In the United States, direct primary care (DPC) is a type of primary care billing and payment arrangement made between patients and medical providers, without sending claims to insurance providers. It is an umbrella term, incorporating various health care delivery systems that involve direct financial relationships between patients and health care providers. Background Direct primary care has been promoted by certain groups of physicians as a means for patients to save money on their primary care services, as well as other ancillary-performed services such as laboratory testing, etc. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. The objective is to provide better free-market competition with access to higher quality care at lower prices. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees which grant them access to a set of medical services, including same and next-day appointments, which may take the form of office visits and/or house calls. Typically a direct primary care arrangement is paired with either: a high-deductible health plan, as DPC alone will not cover catastrophic health care such as most surgeries; or a health reimbursement account as the associated tax-benefits can generally be applied to DPC and other medical expense; One of the lesser known provisions of the 2010 Patient Protection and Affordable Care Act in the United States can be found in Section 1301 (and amendment Section 10104). This provision allows for direct primary care to compete with traditional health insurance options in the mandated Health insurance exchange when combined with a low cost high deductible plan. Advantages Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can take as much as $0.10 - $0.20 of each medical dollar spent. Consequently, because direct pay members are usually automatically billed a physicians practice's cash flow can also be improved. An emerging model of direct primary care involves the medical practice contracting with self-insured (or self-funded) employers who offer the direct primary care option as a means of accessing care for free or drastically reduced office visit fees. This is also known as onsite health. The employer pays the membership fees on behalf of the employee to the DPC practice directly. This option usually provides the employee same or next business day access to care.