By: Roni Caryn Rabin New York Times Oct. 1 st insurance/?ref=health

No More Insurance  Private health insurance is usually more than enough to make an appointment with a doctor.  In affluent metropolitan areas, certain physician's have began to refuse all insurances and require upfront payment.  In the Upper East Side of Manhattan, many pregnant women are paying up to $13,000 out of pocket for childbirth and prenatal care Annual Check-ups can cost up to $650 Pediatricians will charge $150-$250 per reactive medical checkup

Insurance Companies  Insurance companies try to rein in health care costs by holding down physicians fees. This affects primary physicians the most.  As a result, the trend towards not accepting insurance is increasing in affluent neighborhoods, making it difficult to find an in-network physician close by.

Insurance  Data is very sparse on how many doctors participate in no-insurance or concierge practices However, The Physicians Foundation found that within the next 1-3 years, 7% of physicians will switch to upfront payment or concierge practices  Patients whose physician stop accepting insurances can go to out-of-network physicians, but must excise caution, as many insurances will not cover the full cost of out-of-network services.

PPACA  PPACA will widen access to health care for individuals, but what happens if primary doctors refuse insurance? If contained to the wealthy, then this is not a public problem.  But, The Physicians Foundation also found that 50% of physicians plan on reducing patient access to their services within the next 3 years.

Shortage  Association of American Medical Colleges states that we are already facing a shortage of physicians, and by 2025, there will be a shortage of 100,000 physicians. Most Acutely In Primary Care  A report done by the Medicare Payment Advisory Commission found that adults between the ages of are having difficulty making an appointment with a new physician. 30% of privately insured individuals reported difficulty, compared to 26% in 2008 Reactive Medicine Could Become A More Common Alternative

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