NCPA - National Center for Policy Analysis

Is Physician Care Moving To Two-Tiered System?

March 17, 2000

Health-care experts are noting that suddenly doctors who never before dared to abandon health insurance plans are moving toward a higher level of practice which only accepts cash. Patients who have the means to pay out-of-pocket or submit their medical bills to their own insurers enjoy uncrowded waiting rooms and longer office visits.

  • There are no national figures on how many doctors are joining the new tier, but their ranks include family practitioners as well as specialists, observers report.
  • These doctors tend to be located in urban areas and some of them accept Medicare payments or payments from a few other select medical plans.
  • Some of them are asking patients to give them annual retainers of thousands of dollars.
  • People's growing irritation with impersonal medical care from rushed doctors and new levels of prosperity are propelling the change, according to health policy experts.

Dr. Alan Garber, an economist and specialist in internal medicine at Stanford University sees the trend as the market reasserting itself. "In characteristic fashion in America, markets have emerged where they didn't exist," he observes.

Dr. Thomas Reardon, a general practitioner and president of the American Medical Association, explains that what the doctors are saying is, "We're tired of managed care, we're tired of Medicare, we're tired of the hassle."

Doctors who once tried to go independent and had trouble finding patients report that the climate has changed and patients are now searching them out.

Source: Gina Kolata, "For Those Who Can Afford It, Old-Style Medicine Returns," New York Times, March 17, 2000.


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