January 7, 2008 
If you’ve never heard of it, concierge medicine is an interesting extreme of consumerism. I met a physician in St. Louis about 7 years ago who had such a model. He didn’t take insurance. Each patient had their own voicemail box for exchanging messages with the physician. Everyone paid him an annual fee for unlimited access. Most of his revenue was for a private company’s executive team and their families. He spent lots of time with the patients, focused on preventative care, and kept trying to find ways to keep them healthy.
Newsweek had an article about this in their 11/26/07 publication called “The Blue Chip Checkup“. It talks about the Concierge Medicine clinic in LA where you can go get a $1,400 Vehicle Loans physical just like the President gets. It is so comprehensive that it even includes a skin consultation. Apparently, over the past year, they have had 600 people come in to get this physical.
I know lots of people are pretty skeptical about this. I am not sure I have an opinion yet. It’s interesting. Obviously, you don’t want to create unneeded costs and certainly we don’t want to make care a luxury good. But, having people take responsibility for their health and wanting to learn as much as possible about how to manage their care seems like a positive.
Ideally, there should be lots that we can learn about patient-MD interactions, value of testing, preventative care, and what would happen in an ideal setting where insurance and money was not an issue.
Enabling Healthy Decisions 
Contrary to what people believe more tests, especially non-recommended tests, don’t equate better health. Additionally, also contrary to popular belief tests aren’t risk free. There is a reason that USPSTF recommendations for some tests read “risks likely to outweight the benefits”. Some tests have a high rate of false positives that in turn lead to more invasive tests which can have serious risks. Especially, if a test hasn’t been shown to actually reduce mortality from the desease (per tested vs non-tested population), the probability one will benefit may way be lower than the risk of invasive tests triggered by false positives. There is also the issue of radiation from unnecessary ct scans. Additionally there is an issue of overdiagnosis with some tests — diagnosis of very early desease that may never cause problems in one’s lifetime yet if diagnosed will be treated and treatment may cause serious harm.. For a good example how a screening test can cause more harm than good, please look up history with testing for neurablastoma in Japan.
Just because something is detected early doesn’t mean someone’s life will be extended. I often read how some problems were picked up in one of those physical, but just because something was picked up doesn’t necessarily mean the person’s life would be edxtended. In some cases, the desease would’ve been just as treatable when detected later; in others – it is fatal anyway, yet in others – it is overdiagnosis. This is why we have recommendations and studies. Just doing every test in a book whether recommended or not may benefit a lot fewer people than it may harm.
I think very little attention is given to the fact that tests may actually cause harm.
Thanks for the comments. Let me continue the dialogue…
Matthais – I didn’t mean that the $1,400 was itself extreme consumerism, but the fact that people are willing to pay cash for non-covered activities is the extreme or farthest horizon of consumerism. This is a new area for us where people are taking responsibility for themselves by pursuing numerous actions. I think your comparison to a spa is a good one where people are seeking out stress relief or other things that should benefit them.
I actually think many (not all) physicians are underpaid especially if you look at the upfront investment (e.g., student loans, residency) that they have to become a physician.
Dx – I am sorry that the research doesn’t support a preventative exam being helpful. I have found several issues early through some routine blood work and other things I have done with my physician. I would agree with the other individual that if I had $1,400 to spend on a thorough exam I probably would especially when/if they were able to do some genetic analysis.
I am curious why you think that $1400 constitutes “extreme consumerism”. Weekend courses in whatever cost that much, a short trip to Disneyland for the regular family is much more and does not make you much healthier, a day at a great spa, a day at a great hotel costs about that and and and and yes, that as well.
The physicains that offer this should be commended for the good and thorough work they are doing adn for being available to their patients in such convenient ways. Service has it’s price, and the price is actually pretty low considering that with all the counseling and follow up this is going to take at least 5-6 hours. Try to get a lawyer at 250 an hour. Is it “extreme consumerism” to hire a lawyer at 250/h?
If you consider it closely, physicains are not paid well per hour once you look at the total time they truly spend on care. And yes, few outsiders see that and know that. Yes, doctors earn a lot, simply because they work a lot. Something that is generally respected in the US.
It used to be that every year I had access to a great general physical. Pretty amazing it headed off several problems I was having before they became serious problems. I’d be happy to pay $1400 for a decent physical– it would be ammo to force my insurance company to treat me.
Sorry, those 600 aren’t necessarily taking a very active interest in their health. An annual physical has not been shown to be an effective screening tool. It can be just a method to displace responsibility. I believe these guys have $600 of pretax disposable assets. Know your market. They probably had to decide whether to get a physical or a couple more botox treatments.
Smart shoppers with limited income (as has been shown with many surveys/research) don’t buy health insurance.
Most patients today don’t bother to follow recommended care activities, even when they can offered to pay or have insurance to cover it. I don’t see that a very comprehensive physical is going to be an incentive to get people to do it even if they could afford it. We need to see people taking an active interest (like those 600 seem to have) in their health.