A recent study published in Health Affairs documents a rapid expansion of concierge and direct primary care (DPC) across the United States. These fee-based models charge patients annual or monthly membership fees for more personalised primary care; concierge practices typically continue to bill health insurance for visits while DPC usually operates outside the insurance system.
Researchers from Johns Hopkins Carey Business School, the Johns Hopkins Bloomberg School of Public Health, Oregon Health & Science University, and Harvard Medical School analysed a national sample of more than 6,000 concierge and DPC models over 2018–2023. The number of practice sites rose from 1,658 in 2018 to 3,036 in 2023, an increase of 83.1%. Clinicians in these settings grew from 3,935 to 7,021, a rise of 78.4%.
The study reports several reasons clinicians choose these models and warns about ownership changes. Corporate-affiliated practices grew by 576% during the period, and researchers caution that corporate investment could alter the individualised nature of care by operating at scale, changing billing practices, or modifying membership fees. They say policymakers should monitor these trends to help ensure broad access to high-quality primary care.
- Smaller patient panels,
- Less administrative burden,
- Greater professional autonomy (reduced burnout)
Difficult words
- concierge — practices that charge members for extra care
- direct primary care — primary care that operates outside insurance
- membership fee — regular payments patients give to a practicemembership fees
- operate — to run or function in a systemoperates
- corporate investment — money from companies invested in medical practices
- billing practice — methods used to charge and submit paymentbilling practices
- patient panel — the group of patients a clinician cares forpatient panels
- administrative burden — amount of paperwork and management tasks
- policymaker — people who make or guide public rulespolicymakers
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- How might corporate ownership change the patient experience in concierge or DPC practices? Give reasons from the article.
- Do you think membership fees for primary care improve access to care or create barriers? Explain with examples.
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