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Comment & Response
January 15, 2019

Advantages and Disadvantages of Direct Primary Care

Author Affiliations
  • 1Department of Family Medicine, Florida State University College of Medicine, Fort Myers
JAMA. 2019;321(2):207. doi:10.1001/jama.2018.18143

To the Editor The Viewpoint by Dr Adashi and colleagues1 raised several criticisms of direct primary care (DPC) that ignored the context in which DPC has emerged. Direct primary care has evolved in affirmation of the primacy of the patient-physician therapeutic relationship and rejection of bureaucratic and economic burdens on clinicians.

The authors’ suggestion that DPC practices promote adverse selection biases favoring wealthy, healthy, and nonminority patients relies on a false conflation of DPC and concierge practices. Unlike the dominant third party–based model or concierge practices that bill insurance, DPC practices relying on a flat monthly fee are not financially motivated to select patients based on health or socioeconomic status. In fact, DPC practices aim to provide as broad a scope of care as possible on the premise that individuals have the capacity to vote with their feet.