Concierge Medicine - A Retainer Model to Healthcare
Concierge Medicine has been increasingly popular in Western countries due to its promise of “a private doctor providing personalized medical services just for you - at a retainer fee”. But what exactly is concierge medicine, and is there a scope of bringing such a medical model to India?
Concierge medicine is an emerging business model in healthcare that focuses on building a relationship between a patient and a healthcare provider. As such, patients are expected to pay an annual/monthly retainer fee in exchange for which doctors agree to provide enhanced care and commit themselves to treat only a select number of patients. All this means more doctor-patient time, lesser stress on doctors to see a queue of patients, and a healthy doctor-patient relationship.
On paper, this seems like a win-win situation to both patients and doctors, yet still, concierge medicine is hindered by several operational, ethical, and skilled labor challenges; which begs the question, “Will concierge medicine ever fit in the Indian healthcare ecosystem?”
Where does concierge medicine fit in?
Currently, Indian healthcare is primarily distributed through institutions. Large hospital chains, single-specialty, and multi-specialty hospitals have collectively turned the health spotlight away from individual doctors, small clinics, and medico-startups, and stand as the face of the Indian healthcare ecosystem.
When it comes to concierge medicine, Dr. Vishal Sehgal, Medical Director, Portea Medical says, “These are the early days of concierge medicine in India as compared to the West. In India, there is more stress on curative practices and a lack of emphasis on preventive practices. As a country, we Indians don’t think preventive healthcare is as important. We have to see a shift in this mentality before concierge medicine truly begins to take shape in India.”
However, there is much more to the equation than just a mentality shift. The fact of the matter is healthcare diagnosis and coordination are much easier in the 21st century owing to the daily advancements in the health ecosystem. Not only is tech adoption increasing in this space, making concierge medicine easier to practice, but the laws that govern the economics and insurance of healthcare are slowly becoming open to healthcare at home, and out-of-hospital services.
The Economic Models of Concierge Medicine
In terms of business models, concierge medicine is usually of three types:
Fee For Care: An annual retainer model where the retainer fee covers most services provided by the physician. Usually, vaccinations and lab work are excluded and charged separately.
Fee For Extra Care: Similar to FFC, but additional services are charged to the patient’s insurance plan.
Hybrid: A model where physicians charge a retainer for services not covered under the patient’s insurance plan.
Concierge medicine is practiced by individual doctors and services in pretty much most countries of the world, ranging from the likes of Denmark and Canada to India and Japan. However, the spread of such a practice, owing to the models so far, is primarily restricted among the upper economic echelons of these countries.
In the USA, where concierge models have developed to accommodate for more physicians, concierge fees range from $125 - $ 200 a month; and in institutions this figure may range from $100-$200 for an initial visit. In Canada, concierge medicine may cost up to 200CAD per month, whereas an average visit to the doctor costs CAD 54. These disparities show exactly how different countries look at the business practice, and using trickle-down economics and pricing, there is a possibility of concierge medicine slowly being more affordable to larger sections of society.
As for patients, those with high affinity to infections and ailments would, in theory, save money on concierge medicine whereas those without such issues might be losing money. This creates an inverted pyramid structure similar to insurance companies, and if insurances work towards everyone’s mutual benefit, there’s no reason to doubt concierge medicine in the same context.
Pros and Cons of Concierge Medicine
First, let’s study the cons of such a healthcare model, which broadly fall into three main categories: a. Credibility; b. Economics; c. Scale
Both of these are addressable although it would require a fair amount of effort from the government, individual doctors and practitioners, and other stakeholders in the ecosystem. A simple fix for the credibility problem would be along the lines of a government-controlled accreditation system.
When it comes to the economics of the matter, it starts and stops with insurance providers. The quicker insurers move into the market, the faster the growth and adoption of this model would be. Dr. Farah Ingale, Director, Internal Medicine, Hiranandani Hospital, Vashi- A Fortis Network Hospital echoes these sentiments and says, “the concierge model can be more successful in case of having direct empanelment with agencies or medical tourism companies. Moreover, I think even for hospitals and insurance companies, it will be a successful model if they don’t restrict their services and provide maximum coverage.”
Scale is always an issue with such a model as replicating it does rely more on individual doctor skill and business acumen. Not all doctors, despite being terrific at their job, have the necessary skill set required to run a business, and at its core concierge medicine is just that. A business practice with a business model. In simpler words, freelance for doctors.
It also doesn’t help that the doctor-patient ratio in India is poor, which may plant a seed of ethical doubt in the mind of practitioners. That said, the medical community is split on personal choice of doctors, with some doctors preferring to work with a work-life balance and a higher job satisfaction, whereas others look at their work more from a mass saviour view point. However, the ethics discussion surrounding concierge medicine, and whether an individual doctor chooses to go forward with a concierge practice or not is a decision solely on the individual.
Now that the cons are out of the way, let’s take a look at the pros of such a healthcare model.
Concierge medicine puts a lot of focus on patient-doctor relationships which go a long way in the mental and physical recovery of a patient. It also lays emphasis on preventive care, which in theory, stops small health concerns from becoming major health risks. This practice would also go a long way in infectious disease management and chronic long-term disease management as well. These pros are at an ecosystem level. Looking closer at the individual level, it’s abundantly clear that concierge medicine allows for better doctor-patient relations, more time spent by a doctor on each patient, and a general humanization of healthcare which prevents doctors from looking at their patients as a bed number or a victim of any ailments.
Is there a possibility of bringing this model to India?
Over the past few years (minus 2020), India has been growing rapidly which means increased disposable incomes, growing urbanization, and a higher level of literacy. Put this together with active patient involvement in their own personal healthcare and smart technology like wearables, and suddenly an avenue of customer-centric healthcare models opens up.
Dr. Farah says, “Although we cannot comment on the overall impact of concierge medicine on healthcare until we study the results, I believe, considering the pandemic, people will respond well for such practices or services offered. The demand for these services is now on the rise, and the model also fits in to enable a flexible and convenient model for the physicians, who usually have a personal practice and are not associated with any single multi-specialty hospital.”
Another factor to keep in mind is the existing socio-economic inequalities deeply rooted within the Indian social fabric. Although all humans bleed red, Tier 1 and Tier 2 populations in the middle class and upper strata have a much higher chance of stopping said bleeding.
Does concierge medicine have a future in India?
It comes as no surprise that a shift towards outpatient services will most definitely help fix some of the inherent imbalances in healthcare delivery while improving the quality of healthcare and ease of affordability for the patients.
Source :Conclerge Medicine today, Direct Primary care Journal
Dr. Vishal adds, “I believe this would be a welcome change for doctors and GPs would love to work under such a model.” That said, it is impossible to predict the future, but according to the business experts, ‘the future of Concierge Medicine in India depends upon the physician and patients choice to accept the model.’