Direct Primary Care: A Bioethical Analysis and Discussion of Practice Characteristics

Abstract

Primary care providers in the United States face many challenges that complicatecare delivery and contribute to burnout, including heavy administrative burden, large patient panels,, and relatively low compensation when compared to other medical specialties (Carlasare 2018). In response to these problems, alternate models of primary care delivery have emerged. Direct primary care (DPC) is one alternate model of primary care delivery that some think could provide a solution to problems affecting primary care. DPC is a model of primary care delivery in which insurance is not charged for services provided by a practice. Instead, patients pay a recurring membership fee in exchange for access to services provided by the practice (Eskew and Klink 2015; DPC Frontier 2020). While DPC may decrease physician burnout and provide a viable source of primary care for some patients, there is the potential for DPC to contribute to already existing health inequities. This thesis will explore characteristics of DPC practices in the United States to identify qualities that could impact the delivery of ethical, equitable health care. These qualities will then be examined through a bioethical lens using the principles of equity, agency, and distributive justice to guide future directions for DPC and primary care delivery as a whole with the goal of establishing a care system that serves patients of all backgrounds and socioeconomic classes.