By David Jesse
Detroit Free Press, March 9, 2018
Michigan Medicine — the health system owned by the University of Michigan — is drawing fire from its own staff over a plan to offer personalized service, reduced waiting times and preferential access to physicians for a hefty yearly fee.
The plan, part of the growing nationwide movement known as concierge care, is drawing protests from U-M doctors who are concerned it strays from the institution’s public mission. The program is currently enrolling patients.
“Victors Care purports to offer ‘better’ health care to those with enough money to pay a large access fee,” says a letter sent to the health system’s administration by 200 doctors and staff. “The University of Michigan is a public institution and our commitment is to serve the public, not a private few. We do not feel this is the role of a state university and are unable to justify this to the patients and families we serve.”
The program works like this, according to the Victors Care website: People interested in the program pay a yearly fee — $2,700 now, going up to $3,600 after July 1. In exchange, the program promises shorter waits in waiting rooms, more face time with doctors, 24-hour access to a doctor via e-mail and the doctor’s cell phone number, and “assistance” with scheduling tests and other specialty appointments.
“We urge Michigan Medicine leadership to focus on increasing access for all of our patients,” the letter from the Michigan Medicine staff says. “We need greater efforts to improve infrastructure, space, and clinic support for all. We are eager to promote and strengthen primary care services at the University of Michigan, but we feel strongly this should be done for all patients, not based on their ability to pay.”
Susan Goold, professor of internal medicine and health management and policy, said she believes there are ethical questions that must be addressed.
“Does this make it harder for people who don’t pay for Victors Care to see their doctor or get in to get a test they need done?” she told the Free Press. “That’s an issue of fairness for a public university. It’s not just because it’s supported by public dollars, but our mission — we serve the public.”
By Don McCanne, M.D.
Should wealthy patients have a right to buy their way to the front of a queue?
Or instead should we ask if we’ve optimized our health care resources to ensure appropriate capacity and queue management to prevent excessive queues for everyone? Rather than devoting resources to cater to the wealthy by allowing them to bypass problems in the system, wouldn’t it be better to use our resources to resolve those problems and improve the system for everyone?
The wealthy have a much greater political voice than the rest of us. If the health care system treats the wealthy the same as the rest of us, then if the system is not performing well they would be motivated to advocate for reform. If the system performs well for them but worse for everyone else, they may not be sensitive to the issues and thus not as motivated to advocate for improvement.
Then there is the matter of fairness. At the DMV, or at the post office, or at the checkout line of the supermarket, usually there is some effort to manage the queues (DMV appointments, quick check line, etc.), but we would still be offended if the wealthy were moved into the front of the line. In health care, which should be a fundamental right for all, we should be even more sensitive about queue jumping.
There is debate as to whether Americans are less egalitarian than citizens of other nations, but, regardless, we still do have some sense of fairness. Except for medical problems of great urgency, queue jumping is never fair, and we should not institutionalize it.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.