The Three Faces of Retainer Care: Crafting a Tailored Regulatory Response

42 Pages Posted: 24 Mar 2006 Last revised: 12 Nov 2007

See all articles by Frank A. Pasquale

Frank A. Pasquale

University of Maryland Francis King Carey School of Law; Yale University - Yale Information Society Project


Retainer care arrangements allow patients to pay a fee directly to a physician's office in order to obtain special access to care. Practices usually convert to retainer status by concentrating their attention on a small panel and dropping the majority of their patients. Proponents call retainer care a triumph of consumer-directed health care; opponents deride it as boutique medicine. Both sides are deploying a variety of legal tactics in order to attain their goals.

After surveying these conflicts, this article clarifies what is at stake by analyzing the three key features of retainer care: preventive care, queue-jumping, and amenity-bundling. Most commendably, retainer physicians are aggressively counseling their patients on how to avoid getting ill. More questionably, they are trading faster access to better health care for cash. Most troublingly, they are bundling medical care with unrelated amenity services.

Each of these faces of concierge care deserves a different legal response. This article develops a normative framework for tailored intervention. Regulators have taken some promising steps toward mitigating the worst aspects of retainer care conversions. However, taxation may be the only approach sufficiently targeted to reduce incentives for queue-jumping and amenity-bundling while promoting innovation in preventive care.

Keywords: health, boutique medicine, concierge care, retainer care, Medicare, balance billing, insurance, regulation, taxation, tiering, inequality, consumer-directed health care

JEL Classification: A14, H51, I11, I19, K32, M40, P46, Z10

Suggested Citation

Pasquale, Frank A., The Three Faces of Retainer Care: Crafting a Tailored Regulatory Response. Yale Journal of Health Policy, Law, and Ethics, Winter 2007; Seton Hall Public Law Research Paper No. 890354. Available at SSRN:

Frank A. Pasquale (Contact Author)

University of Maryland Francis King Carey School of Law ( email )

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Baltimore, MD 21201-1786
United States
410-706-4820 (Phone)
410-706-0407 (Fax)

Yale University - Yale Information Society Project ( email )

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