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For Uninsured In Ore., A Flat Fee For Health Care


In the U.S., as we all know, getting basic health care can be financially out of reach for many people who don't have insurance. Some doctors are trying to fill that need by charging patients a flat monthly fee for medical care.

From Oregon, we have story about one of those medical clinics where the doctor is effectively on retainer. Rachael McDonald of member station KLCC reports.

RACHAEL MCDONALD, BYLINE: Steven Kennedy sits in an exam room with Dr. Steven Butdorf. He's getting a physical.

DR. STEVEN BUTDORF: So Steve, what I want to do here is go through my checklist of everything else. Any heart worries or concerns?


MCDONALD: Kennedy is 60 years old. He was laid off about a year ago from his job as a computer technician. It's been more than four years since he's had a physical.

KENNEDY: I'm at the moment without insurance. So I needed something where I could come in and, you know, be a little more in my price range.

MCDONALD: Members of Dr. Butdorf's clinic don't have to have insurance. He charges a monthly fee to patients. There's a sliding scale that ranges from 39 to 79 dollars based on age. Butdorf opened this clinic, called Exceptional Health Care, in February.

Under a new Oregon law, it has to be registered with the state, but is exempt from insurance regulations. The 56-year-old says at his previous practice, many of his patients complained about the cost of medical care.

BUTDORF: You know we'd end up sitting in a room having discussions about macro-economics of health care instead of their medical issues. And as I learned about this model and came to understand it better, it just had a strong appeal to me as a better way to practice medicine.

MCDONALD: Butdorf says he came to a point in his career where he needed to make a change.

BUTDORF: I had these years of experience. I knew how to run a medical practice. I felt some sense of being in a day-to-day rut that was not stimulating me professionally.

MCDONALD: Butdorf opened this clinic with money from savings. He hasn't yet drawn a paycheck. But he believes once he has 500 patients, he'll break even. He currently has about 200. Similar clinics can be found in at least a dozen other states, including New York, California and Washington. Butdorf likes that he doesn't have to deal with insurance companies. And he can spend more time with his patients. He says many of the people he sees have jobs and make enough money that they don't qualify for state provided medical care, but they don't have health insurance either.

Dr. Jeanene Smith is an administrator with the Oregon Health Authority, which oversees public health care in the state. She says retainer clinics fill a gap.

DR. JEANNE SMITH: Ideally, the retainer practice would help to control a lot of their prevention and or control of a chronic disease but there are still things that happen that can be very expensive.

MCDONALD: Smith points to lab tests and X-rays for example. If patients get cancer or are in accidents and don't have catastrophic health coverage, they could be in financial trouble.

The federal health care law would require that major medical coverage if the Supreme Court upholds the individual mandate. Butdorf's patient Steven Kennedy is just happy to have a doctor. He has debilitating arthritis in both knees. A few weeks ago, the doctor administered cortisone shots.

KENNEDY: Well, for one thing, that means I can walk across a parking lot again. It means I can get out and do what I, normally, I'm, usually I'm a pretty active person and that's the last almost a year that's come to, almost to an end. And sometimes I even had to use a cane. And I'm not quite ready for the cane brigade yet.

MCDONALD: Kennedy says, even though he's presently unemployed, at $59 a month, he's not having any trouble paying for the care he gets from his new doctor.

For NPR News, I'm Rachael McDonald in Eugene, Oregon. Transcript provided by NPR, Copyright NPR.

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