Derek Monson: Entrepreneurs in the marketplace help health care reform in Utah

(Elise Amendola | AP file photo) In this June 15, 2018, photo, pharmaceuticals are seen in North Andover, Mass.

Utah legislators are hard at work debating a range of health care policy reforms intended to make healthcare more affordable, from reducing pharmaceutical costs to eliminating wasteful health care spending. As these debates progress, legislators should keep in mind the entrepreneurial approach that has brought Utah the prosperity we enjoy today.

Utah has a longstanding tradition of entrepreneurship. Those who journeyed here in the 1800s risked everything on a religious entrepreneurial venture, launching into the uncertainty of a land unknown to them to find a place to live free of religious persecution. Today, our public and private university graduate programs are ranked among the top 25 for entrepreneurs, and the number of successful entrepreneurial ventures in Utah in 2017 was only surpassed by California, New York and Massachusetts.

Utah’s entrepreneurial spirit – the free market drive to innovate to fulfill people’s unmet needs – is particularly strong and visible in Utah’s health care sector. Utah’s health care entrepreneurs offer a glimpse of how a market-based approach, and public policies that align with it by promoting a free market in health care, can make medical care more affordable and convenient, without new taxpayer-funded programs or additional regulatory burdens.

In primary care, numerous health care entrepreneurs across Utah are using innovative direct primary care (DPC) models to offer affordable versions of the medical care that most families use the most. Examples include networks of DPC clinics, such as Medallus Medical or Zenith Direct Care, and stand-alone clinics like Kaysville Clinic Family Medicine. DPC offers predictable, transparent and affordable prices: monthly membership fees comparable to the cost of some other monthly bills ($50-$60 for an individual adult and $120-$130 for a family) and a nominal payment per doctor visit (e.g. $10). Utah has more than 20 DPC clinics along the Wasatch Front, St. George and rural Utah.

For working families who lack insurance or small employers who cannot afford a typical health benefit package, DPC offers an affordable approach to health care, driven by entrepreneurs innovating to meet a need in the healthcare market.

Health care entrepreneurship in Utah is not limited to primary care, however. Surgical centers in Utah are also innovating to make their prices transparent, predictable and affordable. One example is Cedar Orthopaedic Surgery Specialty Clinic in southern Utah. The clinic posts its prices on its website and does a range of joint and musculoskeletal surgeries, including knee replacements and hip surgeries, as well as MRIs and physical therapy.

Utah is also a medical tourism destination, which is when a patient and family plan a vacation around a medical procedure at a tourist destination, often paid for by a health plan or self-insured employer. This is possible because the clinic’s medical services are much more affordable than surgeries at clinics or hospitals that don’t have transparent pricing. Medical imaging in Utah is similarly seeing entrepreneurs who open medical imaging centers that post MRI prices online, often for a lower cost than an MRI done at a hospital.

What is required for the success of the market-based approach to health care?

1. Public awareness of the outcomes that health care entrepreneurs are achieving.

2. Recognition of the merit of market-based approaches to health care.

3. Willingness among policymakers to remove regulatory barriers to market-driven medical care.

4. Political courage to promote a free market in health care by discouraging plainly anti-competitive contracting practices by health care providers.

5. Aligning public policy with the market incentives driving health care innovation.

Achieving this vision will require political and industry leaders to follow the entrepreneurial example of many of our forebears: embarking in an uncharted direction. But if Utah is to remain prosperous for current and future generations, then the entrepreneurial spirit that made Utah what it is today is the right diagnosis for our health care policy.

Derek Monson | The Sutherland Institute

Derek Monson is vice president of policy at Sutherland Institute.