TICKET SCALPING
DOCTOR APPOINTMENTS
Queuing for pay is not only an American phenomenon. In China the line-standing business has become routine at top Beijing hospitals. The market reforms of the last two decades have resulted in funding cuts for public hospitals and clinics, especially in rural areas. So patients from the countryside now journey to the major public hospitals in the capital, creating long lines in registration halls. They queue up overnight, sometimes for days, to get an appointment ticket to see a doctor.
The appointment tickets are a bargain --- only 14 yuan (about $2). But it isn't easy to get one. Rather than cam out for days and nights in the queue, some patients, desperate for an appointment, buy tickets from scalpers. The scalpers make a business of the yawning gap between supply and demand. They hire people to line up for appointment tickets and then resell the tickets for hundreds of dollars --- more than a typical peasant makes in a months. Appointments to see leading specialists are especially prized --- and hawked by the scalpers as if they were box seats for the World Series. The Los Angeles Times described the ticket-scalping scene outside the registration hall of a Beijing hospital : "Dr. Tang. Dr. Tang. Who wants a ticket for Dr. Tang ? Rheumatology and immunology."
There is something distasteful about scalping tickets to see a doctor. For one thing, the system rewards unsavory middlemen rather than those who provide the care. Dr. Tang could well ask why, if a rheumatology appointment is worth $100, most of the money should go to scalpers rather than to him, or his hospital. Economists might agree and advise hospitals to raise their prices. In fact, some Beijing hospitals have added special ticket windows, where the appointments are more expensive and the lines much shorter. This high-priced ticket window is the hospital's version of the no-wait premium pass at amusement parks or the fast-track lane at the airport --- a chance to pay to jump the queue.
But regardless of who cashes in on the excess demand, the scalpers or the hospital , the fast track to the rheumatologist raises a more basic question : Should patients be able to jump the queue for medical care simply because they can afford to ay extra ?
The scalpers and special ticket windows at Beijing hospitals raise this question vividly. But the same question can be asked of a subtler form of queue jumping increasingly practiced in the U.S. ---the rise of "concierge" doctors.
CONCIERGE DOCTORS
Although U.S. hospitals are not thronged with scalpers, medical care often involves a lot of waiting. Doctor appointments have to be scheduled weeks, sometimes months, in advance. When you show up for the appointment, you may have to cool your heels in the waiting room, only to spend a hurried ten or fifteen minutes with the doctor. The reason : Insurance companies don't pay primary care physicians much for routine appointments. So to make a decent living, physicians in general practice have rosters of three thousand patients or more, and often rush through twenty-five to thirty appointments per day.
Many patients and doctors are frustrated with this system, which leaves little time for doctors to get to know their patients or to answer their questions. So a growing number of physicians now offer a more attentive form of care known as "concierge medicine." Like the concierge at a five-star hotel, the concierge physician is at your service around the clock. For annual fees ranging from $1,500 to $25,000, patients are assured of same-day appointments, no waiting, leisurely consultations, and twenty-four-hour access to the doctor by email and cell phone. And if you need to see a top specialist, your concierge doctor will pave the way.
To provide this attentive service, concierge physicians sharply reduce the number of patients they care for. Physicians who decide to convert their practice into a concierge service send a letter to their existing patients offering a choice : sign up for the new, no-wait service for an annual retainer fee, or find another doctor.
One of the first concierge practices, and one of the priciest, is "MD-squared, " founded in 1996 in Seattle. For a fee of $15,000 per year for an individual { $25,000 for a family } , the company promises "absolute, unlimited and exclusive access to your personal physician." Each doctor serves only fifty families. As the company explains on its website, the "availability and level of service we provide absolutely necessitates that we limit our practice to a select few." An article in Town and Country magazine reports that the "MD-squared" waiting room "looks more like the lobby of a Ritz-Carlton than a doctor's office." But few patients even go there. Most are "CEOs and business owners who don't want to lose an hour out of their day to go to the doctor's office and prefer instead to receive care in the privacy of their home or office. "
Other concierge practices cater to the upper middle class. MDVIP, a for-profit concierge chain based in Florida, offers same-day appointments and prompt service (answering your call by the second ring) for $1,500 to $1,800 per year, and accepts insurance payments for standard medical procedures. Participating physicians cut their patient rolls to six hundred, enabling them to spend more time with each patient. The company assures the patients that "waiting will not be a part of their health care experience." According to The New York Times, an MDVIP practice in Boca Raton sets out fruit salad and sponge cake in the waiting room. But since there is little if any waiting, the food often goes untouched.
For concierge doctors and their paying customers, concierge care is everything medicine should be. Doctors can see eight to twelve patients a day, rather than thirty, and still come out ahead financially. Physicians affiliated with MDVIP keep two-thirds of the annual fee (one-third goes to the company), which means a practice with six hundred patients makes $600,000 per year in retainer fees alone, not counting reimbursements from insurance companies. For patients who can afford it, unhurried appointments and round-the-clock access to a doctor are luxuries worth paying for.
The drawback, of course, is that concierge care for a few depends on shunting everyone else onto the crowded rolls of other doctors. It therefore invites the same objection leveled against all fast-track schemes : that its unfair to those left languishing in the slow lane.
Concierge medicine differs, to be sure, from the special ticket windows and the appointment-scalping system in Beijing. Those who can't afford a concierge doc can generally find decent health care elsewhere, while those who can't afford a scalper in Beijing are consigned to days and nights of waiting.
But the two systems have this in common : each enables the affluent to jump the queue for medical care. The queue jumping is more brazen in Beijing than in Boca Raton. There seems a world of difference between the clamor of the crowded registration hall and the calm of the waiting room with uneaten sponge cake. But that's only because, by the time the concierge patient arrives for his or her appointment, the culling of the queue has already taken place, out of view, by the imposition of the fee.
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