Direct Primary Care: A Positive, Promising Health Care Trend
The private sector is stepping in to serve consumers better in a health care system being destroyed by government interference.
One of the most promising trends in health care today is the proliferation of direct primary care (DPC) practices across the United States. The number of DPC practices in the United States grew from approximately 100 in 2009 to more than 2,500 in 2025. These practices are now available in 48 states, currently serving more than a quarter-million people.
Primary care includes routine and preventative services such as annual check-ups, urgent care, management of chronic conditions, medications, and diagnostic tests, imaging, and labs—all for a low, monthly fee. The patient pays a membership fee of $50 to $100 a month that allows unlimited access to a doctor, often same-day or next-day appointments, and big discounts on tests, prescriptions, and other services.
DPC provides a marked contrast to the single-payer model. While patients in single-payer systems suffer from a lack of choice of doctors, treatments are subject to endless restrictions in a fruitless effort to push prices down, and many must suffer and even die while on long waiting lists, patients in direct primary care enjoy next-day appointments, personalized care, and close, lasting relationships with their caregivers.
DPC providers are much freer to care for their patients because they do not bill insurance companies. Combined with high-deductible, low-cost insurance against catastrophic health problems, direct primary care provides low-cost, high-quality, personalized care while the separate insurance provides protection from financial disaster.
“According to the Medical Economics 89th Annual Physician Report, when asked about the main problem facing primary care today, 70% of physicians tagged ‘third-party interference’ as the biggest challenge,” writes Rep. Chip Roy (R-TX) in his The Case for Healthcare Freedom report released in January 2025. “The Direct Primary Care model seeks to rid this third-party interference—putting doctors and patients in control—not money-hungry bureaucrats. Importantly, DPC practices do not exclude patients for ‘pre-existing conditions.’ DPC practices typically age-stratify their pricing. Therefore, a healthy 64-year-old patient may pay more than a 24-year-old but will still pay the same as a 64-year-old with diabetes and heart disease.”
Direct primary care is not concierge care: DPC does not accept insurance payments, giving patients and caregivers greater freedom; the low monthly fee is much more affordable and can be canceled easily; and DPC allows access to a broader range of services without additional payments.
“The DPC model is a financial business model that supports the clinical practice model,” wrote Amy R. Mechley, M.D., in the American Journal of Lifestyle Medicine. “This is an important concept—this financial business model allows the clinician the freedom to support the patient’s health care goals, without improper intrusion by third parties. DPC practices are still responsible for demonstrating value. The key difference is that instead of needing to demonstrate value to an insurer, it is provided directly to the person receiving the care.”
The simple subscription payment approach of DPC eliminates the paperwork and rigid treatment rules that interfere in the doctor-patient relationship, raise costs, and reduce the quality of care. U.S. physicians currently spend more than one-third of their work time on paperwork and other administrative tasks insurers require, according to the Medscape Physician Compensation Report for 2023. In addition, doctors spend more than half of every patient visit typing data into a computer.
This busywork is a prominent source of physician burnout. A March 2023 study in the Journal of Internal Medicine found 49.9 percent of U.S. health care workers met the criteria for burnout. This is a particular problem for primary care doctors, a study published in the Journal of Primary Care & Community Health in 2023 found. “Physician burnout has been increasing in the United States, especially in primary care, and the use of Electronic Health Records (EHRs) is a prominent contributor,” the study states.
Direct primary care eliminates those problems, enabling doctors to take more time in examining patients and develop much greater knowledge of their particular conditions. DPC doctors also have a much smaller patient load, generally around 400 to 600 (averaging 402), whereas physicians in traditional medical clinics can have 2,000 to 3,000 or more. The reduced paperwork burden for DPC doctors can save practices as much as 40 percent on their operating costs, savings they pass on to their patients through low membership fees.
Direct primary care also benefits patients by improving overall health outcomes. The fixed-payment approach gives DPC doctors a financial stake in providing the most effective care and preventive medicine, because additional visits do not increase their revenue. “U.S. adults who regularly see a primary care physician have 33% lower health care costs and 19% lower odds of dying prematurely than those who see only a specialist,” states the Purchaser Business Group on Health. A five-year study published in the American Journal of Managed Care found Medicare patients who visited DPC doctors were 52 percent less likely to be hospitalized.
There is a shortage of primary care doctors in the United States. The shortage “could exceed 120,000 by 2030,” and it is “[d]riven by a lack of primary care physicians,” according to the Cicero Institute. The physician shortage has accelerated since 2020, and at present 42 percent of clinical physicians are 55 or older and heading toward retirement in the coming years. “This projected shortage means patients will experience longer wait times, fewer healthcare facilities due to minimum staffing requirements, and that patients will have less time with their healthcare providers,” another Cicero Institute article states.
DPC can help address the physician shortage by providing better care at lower cost, which reduces the need for hospitalization and other more-intensive services. The main barrier to expansion of DPC is the complicated regulations imposed by state bureaucracies and consumer protection authorities that regulate insurance companies. Freeing direct primary care from insurance regulations is important because such agreements are not insurance. DPC practices provide routine health services, not insurance against expensive, catastrophic conditions.
Removing the burdensome and misguided government regulation of direct primary care as insurance helps patients get truly affordable care in a timely manner, improves patients’ health, increases access to care, and frees doctors to provide individualized treatment while avoiding unnecessary, costly paperwork that does nothing to improve people’s health.
Another positive reform would require action from Congress: allowing patients to use health savings account money to pay for DPC monthly fees. Rep. Roy recommends four major reforms:
Congress should clarify that DPC is not health insurance in the Internal Revenue Code.
Congress should clarify that DPC is an HSA-qualified medical expense.
Congress should not have a limit on how much of a DPC fee is eligible for use by an HSA.
Congress should work to replicate the DPC model within government healthcare programs
Direct primary care is one of the most promising, positive trends in health care in the United States. Government reforms to remove obstacles to its expansion could make this option available for millions more Americans and improve the effectiveness, affordability, and individualization of health care across the United States.