Unintended consequences

One of the new emerging trends in medicine is for primary care providers to establish “boutique” practices.

Basically what this means is that there will be an extra fee charged to guarantee access to a physician. Some of these boutiques are national and have ties to well-known medical centers that will consult on your case, if needed.

The fees for being part of a boutique practice will be in addition to the reimbursements from your health insurance. We have heard prices for participation in a boutique practice in the neighborhood of $5,000 per year for an individual.

Physicians establishing boutiques or joining a national one will limit their practice in most cases to several hundred patients. The fees, of course, will serve as a deterrent for many patients seeing a doctor in a boutique practice.

One of the immediate consequences here in Hawaii will be the exacerbation of our already existing severe doctor shortage. As the boutiques see fewer patients, the load will fall on those who still only require insurance payments and co-pays.

Another unintended consequence probably will be the speed-up of socializing medicine in the country. Citizens who have lost their doctors because of boutique pricing will undoubtedly pressure government to find a solution. Generally, government solutions are simply more government.

In such a scenario, we can envision the boutiques being the equivalent of private practitioners in England with other physicians falling into a British-style National Health Service. Where that would leave private insurance companies is anybody’s guess. Probably much smaller at least.

We can understand doctors who are dissatisfied with insurance reimbursements and very long hours. But the temptation of the boutiques may have consequences that hurt patients and doctors – and, ultimately, the health care system itself.

* Editorials reflect the opinion of the publisher.