LEGAL: Concierge Medicine, Tension Between Physician Autonomy and the Ethical Obligation to Provide Indigent Care

By Kristi L. Tonn, J.D., LL.M. candidate (Health Law)

Health Law and Perspectives. University of Houston Law Center


Primary care physicians and patients alike are becoming increasin gly unhappy with the way primary care is currently being delivered. Physicians often see in excess of 2,000 patients per year, 1 receive reduced reimbursement rates, and experience other frustrations associated with not being able to deliver th e best care possible due to time restraints. 2 Similarly, patients are frustrated by the diffi culty in scheduling appointments and short, impersonal visits with thei r physician. Concierge medicine 3 addresses some of these concerns by allowing physicians to drasti cally reduce their patient loads and conduct more personal visits with their patients. In a common model of conc ierge care, physicians provide enhanced services to patients beyond th ose available in trad itional practices in exchange for a yearly retainer fee. 4 However, only those able to pay these fees, which range from hundreds to thousands of dollars, are able to access this type of care. Therefore, a critical concern with the growth of concierge medicine is whether this type of care is discriminatory in practice, because these physicians are in effect only treating wealthier patients. 5 As one doctor puts it, “[t]his is not how any of us doctors wanted care to be set up, but the syst em, as it is now, is broken. Patients are asking for more, doctors are under huge pressures, and ther e is not enough money in primary care.” 6



Health Law Perspectives (December 2010) Health Law & Policy Institute University of Houston Law Center

The opinions, beliefs and viewpoints expressed by the various Health Law Perspectives authors on this web site do not necessarily reflect the opini ons, beliefs, viewpoints, or official policies of the Health Law & Policy Institute and do not constitute legal advice. The Health Law & Policy Institute is part of the Univ ersity of Houston Law Center. It is guided by an advisory board consisting of leading academicians, health law pr actitioners, representatives of area institutions, and public officials. A primary mission of the Instit ute is to provide policy analysis for members of the Texas Legislature and health and hum an service agencies in state government

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