From Hippocratic oath to Corporate Medicine and back!
Originally published by Being well on Medium
The concept of Concierge Medicine, retainer medicine (also referred to as Direct Primary care), characterizes a liaison between a patient and a physician in which the patient disburses an annual fee or retainer. Within the retailer agreement's membership, doctors generally provide medical care to patients by providing 24/7 admission. They provide access to a cell phone number to communicate with their medical doctor directly, grant same-day appointments and visits that last as long as necessary to address their needs varying other amenities. The Concierge Doctor collects a fee generally averaging $125 — $220 per month in exchange for convenient access to the physician and personal attention.
The surge in concierge medical practice is not without reason. It is primarily the upshot of increased patient expectations, physician burnout, and the prevailing healthcare system's failure to satisfy the healthcare community's expectations with patients at its core center.
Over the past couple of centuries, the practice of medicine and healthcare delivery has transitioned from being a personal experience to a collective mission, corporate treatment and now facing a comeback once again as a personalized medical practice. That is what we observe today with the emergence of concierge medicine.
The concierge medical Practice is the reaction to overwhelming medical practice challenges. To understand why and how, we must first look into the chronological evolution of medical practice as a whole.
What is Personalized Healthcare?
Personalized healthcare stands for a comprehensive phrase about delivering medical service between a patient and a clinician. It merely pertains to individual experience when an individual's understanding is the core driver of the medical care rendered. That is something not explicitly encountered today by the patients. Even though expected by patients and physicians, it is not fulfilled by the current system. Today, a personal opinion of the quality and value of service and commodity doesn't confer individual need. Instead, it follows an artificially generated factor on people's profile as a group, I.e., Population health with bureaucratic influence.
Hippocratic Medicine is and was Personalized Medicine
Ever Since Hippocrates wrote the famous oath, medical students, after centuries, still swear upon graduation. However, ironically, only a handful of physicians practice Hippocratic oaths. That is not necessarily because they recuse to follow their declared mission but simply because the lexical practice model has transformed from medical care as a personal thing to population health as a collective phenomenon.
Concepts of personalized medicine and healthcare existed in Hippocratic medical practice, considering people's physical and behavioral differences and accounting for variability in treatment responses and disease prognosis.
Photo by Derek Finch on Unsplash
Personalized healthcare is compatible with the proper appreciation of the patient's individuality and liberties, which are reﬂected in the medical ethical principles, informed consent, and patient sovereignty, reﬂected throughout the Hippocratic writings.
The shift in Medical Practice since the Hippocrates era and the emergence of Population Health
The physician's practice, since the time of Ancient Greece, has become more expansive and subspecialized. But that is not the sole determinant of the shift away from personalized care as the one we currently witness.
The emergence of population health had an honest government's effect on medicine being practiced today. Individual choice is no longer relevant in quality of care, as it is replaced by collective criteria based on social measures and the financial strategy of 3rd-party payers on the other.
The history of population health dates back to the relationship between economic growth and human Health in Britain and France, when the industrial revolution disrupted the health delivery of the population and simulated launching epidemiological studies, announcing the first preventive public health movement. Later, the 20th-century welfare states stemmed as arduous political mechanisms for revamping economic expansion into enhanced population health. This surge of the "neoliberal" schema, emphasizing the title role of government, has newly brought to the fore the importance of preventative medicine and a population health strategy to map by revealing the health consequences of a new phase of "global" economic growth.
Population health emphasizes the Health of a group of individuals by encompassing the medical treatment or prevention outcomes within that group.
The nineteenth century marked a significant advance in public Health that started the population health march. That coincided with Winslow's great sanitary awakening, 1923, and the recognition of filth as both a cause of disease and an agency of transmission. They determined then that the embrace of cleanliness was a central element of 19th-century social reforms. Therefore, Sanitation transformed the publics' view of Health. The illness became an indicator of insufficient social and environmental provisions and inadequate poor moral and spiritual conditions.
For the same reason, in the early 20th century, the state and local public health departments' roles expanded considerably. After that, as public agencies moved into clinical care and pedagogy, public health's bearings stirred from disease prevention, infectious origin, in particular, to promote "overall health." Epidemiology contributed a scientific justification for health programs that had dawned with social reforms. Then, public health became a task of promoting a healthy society.
Mid-20th-Century further marked the further expansion of the governmental role in personal Health. Between the 1930s and the 1970s, local, state, and federal engagements in Health further stretched, and the federal role in Health also became exceedingly noticeable.
The birth of population medicine based on epidemiologic science was an unusual move for the prevalent infectious disease and public safety. However, the rise of population health and uptake by the administrative bureaucracy instrument uttered Hippocratic personalized medicine and healthcare irrelevant. After that, progressively, the individual's choice in health outcome became solely relevant within the collective burden of proof of the society within which that individual lived or to a profile of a group they related. Hence, Individual factors of Health and disease were replaced by social factors. For example, if a treatment is appropriate for most individuals within a group, then that is the standard, and the minority must unconditionally follow such therapy, only with minor exceptions.
Evolution of the Insurance Industry and the rise of Corporate Medicine
The advent of the population-driven medical practice served as another instrument for an advanced class of despotism, that is, the "insurance industry." Because of the 20th-century population health and bureaucracy, welfare-statism offered a perfect milieu for the business industry to make the big buck, thus the "social determinants of health and disease."
By segregating individuals based on their social profile, the insurance industry would have ample leeway to meddle data to strategize maximum return. That is something that genuinely personalized healthcare does not offer to the Health insurance industry.
Health insurance in the United States comprises any schedule that encourages medical reimbursements through privately acquired insurance and social security. One may obtain even it through the social welfare program funded by the government. It is also referred to as "health coverage," "health care coverage," and "health benefits." Before developing medical expense insurance, patients paid all healthcare costs out of their sacs; it is referred to as the fee-for-service business model in the modern sense.
It was not until the late 20th century when traditional disability insurance (the original form of insurance by any means) evolved into current health insurance programs. Even then, health care insurance primarily covered acute medical care and hospital expenses. But over time, most comprehensive private health insurance programs started covering the cost for routine, preventive, and most prescription drugs. The rise of private insurance was also followed by the creeping expansion of municipal insurance programs for individuals unable to get coverage through the market.
On the one hand, the perpetual expansion of the for-profit industry, their involvement in government affairs through a lobbying system, on the other, made the healthcare space one of the most monopolized markets in human history. Henceforth, population health as the instrument gave rise to what we call today the concept of "corporate medicine."
Despite miss conception, it is noteworthy that personalized medicine, service fee, or modern terms, Concierge Medicine is not equal to corporate treatment. That is simply because concierge medicine is a decentralized small practice model that provides an intimate environment for patients to relate with their doctor closely. In contrast to the more centralized, bureaucratic, highly structured system where the individuals are synonymous with numbers, doctors are called "providers," and strategies are defined around fiscal success rather than patient satisfaction.
Today's populace has lost its concept of healthcare. That is mere to the extent that the prevailing legislations utter the public healthcare coverage option that will need a government subsidy to establish cost control. As a result, over time will drive healthcare to the one hundred percent available opportunity as happened with home mortgage goliaths Fannie Mae and Freddie Mac. Nonetheless, the health insurance industries are not welfare companies. Like every other business, they will pivot their artifacts to maximize profit. The mainstream public, by predestination, holds a different mindset. The average person assumes that healthcare costs can only be paid for by the third-party substance, which often concerns the for-profit insurance industry. The latter attitude ultimately plays in favor of the insurance industry, just as we see today.
Patient Expectation and Population Health
Although population health offered the best of what it could throughout the 19th and 20th centuries, it is not keeping its promises to satisfy the 21st-century individual expectations. That is because amid ease of access to unlimited cyber data, the public, in general, is becoming more knowledgeable and acquiring expectations that 19th-century society did not have. The millennials' modern attitude has triggered notable discontent towards receiving medical care in today's corporate medical environment. With the dissatisfaction and sense of desire to take their healthcare into their own hands, the young generation is more inclined to try alternative modes of receiving medical care that is spacious, empathic, and affordable. But, population health, with all its legit intentions, seems to fail when offering what an individual wants versus what they need, given the collective circumstances.
By continuing to follow strict population health guidelines, we tend to affirm deception in our healthcare system. For part, we invent technologies that are unaffordable due to a healthcare market monopoly. We find cures we can't use for ourselves because we don't fit the pseudo-social determinants data-driven criteria by corporate cartels' hands. We set prices too high on healthcare by allowing market monopoly (and abolishing fair market competition) and political lobbyists, yet we complain that it is so expensive. We expect others to pay for our healthcare, and we create entitlement programs that only benefit the abusers of our system.
Once again, the millennials demand more, Convenient and Better. Someplace their trust in the government under the notion of Universal health coverage or government welfare programs in addition to looking for alternatives. But, unlike the common perception, universal healthcare coverage is a short-falling triumph. Universal care can't afford the population health scheme of offering, more so individualized healthcare. Since National Health or Universal coverage relies on population health criteria, the bureaucratic system neither offers personalized attention nor achieves millennials' expectations. The clash of the Younger generations' modern attitude with that of the traditional government-labored healthcare reimbursement system has created notable displeasure with how they are experiencing medical care. Such clash of supply and demand and the overwhelming pressure that public health administration has brought upon the medical community have led some physicians to contemplate something more constructive. That is returning to the Hippocratic medicine model, personalized medical care, or modern sense the Concierge medicine.
Concierge Medicine, a doorstep to Personalized Healthcare
Direct Primary Care, or as we call it here, the Concierge medicine model, is more than just reimbursement. It's a clue that physicians are springing to realize their value and educate their patients to do the same. The aforementioned is the most important and valuable aspect of this model. It is about putting the healthcare industry back where it belongs, in the hands of patients and themselves. Concierge medicine, under personalization, adapts to the patient's needs. Even if the patient sounds fatuous, the concierge physician has the flexibility to guide them the right way. For that, the whole culture of healthcare needs to reform, and any status that doesn't adapt will be left out. Physicians cannot afford to stay silent amid healthcare commoditization.
Concierge medicine and its philosophy are about the desire to go back to how it used to be when a doctor was more like family. It offers care based on a personal relationship, addressing every patient's unique demands, coupled with the best of contemporary medical knowledge and technology. It is personalized, hence standing for the modern equivalent of the original Hippocratic medicine. However, for personalization to happen, more physicians need to change their attitude, make informed and educated decisions, and provide all tools and resources to empower themselves, patients, and care delivery. Only then will physicians gain a competitive edge over the large corporations.