Cash-only doctors

Some doctors today take only cash as payment. That is, they won’t accept health insurance for payment of services provided to patients. What are the pros and cons of this system, which used to be common years ago, but is definitely unusual today? N.C. State University economist Mike Walden responds.

“In fact … I can remember as a little tike growing up in the 1950s when my parents took me to the doctor and checked my ears or my eyes or something like that, as I recall they paid with cash. We didn’t have health insurance, and, yes, you are seeing not a big movement but a small movement toward some doctors moving in that direction.

“I think for the doctor it means a lot less paperwork. It means a lot less oversight by the insurance company. Also the doctor may be better able to adjust the fee to suit the patient. If someone has limited financial resources, there are many examples out there of doctors who say ‘Well, only pay me this amount.’ For the patient, it’s sometimes actually going to be cheaper, especially for routine care, because you don’t have to deal with the insurance company.

“But there are some cons. For the doctor, this means that they’re going to limit their practice to people who are willing to pay with cash — for example, it means no Medicare patients. Medicare, of course, is the federal insurance company program for the elderly. So you’re going to cut out basically everyone over age 65. It, therefore, may limit the size of the practice. For the patient, it means for complicated or very expensive care, they may not be able to afford it. That is, they may need a backup insurance policy to do that. But definitely, this is a trend to watch. I think it is a reaction to the complications that we now see in our health-care system.”