Concierge care for the rich

Premium medicine: Extra-fee doctors find market demand, ethical and legal criticisms.

September 03, 2001

WANT A DOCTOR who makes housecalls? Who takes your phone call personally at all hours? Who makes same-day appointments when you want?

For the wealthy and the demanding, there's a new kind of medical practice emerging: concierge care or retainer medicine. For a hefty yearly fee, patients in places like Seattle and Boca Raton can sign up for personalized service that avoids waits and other managed-care headaches.

With its initial popularity, doctors are moving to open these preferred-treatment franchises in cities around the country. Participating physicians may accept Medicare and private insurance, but drastically limit their patient list to provide the extra service.

All of which is raising legal and ethical questions. Is this a highest-bidder brand of medicine, or an effort by overworked physicians to improve their delivery of service?

With insurers squeezing physicians to limit patient times and expand their caseload, this type of selective patient practice may find wider appeal. And that is cause for concern about the possibility of a multi-tier medical system financed by the same insurance providers.

Doctors can always limit their patient lists and refuse to participate in any health plan. But if they accept only patients who pay a fee in addition to insurance, the insurance plan is devalued. Dropping patients simply to raise a doctor's income may give rise to medical licensing questions.

While this development reflects the pressures of managed-care and the market response, its growth potential may be limited. But the attention it focuses on problems of the health care system for patient and physician may provide the basis for finding a better cure than platinum-card medicine.

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