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Concierge medicine (also known as retainer medicine) is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient.〔("Concierge Medicine: Greater Access for a Fee" ), PBS NewsHour, PBS television, July 9, 2012〕 The practice has been referred to as concierge medicine, retainer medicine, membership medicine, cash-only practice, and direct care. While all "concierge" medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the fee charged. Estimates of U.S. doctors practicing concierge medicine range from fewer than 800〔(University of Chicago/Georgetown University Study )〕 to 5,000.〔(Daily Finance article quoting AAPP (formerly SIMPD) )〕 == Business model == There are typically three primary types of concierge medicine business models practiced today. Variations of these models exist, although most models usually fall into one of the following categories. The Fee for Care (‘FFC’) is an annual retainer model, where the patient pays a monthly, quarterly, or annual retainer fee to the physician. The retainer fee covers most services provided by the physician in his/her office. Often, vaccinations, lab work, x-rays and other services are excluded and charged for separately on a cash basis. The Fee for Extra Care (‘FFEC’) is similar to the FFC model, however, the additional services are charged to Medicare or the patient’s insurance plan. Some of the benefits and services typically included in these two retainer models are: same day access to your doctor; immediate cell phone and text messaging to your doctor; unlimited office visits with no co-pay; little or no waiting time in the office; focus on preventive care; unhurried atmosphere; cell phone, text message, and online consultations; prescription refills; and convenient appointment scheduling. Many FFC or Retainer plans may be purchased with pre-tax dollars utilizing HSA and/or FSA accounts attached to patients' insurance plans. There is also a Hybrid concierge model where physicians charge a monthly, quarterly, or annual retainer or membership fee for services that Medicare and insurers do not cover. These services may include: email access; phone consultations; newsletters; annual physicals; prolonged visits; and comprehensive wellness and evaluations plans. For all covered services, these providers will bill Medicare and insurance companies for patient visits and services covered by the plans. .〔("Business Models Used In CONCIERGE MEDICINE" Concierge Medicine Today, 2011 )〕 This model allows the physician to continue to see their non-retainer patients while providing their "concierge" patients a fee for the increased or "special" services. Some concierge practices are cash-only or ‘direct’ primary care practices and do not accept insurance of any kind. In doing so, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients.〔("Cash-Only Healthcare Still Works" Physicians Practice journal, July 2008 )〕 Concierge physicians care for fewer patients than those in a conventional practice, ranging from 50 patients per doctor to 1,000, compared to 3,000 to 4,000 patients that the average traditional physician now sees every year.〔("On Panel Size" Physicians Practice journal, June 2005 )〕 All generally claim to be accessible via telephone or email at any time of day or night or offer some other service above and beyond the customary care. The annual fees vary widely, ranging, on average, from US$195 to US$5,000 per year for an individual with incremental savings when additional family members are added. The higher priced plans generally include most "covered" services where the client is not charged additional fees for most services (labs, xrays, etc.). Some of the other benefits of concierge healthcare are: in-home visits, worldwide access to doctors and expedited emergency room care. An informal one-year summary of findings related to the concierge medicine marketplace in the US was released in February 2010.〔(askthecollective.com )〕 The summary of the study concluded that at the end of 2009, over 66% of current U.S. concierge physicians operating practices were internal medicine specialists; and the second most popular medical specialty in concierge medicine was family practice. The study also noted that the number of concierge dental and pediatric practices increased markedly since February 2009. In 2004, the Government Accountability Office counted 146 such practices, mostly concentrated on the US east and west coasts with practices such as MDVIP, 1 on 1 MD, and Signature MD being among the oldest. The American Medical Association does not track the number of concierge practices because the concept is so new.〔"Boutique Medicine: When wealth buys health", CNN.com, October 19, 2006.〕 Lower-cost concierge medical business models have also been attempted, such as GreenField Health in Portland, Oregon, which charged an annual fee between $195-$695 depending on age. Another is One Medical Group, the first major low-cost concierge medical group to attempt this model in a large scale, which requests a $199 annual membership fee.〔"Concierge Medical Care With a Smaller Price Tag",NYTimes,January 31, 2011.〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Concierge medicine」の詳細全文を読む スポンサード リンク
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