NCPA - National Center for Policy Analysis

Boutique Medicine

January 15, 2002

Nationally, a small but growing number of doctors are opening practices that -- for an extra fee, presumably paid out-of the patients' own pockets -- cater to the upper middle-class with certain amenities that were once only available to wealthy patients.

Although critics accuse them of abandoning lower-income patients, the doctors respond that they are only trying to give patients more attention at a time when managed care pressures physicians to crowd more and more patients into ever-shorter appointments.

  • For annual fees ranging from $1,500 up to $20,000 for a family, patients get such amenities as round-the-clock cellphone access to doctors, same-day appointments, nutrition and exercise physiology exams at patients' homes or health clubs and doctors to accompany them to specialists.
  • Several such practices are franchising -- planning to add doctors in New York, California, Illinois, Texas, Maryland and Virginia.
  • Doctors setting up "boutique" or "concierge" services say their regular practices had become treadmills and that they had simply lost the ability to spend adequate time with their patients.
  • But such arguments don't impress critics, who are taking steps to try to discourage or outlaw the deluxe services.

Government agencies, including the federal Centers for Medicare and Medicaid Services, are investigating whether the arrangements illegally charge patients for services also covered by insurance or Medicare -- which doctors contend they do not.

In Massachusetts, a private medical insurer, the Tufts Health Plan, has questioned whether such practices discriminate against patients who cannot pay. The state's insurance department is investigating.

Opinions among patients who have been affected by the change in services range from accusations of "pure greed" among doctors, to one woman's observation that it's worth the sacrifice to keep someone she likes as her physician.

Source: Pam Belluck, "Doctor's New Practices Offer Deluxe Service for Deluxe Fee," New York Times, January 15, 2002.

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