Why Not Have A Two-Tiered Medical System?

Richard Gunderman argues in favor of concierge medicine, a system in which patients pay hefty fees to spend more time with their doctors:

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness….

Of course, there are drawbacks to concierge practice. For one thing, some patients cannot afford it, and others will choose not to pay the fee. Critics also see such models as promoting a two-tiered system of healthcare, in which those with more money get better care.

“But we have always had a two-tiered system,” [internist Frederic] Becker counters, “and it is better to care for 600 patients well than just adequately for three or four times that number. Someday patients, physicians, and healthcare payers will recognize that slower-paced but truly high-quality medical care is a better value than the fast medicine many physicians feel pressured to practice today.”

Meanwhile, Christopher Flavelle fears the rise of specialists who demand cash payments:

The slice of the population that’s willing and able to pay for specialty care in cash is small; the share of physicians in cash-only practices was just 6 percent last year. But that’s double the level from 2011. And if the income gap keeps growing, so will the number of doctors who can find enough cash-only patients to stop taking insurance. …

If the trend accelerates, it may call for new guidelines from the American Medical Association. The AMA now says doctors moving to cash-only practices must “facilitate the transfer of their non-participating patients to other physicians” – for instance, not charging for the transfer of medical records. If no other physicians are available in the community, the doctor “may be ethically obligated to continue caring for such patients.” The AMA also reminds doctors of their “professional obligation to provide care to those in need.” Those guidelines may start to look too vague if the best specialists drop out of the insurance system altogether.

Previous Dish on concierge medicine here.