Just when you began to hope things could not get any worse in health care in the United States, hospitals come along to show you what a sucker you are.  The latest trend is hospitals getting in on concierge care.

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Concierge care has been with us for a while, but up to now it has been confined to the practices of individual physicians.  It began in the wealthy enclaves of Boca Raton, Florida, and La Jolla, California and spread from there.  The principle is simple: patients pay an annual fee to become patients of the concierge physician.  The physician enjoys the same or better income while caring for fewer patients.  The patients get more individualized attention and less-rushed care from the physician, who can often see patients the same day.  A win-win for everyone, right?  Not so fast.

We already have a shortage of primary care physicians, who are the most likely physicians to be involved in concierge care.  The main selling point of concierge care is that you get better care because the doctor has fewer patients to care for.  This aggravates our primary care shortage.  This is absolutely not a win for society as a whole, nor is it a win for those patients who cannot afford concierge care and who may find it even more difficult to locate a doctor who will care for them.

Hospital chains, never ones to pass up an opportunity to grab some cash, have begun to offer concierge care.  Originally, the care was offered as a perk to their largest donors free of extra charge.  Now, even you can get in on the action, if you are willing and able to pay the annual fee.  From the point of view of the hospitals, concierge care creates a new income stream and who doesn’t need a new income stream?  It also gives hospitals a tool with which to attract doctors to its staff.  The more doctors who are on the hospital’s staff, the more patients are likely to be referred to the hospital by those doctors.  Think a bigger net catches more fish.

Referrals from concierge care physicians are particularly valuable because the patients being referred are well off enough to be able to afford concierge care in the first place.  They are likely to have private insurance, to be free of bad debts, and unlikely to be in need of charity care.  They are likely to demand the best care and to be happy to pay for it.

All of this drives up the overall cost of health care, which is already higher in the United States than anywhere else in the world.  Studies of Medicare data for patients in concierge practices show a 30-50% increase in overall health care spending.  We all pay more when some patients overuse health care and incur large bills.  While it is obvious that we are all paying when the patient is a Medicare enrollee, it is even true for patients with private insurance since more expensive claims drive up premiums for everyone.

There are only so many physicians providing primary care in the United States.  When you give the patients, who can afford it, quick access to a concierge physician who cares for only a relatively few patients, you of necessity leave the vast majority of patients fighting for access to the smaller pool of doctors who remain.  Improved access for the well-to-do means poorer access for those who cannot afford to participate.

Our country has more than enough income inequality already.  It does not need hospitals, especially non-profit hospitals which receive special tax treatment because they are supposedly providing free services to the public, to be contributing to inequality in the delivery of health care.


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