Concierge Medicine - Controversy

Controversy

The concept of concierge medicine has been accused of promoting a two-tiered health system that favors the wealthy, limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. Detractors contend that while this approach is more lucrative for some physicians and makes care more convenient for their patients, it makes care less accessible for other patients who cannot afford (or choose not) to pay the required membership fees.

One physician in a CNN.com article noted that he might not be treating patients at all if he hadn’t made the switch to concierge medicine: "…many doctors are becoming so disillusioned with primary care that they are quitting altogether." Others physicians feel like they can't abandon patients unwilling to pay the additional fee. This was where physician Brent Cohen ended up after considering the model, for example.

Proponents of concierge claim that it meets consumer demand, allows physicians to provide the treatment they deem necessary, and improves quality of care by increasing the amount of time that can be spent on preventive medicine. Preventive care such as lifestyle advice, and follow-up phone calls and emails are not usually reimbursed by insurance. Physicians significantly reduce the number of patients they see in a day, which allows them to spend extra time and attention with each patient. It has also been noted that while some concierge medicine practices do not accept insurance, all of their patients are encouraged to carry health insurance for services utilized outside of the practice.

The hybrid model is an alternative approach to concierge medicine and does not disenfranchise patients or exacerbate the physician shortage. Physicians with a hybrid practice accept from a few to up to three hundred patients from their current practices who choose to join the concierge option. Patients who do not want to join the concierge model, do not have to leave the practice and can still see their primary physician as they always have. In these practices, doctors continue to be highly productive and take care of at least the same number of patients as they would in a traditional practice. While concierge patients get a special contact number, dedicated appointment time, and various other benefits that enable the doctor to offer more advise and advocacy, the quality of the care remains the same for either group of patients. There is a difference in the service level in the concierge program. The increased face time with the physician in the hybrid concierge program enables the physician to deliver the services that are often identified with the "medical home" model.

Some say that concierge medicine is not the solution to the healthcare system’s woes, but is a symptom of "too much emphasis being placed on cost control and too little emphasis on the patient."

In early 2008 it was reported that one health insurer was dropping from their provider networks some physicians who charge an annual fee. Another insurer also expressed opposition to annual fees. Other insurers do not oppose concierge medicine as long as patients are clearly informed that the fees will not be reimbursed by their health plan.