Sunday, February 21, 2016

Concierge Medicine - Is it Ethical or Elitist?

Massachusetts General Hospital (MGH), perhaps the most prestigious hospital in the United States, has just announced that it is joining the concierge medical universe.  Concierge medicine offers patients Rolls Royce care for an extra fee.  This model has gained popularity across the country and is attracting both patients and physicians.  Patients receive white glove treatment on demand and physicians have more time with each patient as they no longer are pressured to increase patient volume to pay bills.  I’m sure that some of these physicians have increased their incomes, but others may be paid the same, but enjoy seeing 6 patients per day instead of 20. 

I was struck by $6,000 annual feel that MGH was charging concierge patients, the highest I had ever seen before.  The typical fee I had seen was in the $1,500 per year range.  Six grand per year will get Bay Staters personalized care whenever they want.  They will never wait for an appointment.  I imagine that the waiting rooms will be zen gardens, with music, art and aromas that create an aura of wellness.

Concierge Medical Practice Waiting Room

Keep in mind that the concierge medicine fees are in addition to medical insurance payments.

A criticism of concierge medicine is that it is an elitist two-tiered system of medicine for Americans.  This is ridiculous.  We already have a multiple-tiered medical system in place.  Does anyone doubt that wealthy individuals receive a different level of medical care and quality?  Concierge medicine is simply another avenue for them to do so.  Incidentally, this option is not just for the wealthy.  I know working people here in Cleveland who have paid a $1,500 yearly fee because they are frustrated with the medical status quo and are willing to pay more for a higher quality product.  Another working family may decide instead to pay $1,500 for a family vacation.  We all have different priorities.

While I believe that every American is entitled to receive quality medical care, I don’t believe that someone should be prevented from paying more for a higher quality of service.  The same argument applies to college education, automobiles, vacations, homes, and legal advice.  Preventing folks from paying more to get more harms them, but helps no one else.

Full disclosure:  I am neither a practitioner nor a patient of concierge medicine.  Wonder what a concierge gastro practice would look like.  Gold-plated colonoscopes?  Organic hemorrhoid creams?  Sushi laxatives? 

I have also eschewed concierge blogging.  No elitism on this site.  I give it all away for free.

2 comments:

The Medical Contrarian said...

I believe the term used, concierge care, is too narrow and biased from the start. At the most basic level it represents services for which are not covered by insurance and for which patients are willing to pay for out of pocket. Some of these services may be high end, but that is not inherently the case.

The current payment system with it's arcane billing codes and hopelessly complex and inconsistent rules for payment serves as a huge barrier to development of new ways to meet patient needs. Direct patient payment provides an opportunity to circumvent the current dysfunctional payment system.

I see no place with more potential for innovation than the telehealth/remote care space where patients may access care which is much more convenient and patient friendly. The barriers to real deployment are payment issues. We should rename concierge care as patient centered care through removal of third party interference care.

I agree with you that this pathway is not unethical and would go one step farther. I believe it takes a step toward fixing the ethical problems with the current system.

Michael Kirsch, M.D. said...

@MC, WHERE HAVE YOU BEEN? I agree with you that the practice of medicine will evolve galaxies beyond the current doctor-patient model. Patients will be advised by physicians remotely. Robotic surgery will be performed remotely. Devices will measure patient data and transmit them elsewhere for analysis. Treatments will be personalized and tailored genetically. Of course, most of what will occur is beyond my grasp. There will be great progress, and there will be costs to the profession as well.

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