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Dr. Howard Maron, the founder of MD2 International (pronounced MD Squared) and pioneer of concierge medicine, has said of the term: "...I only came up with the concept—not the term 'concierge medicine.' I know what a concierge is, but to describe what I do as simply opening doors and directing people.... I prefer 'highly attentive medicine.'""The Highly Attentive Approach," Worth magazine, July 2005.

The origins of concierge medicine are often traced to MD2, which was launched in 1996 in Seattle by Dr. Howard Maron. Others include MDVIP and numerous individual concierge physician practices across the United States.

Concierge physicians care for fewer patients than in a conventional practice, ranging from 100 patients per doctor to 1,000, instead of the 3,000 to 4,000 that the average physician now sees every year. All generally claim to be accessible via cell phone or email at any time of day or night. The annual fees vary widely, from $60 to $15,000 per year for an individual, with some practices that do not accept insurance of any kind.United States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.

Mostly concentrated on the East and West Coasts, in 2004 the Government Accountability Office counted 146 such practices. The American Medical Association does not track the number of concierge practices because the concept is still so new."Boutique Medicine: When wealth buys health," CNN.com, October 19th, 2006.


CONCIERGE MEDICINE IN CONTEXT


Coverage about Health Care In The United States has been at the forefront of the nation’s headlines. There are many issues that are covered on a daily basis, in both newspapers and books, with a few items highlighted below:

  • Health care consumed 16% of the Gross Domestic Product (GDP) in 2004, and projections place future spending at 20% of the GDP by 2015. http://www.nchc.org/facts/cost.shtml


  • Fewer medical students are choosing to become primary care doctors, and are becoming specialists instead. Over the past decade, the income of a primary care physician has fallen, even though physicians seeing approximately 20 – 35 patients per day with a ten or fifteen minute consultation."Your Own Private Doctor," by Mary Duenwald, Departures magazine, November/December 2004. According to Jerome Groopman, MD, author of ''How Doctors Think'', "insurance companies seriously under-reimburse doctors for primary care," even when the physician may spend an hour diagnosing a complex medical problem, yet specialists who perform a procedure get "a substantial payment."


  • Financial incentives may encourage physicians to provide a more complex medical solution when a simpler one may have sufficed because of the higher reimbursement from insurance. For example, several doctors in Elyria, Ohio have an angioplasty rate that is nearly four times the national average. The New York Times article states that no one is accusing the doctors of any wrongdoing, "but that Medicare and at least one commercial insurer are starting to ask questions. And the hospital where most of the procedures take place says it plans to conduct an independent review." Some outside experts say, according to the article, that they are concerned that Elyria is an example, albeit an extreme one, of how medical decisions in this country can be influenced by financial incentives and professional training more than by solid evidence of what works best for a particular patient"Heart Procedure is off the Charts in an Ohio City," The New York Times, by Reed Abelson, August 18, 2006.

  • By 2013, it is projected that one in five Americans will not have insurance because they cannot afford it.JAMA, March 14, 2007, "State-Federal Partnerships for Access to Care," by Arthur Garson, Jr, MD, MPH and David Blementhal, MD, MPP

  • In ''Overdosed America'', John Abramson, MD, notes that the American health care crisis in about much more than the escalating cost of care. He says it’s about "the low quality of medical care that results when those with health insurance receive too much of the wrong kind of care and those without health insurance receive too little of the care that is necessary."



CONTROVERSY OVER CONCIERGE MEDICINE


Concierge medicine has also garnered increased media attention in the past few years as it continues to grow nationwide, and as the healthcare crisis deepens. The concept of concierge medicine has been accused of promoting a two-tiered health system that favors the wealthy, limits the number of physicians to care for those who cannot afford it, and burdens the middle and lower class with a higher cost of insurance. Critics contend that physicians who choose this route are often seeking a more lucrative, less busy lifestyle.Unites States Government Accountability Office, Report to Congressional Committees, "Physician Services: Concierge Care and Characteristics and Considerations for Medicare," August 2005.

One physician in a CNN.com article noted that he might not be treating patients at all if he hadn’t made the switch to concierge medicine: "…many doctors are becoming so disillusioned with primary care that they are quitting altogether."

Proponents of concierge feel that it meets consumer demand, allows physicians to provide the treatment they deem necessary, and improves quality of care by increasing the amount of time that can be spent on preventative medicine.Overdosed America, by John Abramson, MD, pgs. 169-194 Preventative care such as lifestyle advice, and follow-up phone calls and emails are not usually reimbursed by insurance. Physicians significantly reduce the number of patients they see in a day, which allows them to spend extra time and attention with each patient. It has also been noted that while some concierge medicine practices do not accept insurance, all of their patients are encouraged to carry health insurance for services utilized outside of the practice.

Some say that concierge medicine is not the solution to the healthcare system’s woes, but is a symptom of "too much emphasis being placed on cost control and too little emphasis on the patient."


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