In recent years, subscription-based healthcare has emerged as a revolutionary alternative to the traditional healthcare system. This model, often labeled as “direct primary care” (DPC), involves patients paying a recurring subscription fee to a healthcare provider in exchange for a comprehensive package of medical services (1). Although this model remains relatively new, a 2023 survey showed that 37% of providers offered this form of care, while 80% offered the traditional fee-for-service model (2). Unlike traditional models wherein patients are billed for each individual visit or service, subscription-based healthcare focuses on providing holistic care through a membership-based system (1). With a subscription — typically less than $100 per month (3) — patients can enjoy a range of benefits, including enhanced access to providers and preventative care, while providers can benefit from a reduced clientele and stronger relationships with patients. However, as the system remains in its infancy, several components may render the model impractical for some patients and providers.
Subscription-based healthcare presents several advantages for subscribers. Primarily, this model offers improved access to providers. Traditional primary care providers see their patients an average of 1.6 times per year with an average of 15 minutes per visit; in contrast, subscription-based providers see their patients an average of 4 times per year with an average of 35 minutes per visit (4). Additionally, subscribers benefit from treatment plans tailored to their specific needs (3). This personalized approach fosters a strong provider-patient relationship, which strengthens understanding, trust, and efficacy (3, 5). Subscriptions include comprehensive care, ranging from prophylactic services, wellness programs, and other crucial measures that can prevent health issues in the future, thereby lowering overall healthcare costs (4). Thus, for many patients, the regular monitoring, routine checkups, and holistic care involved in subscription-based healthcare ensure high-quality, cost-effective health maintenance.
For specific patient populations, however, this model does not present a viable alternative to traditional healthcare. Subscription-based healthcare does not replace insurance, nor do most participating providers accept insurance, rendering it impractical for chronically ill patients and inaccessible for lower-income patients (4). First, as subscriptions typically exclude visits to the emergency room or urgent care, referrals to other providers, procedures, and specialty care, this method is unlikely to be cost-effective for patients with chronic ailments, who must continue to pay the subscription in addition to insurance costs for specialty or emergency care (3, 6). Second, the recurring cost of subscriptions presents a barrier to lower-income patients, who may be unable to afford the recurring payment, especially when combined with health insurance premiums (6).
From the providers’ perspective, subscription-based healthcare exhibits the advantages of improved patient-provider relationships and reduced administrative burden. According to a 2018 survey, traditional providers retain an average of 2000 to 2500 patients, while subscription-based providers handle only 300 to 600 (7). With fewer patients, subscription-based providers can devote more time to direct patient care, spend less time completing administrative work, and maintain a smaller staff (2, 3). Moreover, as most subscription-based providers do not accept insurance, the difficulties associated with insurance compliance and management can be avoided altogether, alleviating a significant strain for providers (3, 4). However, with their smaller clientele and absence of fee-for-service payments, subscription-based providers normally generate less income than their traditional peers (3). Additionally, departing from the traditional model and creating a subscription-based practice results in start-up costs and the loss of established patients (8). To deliver quality care, retain subscribers, and still make a profit, providers must find a balance between the costs of care and the subscription fee.
Subscription-based healthcare has surfaced as an alternative to the traditional fee-for-service model, offering benefits to both patients and providers. However, challenges related to insurance coverage, emergency and specialty care, and affordability may obstruct specific patient populations from subscribing, while difficulties related to income may prevent providers from adopting this model. Patients considering enrolling in subscription-based healthcare — as well as providers considering offering this model — must assess their own needs before shifting from traditional care to this approach.
References
1: Wolfson, B. 2021. Can a subscription model fix primary care in the U.S.? The Washington Post. URL: https://www.washingtonpost.com/business/2021/06/03/primary-care-one-medical/.
2: Couey, C. 2023. What you need to know about the different types of medical practice payment models. Software Advice. URL: https://www.softwareadvice.com/resources/healthcare-payment-models/#survey-methodology.
3: Lamberts, R. 2017. Pros and cons of switching to a subscription practice. Physicians Practice. URL: https://www.physicianspractice.com/view/pros-and-cons-switching-subscription-practice.
4: Anderman, T. 2018. Pros and cons of concierge medical care. Consumer Reports. URL: https://www.consumerreports.org/healthcare-costs/concierge-medical-care-pros-and-cons/.
5: Goforth, A. 2022. Could subscription model be the answer to US health care cost woes? Benefits Pro. URL: https://www.benefitspro.com/2022/06/27/could-subscription-model-be-the-answer-to-us-health-care-cost-woes/?slreturn=20230516160403.
6: Salter, S. Is subscription model healthcare a real alternative? Daily Leader. URL: https://www.dailyleader.com/2023/03/01/is-subscription-model-healthcare-a-real-alternative/.
7: Rajaee, L. 2019. What is the patient load sweet spot for direct primary care physicians? Elation Health. URL: https://www.elationhealth.com/resources/blogs/what-is-the-patient-load-sweet-spot-for-direct-primary-care-physicians.
8: Haefner, M. 2020. Physician viewpoint: a subscription model beats fee-for-service. Becker’s Hospital Review. URL: https://www.beckershospitalreview.com/finance/physician-viewpoint-a-subscription-model-beats-fee-for-service.html.