A Boutique Hospital? - Boutique or concierge medical practices have received quite a bit of criticism for limiting access to healthcare in a time when the number of uninsured is on the upswing. This article
in the New York Times recaps the familiar debate. There is no doubt that boutique practices create a two-tiered system, where the "haves" get special service and the "have nots" don't, but there is something rational about this rebellion from the norm. When it comes to our health, people would naturally want special attention. Kaiser Permanente hit the nail on the head with their TV commercial featuring a man being followed around by a team of physicians. Surely, many physicians would want to practice this way as well - lighter case loads, deeper relationships, a more thorough understanding of the etiology of their patient's conditions, better service. In fact, it is an artifact, however necessary, of the current healthcare system that "boutique" isn't the standard of care. The economics of our current financing system simply don't allow physicians to provide this level of service (though I am sure that they would argue that they are providing at least adequate care outside the boutique model). In the end, it is a matter of degree and supply. There are probably not enough physicians to provide this level of service to everyone.
So could there ever be a boutique hospital? And what would it look like? Certainly, we could envision a hospital with a higher level of service. The concierges would welcome you to the hospital, orient you to its amenities, and walk you to your room, where you would be met by your personal nurse, who would take the time to discuss your stay and schedule your facial in between your MRI and physical therapy. There are, no doubt, individuals that could pay for such hotel-like services in a hospital, but, as one might guess, this is not a model that would work for the larger healthcare system. Whereas physicians are more of a personal resource, something that people consume individually, hospitals are by nature a community resource, something that is shared. As with all other shared resources, hospitals must operate in a way that is not cost-prohibitive for its users.
So there probably aren't boutique hospitals on the horizon. While hospitals can provide great service, the economics of the current system simply don't allow for highly individualized hospital services, like personal nurses. Nevertheless, we can imagine what boutique hospital care would look like, and as we raise the bar for quality and customer service, we will be brining that vision to everyone.