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MT Health Clinics Are Cost Effective, Not 'Free'

John Commins, for HealthLeaders Media, July 31, 2013

A Montana health clinic about to mark its one-year anniversary has already saved the state $1.5 million by making available primary care services to about 11,000 employees, their dependents, and pre-Medicare retired state employees. Members pay no out-of-pocket costs.

National Public Radio had an interesting piece this week about Montana's innovative and effective efforts to curb healthcare costs by opening "the nation's first clinic for free primary healthcare services to its state government employees."

In an otherwise commendable story, however, NPR makes the mistake of repeatedly calling the services provided at the clinic "free." These services are not "free." Nothing in healthcare is "free."

In fact, the price of the primary care services is baked into the health insurance premiums paid by state employees and their employer, the state of Montana. It is part of a conscious decision by the state to launch affordable alternatives to fee-for-service medicine. It is much more accurate to say that these clinics are proving to be cost effective. This is not pettifogging. This is an important distinction.

Russ Hill, the administrator overseeing the Helena clinic for Montana's Health Care and Benefits Division, was interviewed for the NPR piece. In a subsequent interview with me, however, he made it clear that he's never said the services were free.

"There is nothing free. You won't hear me use that word," Hill says. "What we say is that we have no out-of-pocket costs for our members. They can get their office visit with their primary care physician. Normally that is $15. Under our plan there is no copayment if you come into the health center. With our normal program we have co-insurance and deductible that applies to lab and X-rays, but we don't have any co-deductible for lab or X-ray [work] that is done at the health center, or ordered by a health center provider."

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