Dermatoethics: The ethics of concierge medicine

Abstract

Concierge medicine constitutes a constitutes a care-delivery model in which patients pay a subscription service for enhanced care options. Patients generally pay an annual fee and have increased access to their physician, shorter wait times, house calls, and longer visits. Patients may also maintain traditional health insurance that could be used to cover specialist visits, lab costs, prescriptions, procedures, and other expenses. While practices have expanded in the field of primary care, their market share in dermatology is less well-described in the literature. What is clear, however, is that concierge and cash-only practices not covered by traditional insurance raise a multitude of ethical questions regarding access and quality of care. Moreover, the transition of many physicians from traditional practices to concierge and cash-only practices hightlights some of the difficulties dermatologists face under the current insurance-based model; these challenges include prior authorization hurdles and high patient volumes. Concierge medicine may limit access for all patients but increase access for particular patients. It may contribute to disparities in overall care while improving care for specific patient subpopulations. These and other ethical issues of concierge dermatology are described below.