ABSTRACT
In Chapter 1, I briefly introduced (1) the current state of U.S. health reform, (2) new changes through the Affordable Care Act (ACA) law and HITECH Act, (3) influences on private practice and primary care physician populations, and then focused on (4) the purpose of the study to learn about how direct pay may alleviate the challenges of the ACA for primary care physicians (PCPs). The purpose of the research is to understand how health reform influences direct pay physicians through specific dimensions, which include (1) responses to the changing health reform climate, such as new health reform policies and incorporating a patient-centered medical home (PCMH) model of care, (2) responses to the growing usage of health information technology (HIT) and HIT policies, and (3) creation of an organizational identity to differentiate themselves, especially across pure and hybrid forms of direct pay care. The objective of Chapter 2 is to demonstrate the unique features of direct pay through theory and literature on the subject of direct pay practices. The theory provides evidence for many concepts, including preventative health care, franchise models of care, technology diffusion, and organizational behavior.
