Boutique medicine (also known as concierge medicine or direct care) is a type of personal medical care that is once again gaining traction in the United States. A typical physician sees 3,000-4,000 patients in a year, whereas in boutique medicine the number is almost always under 1,000, and in many cases may be less than 100. As one might imagine, one of boutique medicine’s primary goals is forming and maintaining the patient-physician relationship that is so central to personal medical care. For example, many concierge physicians maintain on-call availability around the clock for their entire patient base, providing personal contact information that can be used during an emergency.
Not surprisingly, concierge physicians cost considerably more to visit than typical physicians, who are normally only obligated to be on-call during their hours at their practice. Such personal medical care means that payment models vary widely, as there are no universal methods establishing means of payment like in a traditional patient-insurance provider-physician relationship. Many concierge physicians operate cash-only clinics, making the out-of-pocket costs to clients quite high and pricing healthcare services out of the reach of many potential patients. This method keeps a physician’s dealings with health insurance companies at a minimum. Many concierge physicians may actually refuse all insurance payments and mandate their clinics to do the same, further increasing the out-of-pocket costs to the patient.
Critics of boutique medicine (itself being a somewhat pejorative term in such circles) cite the extensive out-of-pocket costs as proof of an emerging two-tiered healthcare delivery system that favors wealthy patients. That is, traditional employer-based health insurance typically allows subscribers to visit healthcare providers only within a specific network. In-network providers may be located far away, and specialized care may not be covered. Patients who can afford more out-of-pocket costs have a distinct advantage when it comes to obtaining personal medical care. As for the professional demographics of the concierge physicians themselves, a large portion specializes in family practice. This allows for deeper relationships between physician and patient, as well as naturally reducing the number of relationships a physician must form. Many of these physicians further specialize in internal medicine.
Though critics have cited a potential divergence in American healthcare based on concierge medicine’s payment model, it is this precisely this payment model that will most likely keep concierge medicine a small part of the American healthcare delivery system. This in and of itself is troubling, given that it reflects growing levels of income disparity in the American population. More regulations may be in store to bring a formal standard to concierge service repayment.