When John Farley left his job to start his own energy consulting firm, he couldn’t afford to pay several hundred dollars a month for health insurance, but he still wanted his two kids to have good primary care. His family physician at Hillside Avenue Family Medicine in Scituate, Dr. Michael Fine, offered him a deal: he could pay the practice directly at an affordable rate, instead of paying through an insurance company.

Dr. Fine offered a similar approach to some of his other patients. Local illustrator Emily Lisker gave Dr. Fine six of her drawings, and in exchange, he gave her and her husband six years of free primary care. “It felt very honorable,” says Lisker. She felt like she was giving something back, even though she didn’t pay with cash.

Six years later, Dr. Fine’s initiative has expanded into a network of 10 different practices with 27 physicians providing regular primary care to roughly 500 uninsured Rhode Islanders.

Executive director Kimberly McHale, who calls HealthAccessRI (healthaccessri.com), the first program of its kind in the US, says it has expanded since a marketing campaign was launched to spread the word.

Patients can enroll for a fee of between $15 and $80, depending on a rate each practice sets. Patients then pay $25-$30 a month, and $5 or $10 for each office visit. So for between $300 and $500 a year, patients can re-ceive quality primary care without health insurance.

“Many people don’t realize that [primary and family care doctors] are able to take care of a majority of problems without referrals to other doctors or expensive tests,” says Dr. Jamie Schwartz of Family Doctors of East Providence. HealthAccessRI doctors, he says, are “trying to bring the practice of primary care medicine back to its roots.”

The program is not a substitute for comprehensive health insurance. It doesn’t cover emergency room visits, lab work, or visits to specialists. But HealthAccessRI has made agreements with East Side Clinical Laboratory, XRA Medical Imaging, and RI Rehabilitation Center, so that patients can get lab work, x-rays, and physical therapy at the lowest allowable rate.

HealthAccessRI is a good deal for musicians, artists, independent businesspeople, undocumented immigrants, former RIte Care recipients, and others who don’t receive health insurance through an employer.

Michael Bigney of Nursing Placement in Pawtucket says the company offered HealthAccessRI to its employees as an alternative to health insurance, because some part-time workers or single moms could not afford in-surance co-payments. The company, the first employer in RI to offer the service, pays the full monthly and enrollment costs for full-time workers, and a percentage of the cost for part-timers.

“The hardest part so far has been trying to educate employees that this option is available,” says Bigney. “It’s very different from Blue Cross and United Health, and I think people are hesitant at first until they understand what the plan really is.”

Fine says the program is profitable for his practice, since it costs a practice only about $150 to $300 a year per-person to provide primary care. He says a lot of extra money is funneled into the administrative costs of health insurance companies. It’s also cheaper in a broader sense, since primary care can head off more serious health concerns.

HealthAccessRI has already won national attention, and in the words of Fine, it might turn out to be “kind of a big deal.”

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