Physicians opting out of some insurance create two-tiered medical system

The Fiscal Times: "A small but growing number of physicians are ... abandoning traditional insurance-based practice to offer VIP treatment, including more time with patients, in return for upfront fees. In one common setup, often called concierge or retainer-based medicine, a primary care doctor charges an annual fee ranging from $1,000 to $20,000 just to get in the door. When doctors shift to this model they can cull their patient loads, selecting only those who can foot the bill. The services they provide often include a deluxe annual physical, 24-hour direct cell phone access to a doctor and escorts on visits to specialists. Some doctors still accept insurance and Medicare and bill normally for routine care."

"Some health care experts view this as an ominous trend that could exacerbate socioeconomic disparity in the health care system in light of a looming doctor shortage" (Graham-Silverman, 5/18).

The Houston Chronicle reports that doctors in Texas "are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable. ...More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle" (Ackerman, 5/17).