WHY YOU SHOULD CARE
Obama is trying to remove barriers to health care, but could luxury hospital suites and gourmet meals pose new ones?
By Melissa Pandika
Most have heard about Kimye dropping more than 3 Gs a night for Cedars-Sinai Hospital’s deluxe maternity suite to welcome baby North. The A-list package came complete with a flat-screen TV, fully stocked fridge and spa-style pampering, including haircuts and mani-pedis.
But even non-celebs can experience a cushy hospital stay — if they can afford it. For an extra $2,000 to $4,000, patients can enjoy hotel-style rooms, valet parking, gourmet meals and more. Meanwhile, so-called “concierge care” clinics offer patients 24/7 access to doctors, same-day appointments and other perks for annual fees ranging from $1,000 to $20,000.
Luxury care has flourished in recent years, largely untouched by the Affordable Care Act, says Portland State University adjunct associate professor Martin Donohoe. While the number of hospitals sponsoring luxury primary care isn’t known, the list includes several major medical centers, such as the Mayo Clinic, UC Irvine Medical Center and New York-Presbyterian Hospital.
Critics say this ’boutique’ approach offers the highest quality care to wealthier, healthier patients instead of the ones who need it most — those who can’t afford the extra fee.
Some praise luxury care as a win-win. It frees physicians, once overwhelmed by huge patient loads that allow for a fleeting 15 minutes of face time, to foster patient relationships — and earn more doing so. Plus, what patient wouldn’t want one-on-one attention, especially for more more serious procedures, such as heart surgery or chemotherapy? Yet critics say this “boutique” approach provides the highest quality care to wealthier, healthier patients instead of the ones who need it most — those who can’t afford the extra fee.
Many hospitals offer luxury care to stay afloat in a shaky economy. Facing deep pay cuts and shrinking insurance reimbursements, “hospitals are under a lot of financial pressure,” explained Ashish Jha, a professor at the Harvard School of Public Health. “It’s expensive to run a hospital. Are they able to get a different source of revenue from patients? How can they attract more patients?”
Sure, luxury care has attracted patients — but which ones? Donohoe reported in ”Ideological Debates in Family Medicine” that most luxury primary care patients are white, healthy and hold upper-management positions.
In a Journal of General Internal Medicine study, Johns Hopkins University assistant professor G. Caleb Alexander found that concierge doctors see fewer African-American, Latino and Medicaid patients who are at higher risk for health problems. They also see significantly fewer patients with diabetes — a disease that disproportionately afflicts the poor. And a luxury style of practice might lure doctors away from low-income communities, which already face severe physician shortages.
But the wealthy might also suffer. Donohoe found that upscale perks aren’t only unnecessary — they may even be harmful. Scant evidence supports the clinical or cost effectiveness of body fat measurements, stress tests, chest X-rays to detect lung cancer and other screenings commonly requested by luxury care patients, who rarely show disease symptoms. Excessive testing might also produce false positive results, leading to over testing and over treatment, which can expose patients to radiation and other risks. At the same time, these tests divert resources away from patients with more urgent needs.
“While some might argue that if a patient is willing to pay for a scientifically unsupported test that she should be allowed to do so, such a ‘buffet’ approach to diagnosis makes a mockery of evidence-based medical care,” Donahoe wrote.
Others argue that health care — like education or any other sector — will inevitably include haves and have-nots. In the same way that only a small percentage of families can afford private education, only a minority of patients can pay for luxury care. Looked at that way, private education and luxury care are simply responses to market needs.
Others argue that health care — like education or any other sector — will inevitably include haves and have-nots.
Jha points out that medical care for all income groups has improved — and luxury care has actually become more accessible. “It used to be very exclusive and very expensive,” he said. He predicts it will continue to drop in cost, trickling down to patients at every income level until it becomes standard practice. “That happens in most industries,” he explained.
Donohoe doesn’t buy it. “Trickle down does not occur, just as trickle down economics is a myth,” he said.
As Obamacare seeks to improve health-care access, should we accept the have and have-not divide as an unavoidable reality? Does equitable care mean regulating VIP services — or prohibiting them altogether? Should luxury care be restricted to only certain procedures? Or is there a fairer, more effective way to increase hospital revenues?
- Melissa Pandika Contact Melissa Pandika