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Marzouka, MD: Balancing Sustainability and Access to Care in Concierge Medicine

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HSRM Study | The “Access Assured” model and the “Academic Retainer Practice” (or ARP) model at Tufts University in Boston, Massachusetts. Physicians split their time …Read More …

MARZOUKA, MD: Balancing Sustainability and Access to Care in Concierge Medicine

the_doctors_guide_t_cover_for_kindlejpgIn a 2017 evidence review published in Health Services Research Management, Rocco Palumbo, PhD, from the University of Salerno, Italy, argues that the concierge practice could improve access to care by “cross-subsidizing” underserved patients’ access to primary care services.2 The study he cites, however, did not have a typical concierge model. Rather, the Access Assured model used in the study referred patients, who were uninsured and unwilling to pay the monthly membership fee (which was priced according to a sliding scale fee schedule), to safety net practices.3 This was not a test of a typical concierge model but, rather, a test of a sliding scale fee schedule aimed at improving access for uninsured patients by subsidizing lower-income patients with membership payments by higher-income patients without health insurance. Patients with insurance in this pilot program are not charged a membership fee or retainer fee for continued access, and uninsured patients who paid the membership fee had to pay out of pocket for medicines, labs, and imaging tests.3 Although this pilot program improved access, it is not clear how that access improved outcomes for uninsured patients.




  1. Paul DP, Skiba M. Concierge medicine: a viable business model for (some) physicians of the future? Health Care Manag. 2016;35(1):3-8.
  2. Palumbo R. Keeping the candles lit: the role of concierge medicine in the future of primary care. Health Serv Manag Res. 2017;30(2):121-128.
  3. Saultz JW, Brown D, Stenberg S, et al. Access assured: a pilot program to finance primary care for uninsured patients using a monthly enrollment fee. J Am Board Fam Med. 2010;23(3):393-401.
  4. Lucier DJ, Frisch NB, Cohen BJ, Wagner M, Salem D, Fairchild DG. Academic retainer medicine: an innovative business model for sross-subsidizing primary care. Acad Med. 2010;85(6):959-964.
  5. Klemes A, Seligmann RE, Allen L, Kubica MA, Warth K, Kaminetsky B. Personalized preventive care leads to significant reductions in hospital utilization. Am J Manag Care. 2012;18(12):e453-460.
  6. Musich S, Klemes A, Kubica MA, Wang S, Hawkins K. Personalized preventive care reduces healthcare expenditures among Medicare Advantage beneficiaries. Am J Manag Care. 2014;20(8):613-620.

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