"Concierge Medicine, A Solution, Or A Problem?"

The landscape for health care delivery has evolved significantly over time. What initiated as a home service by a family physician grew into predominately inpatient service, followed by the expansion of outpatient service. Now, the trend is starting to drift back to a more "family physician" approach with an added cost. Reduced reimbursement rates, increased paperwork, increased operating costs, and increased patient case loads have made it difficult for primary care physicians (PCPs) to be successful compared to their peers. Medicare and Medicaid reimbursement rates continue to be adjusted downward, and PCPs are expected to broaden their practices to compensate. Medical school graduates are choosing careers as specialists for an increased income, stability, set hours, and reduced case loads. As a result, the decline of PCPs has increased resulting in fewer providers coupled with a growing population. Those providers remaining in the PCP field, or deciding to enter that area of service, are looking for new ways to generate revenue and reduce the patient case load. As a result, concierge medicine, also known as boutique medicine, retainer medicine, VIP medicine, executive health program, platinum practice, personalized health care, or luxury health care, has evolved and is currently growing (Harris, 2008). Reasons for the shift in care are continued downward pressure on health plan reimbursement rates both from private insurance and Medicare/Medicaid programs, physician administrative burdens, and a demand by patients for a more responsive and personalized treatment. Concierge medicine poses a risk of providing medicine based on a two tiered system, committing health care discrimination, conducting Medicare/Medicaid fraud, further creating a void in the area of PCPs, and creating a serious barrier to