Heated towel racks, marble showers, and personally monogrammed robes. Can you imagine a type of health care for yourself that includes these services? You can if you’re rich or super rich, and in fact you may be quite familiar with such health care. But these notions of health care are bizarre to me, while spa lovers may think I just don’t get it.

Okay.

Well, a few doctors of the rich began providing such services called “concierge” or “boutique” or “direct pay” medicine over a decade ago—for a generous fee, of course. This means cash, paid directly to concierge doctors without insurance being involved.

 

What makes a good doctor-patient relationship? (Source.)

What makes a good doctor-patient relationship? (Source.)

 

After a few years of percolating, concierge medicine has gained a new respectability in some quarters. It has become available to a growing segment of the middle class. A bit surprisingly to me when I read it, the Wall Street Journal published a 2013 article on the “Pros and Cons of Concierge Medicine.”

This article discusses how some of today’s doctors are charging what some may view as a modest monthly fee of $59 for membership and $10 per visit, with no insurance billing to keep overhead low. Even the Affordable Care Act allows for this type of health care as long as patients have a policy to cover catastrophic illnesses and emergencies. This recognizes the rapid growth of the American Academy of Private Physicians, with inexpensive practices driving growth to over 5,000 concierge practices at the rate of 25 percent per year. By some calculations, those with very high deductibles can buy direct concierge medicine for less per year than the cost of the deductibles. 

Young adults have now joined parents and grandparents in worrying about their personal health care and health insurance in the United States. Federal mandates get the credit or the blame for this, depending on your point of view regarding the country’s Affordable Care Act, or Obamacare. I personally think it’s a really good idea for young adults to take responsibility for their own health care. Their parents probably did when they were young.

On January 15, 2002, The New York Times carried a page one story under the banner, “Doctors’ New Practices Offer Deluxe Service for Deluxe Fee.” Two respected doctors in Boston were about to open a practice in which they would charge patients $4,000 a year for services beyond those covered by their health insurance. “Amenities and attention” provided through the added fee include:

    • Round-the-clock cell phone access to doctors
    • Same-day appointments
    • Nutrition and exercise physiology exams at patients’ homes or health clubs
    • Doctors accompany patients to see specialists.

Newspaper columnists and some physicians accuse these doctors of abandoning their lower-income patients to cater to the wealthy. The doctors claim they are seeking a way to give patients more attention in a time when managed-care pressures crowd even more patients into shorter and shorter appointments.

A Florida doctor joining this movement lamented, “I couldn’t stand it anymore—the day was an absolute treadmill.” He and some of his colleagues expressed a desire to spend more time with patients and to enjoy their practices more.

Commentary

Is it greedy doctors who want fewer patients and more fun in their workday? Maybe. Or are doctors perhaps mentally unable to cope with heavy patient loads over extended periods of time, instead seeking affluent patients as a way of coping with their own lives? For their own mental and physical health?

Is it self-indulgent, high-resource patients who want or even demand services that have little to do with fundamental medical care? Maybe patients who do have especially worrisome medical issues needing constant attention? Or maybe patients who have to have heated towel racks and monogrammed robes provided by their doctors just to make them feel better, maybe feel superior to the rest of us?

What happens to doctors and other high-stress professionals who practice in areas where the population is growing so fast that institutions can’t possibly keep up? Will medical care deteriorate with population growth? Will concierge medicine contribute to the doctor shortage facing many communities, large and small?

Is there anything wrong with this picture? Or does it look right to you?

Clearly there are pros and cons. Concierge medicine is a movement that isn’t going away. It is a growing part of today’s health care landscape.

But please don’t tell me your health care includes heated towel racks, marble showers, and personally monogrammed robes. Most of us already feel you should pay higher taxes anyway. Far higher.

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