Insurance and Primary Care

Everyone should have primary care. Everybody should be able to see a doctor, get routine check-ups, have their chronic diseases managed and treated, afford medications, receive vaccinations, get prenatal care, undergo appropriate screening tests, and get patient education about their health, illnesses, preventive care, goals, and medicines. Primary care is the foundation for a healthy society.

But how is insurance involved? Insurance is a transfer of the risk of a loss from one entity to another in exchange for payment. It is used to hedge against the risk of a contingent, uncertain loss. When we buy car insurance, homeowner's insurance, or life insurance, we hedge against the risk of an accident. When we buy health insurance, we hedge against the small risk that we will need expensive care - that an injury will land us in the emergency department, a new cancer will require cutting-edge chemotherapy, or an illness will require a brief hospitalization.

On a first glance, it's not clear why insurance is involved in primary care. Perhaps an analogy with other types of insurance would be car insurance covering oil changes or homeowner's insurance covering roof maintenance. If something is supposed to be routine, then it's not the type of contingent, uncertain event covered by insurance.

But perhaps here is the reason why insurance companies are invested in primary care. If patients get their routine health screening, manage their hypertension, diabetes, cholesterol, and pain, and become educated about taking care and control of their health, then the risk of these catastrophic events is hopefully mitigated. By keeping everyone healthy, there may be fewer injuries and illnesses, and perhaps those that do happen will be less severe. Perhaps in an ideal world, everyone would get primary care, and insurance would be a separate distinct entity.