprehensive and equitable healthcare system 2.
- Studies have shown that private practice physicians face increasing competition from larger practices and hospitals, leading to decreased reimbursement rates and longer working hours 2.
- To address these challenges, private practices may consider expanding their services, forming alliances, and exploring merger opportunities 2.
Role of Technology in Private Practice
- Telehealth interventions have been shown to improve medication adherence for patients with chronic conditions such as type 2 diabetes, hypertension, and dyslipidemia 3.
- Electronic health (eHealth) and telehealth interventions can increase health literacy and improve medication possession ratio (MPR) and proportion of days covered (PDC) rates 3.
- The use of technology can enhance the quality of care provided by private practices and improve patient outcomes.
Primary Care Access and Capabilities
- A study on US primary care practices found that access to care declined during the COVID-19 pandemic, while practice capabilities improved 4.
- Integrated practice ownership and accountable care organization (ACO) participation were associated with better access and capability scores, suggesting that value-based payment and integrated care delivery support high-quality primary care 4.
- Private practices can learn from these findings and strive to improve their capabilities and access to care.
Management of Chronic Conditions
- The management of hyperlipidemia in diabetes is crucial for reducing the risk of coronary heart disease (CHD) 5.
- Combination therapy with metformin and atorvastatin has been shown to be effective in improving HbA1c and LDL-C levels in patients with type 2 diabetes and dyslipidemia 6.
- Private practices can play a critical role in managing chronic conditions such as diabetes and dyslipidemia by providing comprehensive and coordinated care.