Washington Post Examines ‘Boutique’ Medical Care

The Washington Post on May 28 examines the "medical, financial and moral implications" of "boutique medicine," under which doctors provide more services to patients for an additional fee. "Frustrated" by administrative duties, a trend toward "cookie-cutter medicine" and the restrictions of managed care, a "growing number" of doctors nationwide have begun to offer "hassle-free, top-of-the-line services" to patients for additional fees that range from $1,500 to $20,000 per year. Supporters of the practice point out that boutique medicine directs "more money into the overall health system" and allows doctors to volunteer more time to treat low-income patients at community health clinics. However, analysts predict that as more doctors "opt out of the traditional system" of managed care to focus on boutique practices, the "rest of the public may face longer waits and higher fees" for health care. As a result, some patients may "forgo care, especially preventive services, which ultimately means a sicker population," the Post reports. Some opponents also express concern that boutique medicine has "shone a light on the widening gap between rich and poor" in a profession "dedicated to healing one and all." John Goodson, a professor at Harvard Medical School, said, "Change is inevitable, but a change toward elitism in the delivery of health care is pernicious. It undermines the most fundamental commitments of our profession." To address the issue, Sen. Bill Nelson (D-Fla.) has proposed legislation that would prohibit the practice of boutique medicine for doctors who receive Medicaid reimbursements. However, supporters of the practice argue that "rather than eliminate gold-plated medicine, the real solution ... is to provide that sort of care to everyone." Michael Lauer, director of clinical research at the Cleveland Clinic, said, "You can make the argument that all adults should get this kind of checkup. Why should it be restricted to executives and people who can pay?" The American Medical Association plans to discuss the issue at the group's annual meeting next month (Connolly, Washington Post, 5/28).

Cleveland Clinic
In a related story, Washington Post reporter Ceci Connolly chronicles her experience with boutique medicine at the Cleveland Clinic. The Personal Health Management Program at the Center for Corporate Health, launched in 1974, serves about 3,400 patients at the clinic, "mostly men of elevated professional status." Employers pay the clinic an average of $2,500 per year per patient for the program. In the program, patients receive an annual "day-long checkup" that includes a range of services "tailored to each individual." The program also offers "access to the expertise you need, when you need it." In addition, patients can purchase "extras" such as cosmetic surgery, smoking cessation programs, psychiatric evaluation or fitness consultation (Connolly, Washington Post, 5/28).