Well before Obamacare became a political football, healthcare had been a hot button issue in America for decades. While recent changes may well be good for the American public at large – and particularly those who would have otherwise been uninsured – recent changes in how healthcare is delivered to the masses have nonetheless had a curious affect on ultra-affluent families. This has hit US families not only in terms of exposure to health insurance in their portfolios, but also in their ability to receive medical care of a quality that they desire.
Central to these changes is an increasing move in the US towards what's termed a “population-based” model of health management, which assesses the overall health care needs of Americans and makes decisions for the whole population, rather than for individuals. Such a move plays out in guidelines from Medicare as to how and when doctors should check for various health issues. Males should begin colonoscopy screenings at age 50 and women mammograms at 40. The guidelines are based on the statistical occurrences of various diseases. They eliminate inequalities in service provisions by deciding treatment based on the overall health of the population, regardless of an individual's ethnicity, socioeconomics or geography. Fans of Britain's NHS would deem population-based medicine good for society as a whole and it also helps the government manage its bottom line. Yet if pressed, most doctors would agree that statistics can only get you so far in medicine, and each individual's healthcare needs is complex and unique. Another downside is that pre-screening and preventative measures are increasingly not covered by insurance, which means Medicare-funded doctors simply won't do them for the average patient.
Concurrently there are increasing economic pressures on primary care physicians. Sole practitioners are finding it difficult to maintain their own offices and are being bought out by hospital groups. Those small offices that survive have an imperative to see more patients; what used to be regular, comprehensive 45-minute consultations for most patients has turned into quick, infrequent 15-minute visits – hardly enough time for even the best of doctors to get to know their patients and treat them accordingly.
Enter the burgeoning industry of concierge medicine, where patients pay an annual fee or retainer for a high-quality, personalised medical service. Dr Daniel Yadegar MD, a partner at New York-based Goldberg & Yadegar, says concierge medical providers limit their patient loads to somewhere between 50 to 1,000 patients per doctor as compared to the 3,000-plus that most doctors will have on their books. Under the retainer system, physicians are on call for all of their patients 24/7 and can take the time to intimately understand each patient's needs, provide high levels of customised care, house calls, preventative medicine and easy access to the best specialists. His own firm also provides cardiovascular, gastrointestinal and anti-aging services.
As population-based models increase in popularity with governments, insurance companies and the medical industry, it's likely that concierge medicine will become evermore appealing to the ultra-affluent as they see service levels from traditional providers dramatically decline. Like other concierge services, concierge medicine seems a particularly American trend. It will be interesting to see if, like other innovations in concierge services, this one is also exported to the rest of the world.