I did a little research to see what my health care might be like next year. My health is typically good and I don’t regularly take prescription drugs, so I was looking for catastrophic care plans with low monthly payments, and low coinsurance rates. These plans are ideal for people who can’t afford full coverage but want protection in the case of a major emergency – a car accident, a serious burn, a broken limb.
The key financial factors in evaluating a catastrophic care plan, or any health plan, are its monthly cost, deductible, and coinsurance rate. For those of you who don’t know, the deductible is the amount you pay out of pocket before insurance coverage kicks in. Coinsurance is the percentage of the cost for medical treatment that you, the patient, pay, leaving the remainder for the provider. A coinsurance rate of 40 percemt, for instance, means that you pay 40 percent while the provider pays 60 percent.
As you may imagine, for catastrophic care, my priority is a low coinsurance rate. Staying in the hospital is expensive anyway – for a major emergency or care lasting longer than a few days, the cost can climb well into tens of thousands of dollars. Thus, a $1500 deductible, for instance, is a small fraction of the total cost, while even a low coinsurance rate, such as 30 percent, represents a devastating expenditure.
Many HMOs, like Kaiser or Health Net, offer plans with no coinsurance. While they vary in their prescription drug coverage and office visit co-pay rates, these differences seem comparable with their monthly costs. Plans with no coinsurance and moderate prescription drug coverage run, it seems, between $65 and $90 per month.
I wanted to talk about catastrophic care just to give you an idea of what many students get after college. Obviously one of the most important aspects of a plan is what it covers, but this varies significantly between plans and is a better project for personal investigation.
As I was browsing the Internet for information on health plans, I came across an article from the New York Times from Oct. 30 of this past year that presented a striking contrast to the subject of catastrophic care.
The article describes the relatively recent phenomenon of “boutique” or “concierge” doctors—primary care and specialty physicians who offer patients unprecedented access to personalized care in exchange for a yearly cash retainer. These doctors will stay in touch by phone, e-mail, or even text messages, and because they retain fewer patients at higher rates, they can afford to spend lavish amounts of time treating their own patients and coordinating referrals and specialty care.
The majority of these physicians charge $1500-$2,000 per year (on top of regular health insurance), though some go as high as $10,000. These are direct cash payments, not administered through an HMO, though concierge doctors operating under MDVIP, a specialized “boutique” managing organization, enter into a contractual relationship with patients that specifies and secures the desired services. These services usually include 24-hour telephone access, coordination of medical needs during travel, consultations in the patient’s home, and sometimes even accompaniment to specialist appointments or home delivery of medication.
It seems that both the doctors and patients in these relationships appreciate them – patients get luxurious, wait-free, personalized contact, while physicians manage fewer cases, make more money, and enjoy the satisfaction of providing what they consider the best care. As one might imagine, elderly patients with chronic conditions are especially pleased, but concierge services are spreading rapidly among all those who can afford them.
The concern, of course, is how this dynamic contributes to the inequity of American health care, and it fits perfectly with our question earlier about rights and privileges. As boutique doctors reduce their caseloads—from 3,000 patients to a mere 600, on average—and raise prices, they cut out more and more people who must rely on the system of regular doctors. These poorer people are more likely to be sicker in the first place, so the regular health care system must lower its financial expectations while managing the care of a larger, less healthy population.
Of course, it would be just as problematic, if not more so, to argue that the wealthy should not enjoy elite health care. I personally do not bristle at the fact that I shall pay a relative pittance for catastrophic care, while, were I older and wealthier, I could enjoy boutique care. But on a larger scale, the growing association of financial means with bodily health is a troubling one. Boutique care isn’t bribing, by any means, but what would we call it if you could slip the fire department a little extra to come by your house first? Would that be problematic, while boutique doctors are not?
This column relied on information from http://www.ehealthinsurance.com, as well as the Oct. 30, 2005 New York Times article, “For A Retainer, Lavish Care by ‘Boutique Doctors,’” by Abigail Zuger.
Nick can be reached for comments, criticism, or suggestions at ngerrybullar@wesleyan.edu.
Leave a Reply