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Law, Medicine, and Wealth: Does Concierge Medicine Promote Health Care Choice or is it a Barrier to Access?

46 Pages Posted: 21 Nov 2007  

Sandra J. J. Carnahan

South Texas College of Law


Many primary care physicians are unhappy with patient panels in excess of 3000, increased administrative requirements, reduced reimbursement rates, and other earmarks of managed care. Concierge medicine is a new form of medical practice that allows physicians to reduce their patient load to perhaps 300 or less, in order to spend more time with each patient and increase their incomes at the same time. In one model, the physician accomplishes this by charging patients a monthly fee that varies from a few hundred to over a thousand dollars, for which the patient is allowed to access the medical services of the physician. The fee covers special attention from the physician and a list of amenities not usually covered by insurance, while the patients remain responsible for their medical bills.

The dark side of concierge medicine is that thousands of patients unable to pay the fee no longer have access to their physician, and must find a new physician in a market with increasingly fewer primary care physicians available. Because wealthier patients are often healthier, concierge medicine may also require those physicians remaining within the system to absorb the sicker patients. Medicare patients in particular may be disproportionately affected.

This presentation briefly reviews state and federal laws that may impede this new practice form, as well as its ethical implications. More importantly, this presentation focuses on the potential negative effects of concierge medicine on access to health care. It concludes that, although physicians may provide, and wealthy persons may receive, medical care as they wish (or as the market will bear), private insurers should exclude concierge physicians from their networks and physicians should be prohibited from charging Medicare patients access fees.

Keywords: Physicians, Managed Care, Health

Suggested Citation

Carnahan, Sandra J. mname, Law, Medicine, and Wealth: Does Concierge Medicine Promote Health Care Choice or is it a Barrier to Access?. Stanford Law & Policy Review, Vol. 17, No. 1, 2006. Available at SSRN:

Sandra J. Carnahan (Contact Author)

South Texas College of Law ( email )

1303 San Jacinto Street
Houston, TX 77002
United States

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