Dr. Margaret Sun, of East Providence, examines Marissa Medeiros, 14, in her office, as her mother, Rose Zia, and sister, Aisha Zia, 17 months, watch. Sun is involved in a program in which a number of providers charge people $25 for basic medical care.

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The Providence Journal / Steve Szydlowski

For most of her life Emily Lisker was hesitant to see a doctor, no matter how bad she felt. A self-employed artist with no health insurance, she shuddered at office-visit fees of $100 or more. But last winter, when she came down with a bad cough, Lisker immediately called her doctor and immediately got an appointment.

Lisker was finally able to do that because she is one of a couple of hundred uninsured people who have enrolled in an innovative program called HealthAccessRI. In this program, she pays $30 a month for a “membership” in her primary care doctor’s practice, essentially keeping him on retainer. That means that even without insurance, she can get frontline medical help whenever she needs it, paying just $10 for each office visit.

Lisker was especially glad to have that kind of access last winter. Her doctor ordered an x-ray that revealed pneumonia, a serious matter for Lisker because she has asthma. She paid the full cost of the x-ray. She also paid for some expensive antibiotics. But she avoided what might have happened in the days before HealthAccessRI: delayed treatment and even more costly illness.

HealthAccessRI is the brainchild of Lisker’s doctor, Michael D. Fine, who today will join his colleagues in announcing that HealthAccessRI is going statewide and launching a publicity campaign, hoping to reach more of the 120,000 uninsured Rhode Islanders.

Fine’s practice, Hillside Family and Community Medicine, with eight doctors in Pawtucket and Scituate, has been offering the program since 2002, as has Family Doctors of East Providence, with three doctors.

Recently, five other family-medicine practices joined, bringing to 21 the number of participating doctors. The fees vary by practice, with a monthly retainer of $25 or $30 per person (with discounts for families) and office-visit co-pays of $5 or $10. For this price, patients get all the basics of primary care: yearly physicals, well-child visits, checkups, sick visits within a day of calling, school and sports physicals, family planning, preventive health advice and a doctor to call to at any hour when they feel sick.

But they have to pay out of pocket for specialty care, hospitalization, x-rays, laboratory work, prescription drugs, emergency room visits and mental-health care.

The premise underlying the plan, Fine says, is that primary care is both inexpensive and effective, and for most people, it’s all they need.

Christopher F. Koller, the state’s health insurance commissioner, welcomed HealthAccessRI as an interesting experiment and worthwhile effort to promote primary care, but said he did not expect it to attract many people. “It’s an innovation,” he said. “I’m really convinced at this point that we need to encourage experimentation and we need to learn from it.”

But he cautioned: “It is not insurance. It is not a substitute for insurance. People need to be clear about that right from the start.”

Koller also said there is a risk that HealthAccessRI will draw healthy people away from insurance, raising premiums for everyone else, but he considers that unlikely. Another potential pitfall, he said, is that patients will have no place to turn if they have disagreement with their provider about what’s included.

Dale Venturini, president and chief executive officer of the Rhode Island Hospitality and Tourism Association, is sold on the idea. Her industry employs many young people who often don’t want to pay for health insurance. Venturini sees potential for restaurants to offer to pay the monthly fees of employees who enroll in HealthAccessRI. “We thought that our industry would be a likely incubator to get it started off the ground,” she said. “This is an opportunity for people to get basic health care at minimal cost.”

Fine notes that his monthly fee is “less than the cost of a cell phone, less than the cost of cable TV, less than the cost of high-speed Internet,” and he can take care of the vast majority of problems that come his way. The “fancy stuff,” the expensive tests and treatments, are often unnecessary or even harmful, he asserts.

“Take the person who has a headache and wants a CAT scan because they read somewhere that a headache means they have brain cancer,” Fine says. “Most of the time they don’t need the CAT scan.” A trusted primary care doctor can dissuade a patient from needless tests, while helping with the real cause of the headache.

But what if the uninsured person really does have brain cancer? Fine says that such a person is still better off with a primary care doctor. “They have somebody who can tell them where they’re going to go, help them sort out what their options are. … We can sometimes help them figure how to negotiate the expensive tests and really be more precise about how much they need them.”

Financially, HealthAccessRI has worked out well for his practice, possibly even better than payments from insurance companies, Fine says. He estimates that 150 to 200 people are on the plan at any given time and some 500 or 600 have cycled through it.

Rose and Fyed Zia, of Reboboth, stopped buying health insurance for themselves and five children a year and half ago, when the cost rose to a prohibitive $1,500 a month. They run two convenience stores and own some rental property, and have few options for group health coverage. Luckily their doctors are part of Family Doctors of East Providence, which offered them the HealthAccessRI program for $25 a month. It’s been “perfect” for them, says Rose Zia.

“Having a primary care doctor, that eliminates any visit to the emergency room or even to the walk-in,” she says. “If you have a primary care doctor that you can call, they will advise you what to do.”

Under Massachusetts law, the Zias are required to obtain health insurance, but they paid the $219 per-person fine last year rather than buy it. Since then, their children have qualified for MassHealth, the state-run health plan, while the parents were put in a free insurance program with a $15,000 deductible. They don’t want to end their relationship with their doctors in East Provi-dence, so the Zias will pass up the benefits of MassHealth for their children. For the parents, the high deductible in their coverage makes HealthAccessRI an ideal alternative for them.

The Zias are among about 30 patients of Family Doctors of East Providence who have signed up for HealthAccessRI, says Dr. James M. Schwartz.

Schwartz believes primary care should be paid for directly, separate from insurance. Today’s health-care financing perverts the original concept of insurance, which was supposed to pay for catastrophes, he says. “No auto insurance sells you a plan that covers oil changes and tune-ups,” he says. The current system has also harmed primary care, Schwartz argues, by paying doctors per visit, making it financially difficult to give patients the attention they need. HealthAccessRI gives doctors a steady, predictable income to cover predictable costs.

Another patient in Schwartz’s practice is Katia Cabral, who works as a private educator involved with home-schooled and special-needs children. She has been without health insurance for a decade, often trying to solve her health problems on her own. Joining the HealthAccessRI plan at Family Doctors “was kind of a miraculous thing for me,” she says. “I immediately felt so much better psychologically. I knew there was someone I could call if something were up and who would have my history and know everything. I could afford to get over there and see him.”

How it works

HealthAccessRI is a new way for people with little or no health insurance to obtain the services of a primary care doctor at a low price.

Cost: Varies by practice but consists of these elements: One-time enrollment fee of $15 to $80; monthly fee of $25 or $30; office visit fees of $5 or $10.

Doctors: 7 practices with a total of 21 family-medicine doctors

What you get: 24-hour telephone access, sick visits, well child care, check-ups, school and sports physicals, family planning, yearly physicals.

What you don’t get: Hospitalization, specialty care, x-rays, laboratory work, prescription drugs, emergency room visits, mental health care.

For more information: www.HealthAccessRI.com; (888) 647-0400

ffreyer@projo.com