Research & Commentary: Montana Lawmakers Introduce Direct Primary Care Legislation

Published February 12, 2021

The U.S. health care system is broken. Throughout the country, health care costs continue to increase. And there is a shortage of primary care physicians. In fact, according to a 2018 report from United Health Group, 13 percent of American patients live in a county with a shortage of primary care physicians. The United Health Group study estimates that by 2030 there will only be 306,000 primary care providers in the nation. 

There are many factors behind America’s primary care physician shortage. For example, in recent years, many more physicians have chosen to pursue specialty care as opposed to primary care. According to the American Journal of Medicine, the percentage of U.S. primary care physicians decreased from 50 percent in 1961to 33 percent in 2015.

A potential solution to this serious problem is direct primary care (DPC), also referred to as “retainer medicine.” DPC serves as an alternative to the third-party insurance system. Under a DPC agreement, patients pay a flat fee, typically monthly, directly to their doctor. This “retainer” covers all of their primary care visits and this agreement often includes same day appointments and house calls.

Montana is currently debating DPC in the state legislature. Currently, the state allows limited DPC agreements, which are highly regulated. Sen. Cary Smith (R-Billings) is attempting to change that by introducing Senate Bill 101, which states, “One of the really, really high costs of health care is insurance, and one of the things that adds a lot of bureaucracy and complexity to having a relationship between a physician and a patient is government regulation, state regulation. This bill makes it clear that in this type of arrangement, you don’t have that problem.”

This is not the first time DPC has been considered in the Treasure State. Similar bills passed in the legislature in 2015 and 2017, but then-Gov. Steve Bullock vetoed both. With Bullock no longer in the Montana governor’s mansion, a DPC bill has a better chance of becoming law.

Although Montana does have a limited number of DPC practices that face onerous regulations, SB 101 would greatly expand the size and scope of DPC agreements in the Treasure State.

The need for expanded DPC in Montana, and throughout America, is higher than ever. By 2030, demand for primary care is expected to increase by 38 percent for patients over the age of 65, and by 55 percent for those aged 75 and older. Across all age groups, DPC demand is expected to increase by 8 percent.

DPC promotes patient-centered care by removing layers of red tape. Under DPC programs, physicians are able to spend more time with patients, instead of filing paperwork. Currently, there are only 790 direct primary care practices in the United States. This number is expected to increase exponentially in the future.

Without a doubt, government interreference in the health care market is the biggest barrier blocking expansion of DPC. If policymakers aim to lower health care lower and increase access, they should focus on removing barriers to increase the proliferation of DPC in their respective states.


The following documents examine direct primary care in greater detail.


Research & Commentary: Ten Health Care Reform Options for States–commentary-10-health-care-reform-options-for-states  
The Heartland Institute outlines 10 steps state legislators should take to improve the cost and availability of health care in their states.

Direct Primary Care: An Innovative Alternative to Conventional Health Insurance
Insurance-based primary care has grown increasingly complex, inefficient, and restrictive, driving frustrated physicians and patients to seek alternatives. Direct primary care is a rapidly growing form of health care which alleviates such frustrations and offers increased access and improved care at an affordable cost. State and federal policymakers can improve access to direct primary care by removing prohibitive laws and enacting laws encouraging this innovative model to flourish. As restrictions are lifted and awareness expands, direct primary care will likely continue to proliferate as a valuable and viable component of the health care system.

Direct Primary Care: Practice Distribution and Cost Across the Nation
Philip M. Eskew and Kathleen Klink describe the direct primary care (DPC) model; identify DPC practices across the United States; distinguish it from other practice arrangements, such as the “concierge” practice; and evaluate data compiled from existing DPC practices across the United States to determine the cost advantages associated with this model. Eskew and Klink confirmed DPC practices’ lower price points and broad distribution, but data about quality are lacking.

Policy Diagnosis: Seize the Moment to Reform State Health Care Laws  
In this interview, Michael Hamilton asked Dr. Hal Scherz, board secretary for the Docs4PatientCare Foundation, how the Trump administration is changing the health care regulatory environment and what actions lawmakers should take to improve health care


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

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