Concierge Medicine for Those Who Feel Guilty
About using concierge doctors, that is.
Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice. Patients in the retainer practice have longer visits, around-the-clock access to one of five physicians, comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients.
I think you have to be a touchy-feely bleeding heart to even have this problem. Full New York Times report on concierge medicine for the few here.
This is actually very funny.
If people feel guilty about using a concierge doctor, why don’t they also feel guilty about all their other consumption?
As concierge medicine has become more common public health advocates have worried that the poor would lack access to a primary care as physicians shift into retainer-type practices. However, concierge physicians are not the problem. Rather the problem is that government insurance reimburses primary care at 60% to 70% of what private insurers pay. As a result, physicians have to find another way to get compensated for their work.
I have a friend, in her 80s, who has been seen by the same primary physician for 25 years. Now he has told her that he will only keep seeing her if she pays him a $1,500 retainer. (NOT that she will get concierge care.) He has even suggested that she cancel her “medigap” insurance coverage ($400/month) and enter an HMO in which he participates, so she can give the money to him rather than the insurer.
The interesting point to the article is how for $1,800 a year, the “concierge” service can subsidize a considerable amount of primary care for the rest of their patient population. That explains why some doctors like it, it’s much more profitable than the rest of their practice. A more interesting question is how does its cost per patient compare to standard primary care.
As for “government insurance” paying 60 or 70 percent of private insurance, what’s the problem of pricing discrimination? Airlines do it all the time? How about that the way cell phone carriers charge of peak vs off peak usage. Medicare provides doctors with a large volume of customers with a large volume of fee for service medical needs. It’s that evil government insurance that has allowed large numbers of medical specialists to earn 10 or 15 times the US median wage.
artk, I don’t have a problem with price discrimination, when large purchasers extract a bigger discount than small purchasers. However, low Medicare and Medicaid reimbursements are basically a form of price controls. Below-market reimbursements create a shortage of willing providers.
Devon, it’s false to conflate Medicare and Medicaid. Even if every doctor in the US made 70% of their current income, their income relative to the median wage would still far exceed the incomes of doctors anywhere else in the world. As for Medicaid, the reimbursements are grossly inadequate, but then again Medicaid serves poor populations, and they don’t vote.
If I sign on to a concierge doctor, I will feel not the slightest tinge of guilt.
artk,
Please read this article on the deceptive income of physicians at:
http://benbrownmd.wordpress.com/
You, like many other Americans think physicians are wealthy. Maybe they use to be. After you read this article, you will have a better understanding why the price controls of the Medicare, Medicaid, and Insurance companies have led to a shortage of primary care providers. And it isn’t getting any better. Price controls lead to shortages.
As I looked at the list of recommended reading alongside this comment on those who feel guilty using concierge medicine, as well as readers’ replies, I noted one of the books is Herzlinger’s Market-Driven Health Care. Concierge medicine is certainly market-driven. Physicians could offer this style of medical care all they wished, but if there were no takers, it would founder. Instead, it fills a felt need (for those who can afford it). However, in my experience, there are many who think they can’t, but when they analyze it, find they can. If one can buy a Starbuck’s coffee per day, and the concierge physician charges as little as $90/month (as my concierge physician does), it’s easy enough to make the decision and give up the coffee for a less expensive brand. That is, if one makes health care a priority.