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Answering the Critics: Cost, Outcomes and Equity in Concierge Medicine
The most-cited research on concierge medicine is unflattering. This brief lays it out fairly, separates what it shows from what it cannot show, and names what the field still needs to prove.
Updated October 2026: evidence grades replaced with evidence types; funding disclosed on every source.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
The strongest independent study found that patients affected by a switch to concierge medicine had large spending increases and no average change in mortality, and that selection into concierge care tracked income more than health. Industry-funded studies report fewer hospitalizations, but their designs cannot rule out selection. Both sides have limits. The honest position for the field is not denial but measurement: publish outcomes, track what happens to patients who do not join, and own the equity question.
“Don't run from the critics. Read them. The physician who can say, 'Here's what the research found, and here's what we're doing about it,' wins the trust argument every time. Defensiveness is just a slower way to lose.”
What does the most-cited critical study actually say?
A 2023 Journal of Health Economics study found large spending increases and no average mortality effect for patients affected by a physician's switch to concierge medicine, and stronger selection by income than by health.
Go to the full answer ↓Is that study the final word?
No. It is careful and independent, but it measured spending and mortality, not quality of life, continuity or patient experience, and it studied one data setting. It deserves engagement, not dismissal.
Go to the full answer ↓Doesn't other research show concierge care reduces hospitalizations?
Yes, two peer-reviewed studies in the American Journal of Managed Care did. Both are observational and both have MDVIP ties: one was commissioned by MDVIP, and the other's authors were MDVIP-employed or affiliated. They are evidence, with funding disclosed, not proof.
Go to the full answer ↓Is the equity criticism fair?
Partly. The data do show concierge patients are wealthier and practices serve fewer Medicaid and minority patients. The AMA's ethics guidance asks physicians to manage that tension, not ignore it.
Go to the full answer ↓What should the field do about it?
Measure and publish. Outcomes data, transition support for patients who don't join, and open methodology would do more for credibility than any marketing campaign.
Go to the full answer ↓What the critics found
Any field that wants to be taken seriously has to state its critics' best case before answering it. Here it is.
In 2023, economists Adam Leive (UC Berkeley), Guy David and Molly Candon (University of Pennsylvania) published "On resource allocation in health care: the case of concierge medicine" in the Journal of Health Economics. Using the staggered timing of physicians' switches and a matching strategy, they reported "limited evidence of selection based on health and stronger evidence of selection based on income," and "large spending increases and no average mortality effects for patients impacted by the switch to concierge medicine."1 Population Data
Penn's Leonard Davis Institute summarized the details: one year after the switch, enrollees' total health spending was more than 25% higher than a comparison group, with both inpatient and outpatient spending rising. Enrollees were slightly older, had fewer chronic conditions, were more likely to be white, and lived in higher-income neighborhoods.2
The argument has entered mainstream coverage. KFF Health News quoted Leive: concierge medicine "potentially leads to disproportionately richer people being able to pay for the scarce resource of physician time and crowding out people who have lower incomes and are sicker." The same article noted that "there's little reliable data available on the size of the concierge medicine market."3 Becker's reported the critique alongside a market estimate attributed to Concierge Medicine Today.4
When a trade publication's own estimates appear next to critical research, the publication has two choices: ignore the research or engage it. CMT chooses engagement. Credibility is earned by being the place where physicians read the hard evidence first.
What the study shows, and what it cannot show
The JHE study is independent, peer-reviewed and methodologically serious. It should be cited accurately, including its limits. The limits below are CMT's reading of its design, not claims the authors made.
| Question | What the study supports | What it does not settle |
|---|---|---|
| Does concierge care cost the system more? | Yes, for the patients and setting studied: spending rose substantially after the switch.1 | Whether higher spending reflects better-matched care (for example, catching problems earlier) or overuse. Spending is not the same as waste. |
| Does it save lives? | No average mortality effect was detected.1 | Effects on outcomes that rarely cause death in the short term: function, quality of life, continuity, patient experience. |
| Who joins? | Selection is stronger on income than health.1 | Whether the pattern differs across today's wider range of fees, models and hospital programs. |
| Is it generalizable? | It is one well-designed study in one data setting. | Practices with very different fee levels, panel sizes or service models. |
"No mortality effect" is not the same as "no benefit." But "we feel the benefit" is not the same as evidence, either.
The counter-evidence, labeled honestly
The most-cited favorable studies came from MDVIP, the largest national concierge network: one was commissioned by MDVIP, and the other was written by MDVIP-affiliated authors. Both are peer-reviewed observational studies, so they carry the same evidence type as independent work. Industry ties do not make a study wrong. They do mean readers should weigh the design carefully.
Hospital admission rates for MDVIP members were 42% to 62% lower than non-members in five states (2006 to 2010). Authors employed by or affiliated with MDVIP; no external funding reported; observational; the authors acknowledged members may differ in health attitudes and baseline status.5
Among 30,727 Medicare beneficiaries with diabetes, unplanned admissions were about 10% lower and ED visits slightly lower, using propensity matching and difference-in-differences. No significant overall spending change in years one to four. Commissioned by MDVIP; one author is its chief medical officer.6
Independent. Large spending increases and no average mortality effect for affected patients.1
Notice that the 2020 diabetes study, the more rigorous of the two favorable papers, did not find overall savings for most of its follow-up period. Read side by side, the evidence suggests concierge care may change how patients use the hospital without clearly reducing what the system spends.
No independent, peer-reviewed, prospective study of concierge outcomes that CMT could identify measures continuity, patient-reported outcomes and total cost together. Until one exists, both advocates and critics are arguing from partial evidence.
The equity question deserves a direct answer
The equity concern is older than the JHE study. A 2005 national survey in the Journal of General Internal Medicine found retainer practices cared for about 898 patients per physician vs. 2,303 in traditional practice, with smaller shares of Black patients (7% vs. 16%), Hispanic patients (4% vs. 14%) and Medicaid patients (5% vs. 15%). It also found that 84% of retainer physicians reported providing charity care.7 Practice Insight
The system context has tightened since. Membership medicine practices, concierge and DPC combined, grew about 83% from 2018 to 2023, and Health Affairs authors raised the question of what that growth means for patients who remain in traditional primary care.8,
What the AMA asks of retainer physicians
- Present terms clearly; don't imply better medicine for a fee
- Keep participation voluntary
- Facilitate transfer of care for patients who decline
- Keep the commitment to care for those in need regardless of ability to pay
AMA Code of Medical Ethics Opinion 11.2.511
What practices can do
- Run a structured transition program for non-joining patients (see Brief No. 32)
- Offer scholarship or sliding-fee memberships and report how many
- Partner with local safety-net clinics
- Publish who your members are, by age and condition
The answer is measurement, not marketing
From first principles, the purpose of primary care is better health over a lifetime at a cost a society can bear. Concierge medicine will be judged against that purpose. Satisfaction scores and testimonials won't settle it. Data will.
Who membership patients are: what the data show
No national dataset describes concierge members directly. Three sources each show part of the picture.
The Health Affairs authors also describe Medicare participation among these practices as “non-trivial,” which suggests many are hybrids rather than cash-only practices.13 The ownership and clinician figures combine two different models, so they describe membership medicine broadly, not concierge alone. Read with the Leive findings above, the concierge picture is a patient base that is somewhat older and higher-income than average, but not uniform, and a meaningful share that still values insurance compatibility. CMT's Patient Study respondents were self-selected, so its segments describe engaged patients, not all patients.12
“Much of the criticism around concierge medicine focuses on ‘access,’ but that framing misses the bigger issue.” “Burnout, early retirement, and reduced clinical hours have quietly rationed care for years. Membership-based models didn't create those pressures; they emerged as a compliant, rational, thoughtful and transparent response to them.” “Concierge medicine isn't exacerbating the physician shortage,” he argues; “it's revealing it.” (Michael Tetreault, Editor-in-Chief.14) On affordability, one longtime concierge physician told CMT: “Every innovation starts in a focused setting before it becomes accessible.”14 These are CMT's views, offered alongside the critics' evidence, not as a rebuttal of it.
No source CMT could verify reports the share of practices offering scholarship or reduced-fee memberships, or member income and chronic-condition data compared with national norms. Practices that track these can help close the gap the critics point to.
Measure outcomes
Track a short list: ED visits, hospital admissions, preventive screening rates and patient-reported health, before and after membership.
Publish the method
Share how numbers are counted and who funded the analysis. Transparency is the credibility advantage.
Own the equity work
Document transition support and charity care. Answer the critique with what you do, not what you believe.
Read the critics
Cite the JHE study accurately, including what it can't show.
Collect your data
Build outcomes and demographic tracking into your EHR and annual review.
Lead with candor
In interviews and marketing, acknowledge the debate. Candor reads as confidence.
How this brief was built
CMT identified peer-reviewed studies of concierge or retainer-based primary care outcomes, cost and equity, plus major federal and professional reports, published from 2005 through September 2026. Studies were classified by funding source and design. Where CMT relied on a summary rather than the full text (for example, the Penn LDI summary of the Journal of Health Economics study), the reference says so. Direct primary care evidence is excluded except where a study combined the two models. Patient segment figures come from the CMT Patient Study (self-selected respondents), and ownership and clinician-mix figures from Health Affairs, summarized by MGMA and Johns Hopkins.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- Whether concierge care improves outcomes that matter to patients but are rarely measured: continuity, time to diagnosis, functional status, end-of-life care quality.
- What happens, in health terms, to patients who do not join when their physician converts. No large study has followed them.
- Whether results differ between national networks, independent practices and hospital-owned programs.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Leive A, David G, Candon M. On resource allocation in health care: the case of concierge medicine. Journal of Health Economics. 2023;90:102776. doi:10.1016/j.jhealeco.2023.102776. ideas.repec.orgFunding: not stated
- Hinckley J. Concierge medicine drives higher health costs without extending lives. Penn Leonard Davis Institute of Health Economics. September 18, 2023. ldi.upenn.eduFunding: not stated (research summary by Penn LDI)
- Rossheim J. The concierge catch: better access for a few patients disrupts care for many. KFF Health News, republished by WUSF. July 2024. www.wusf.orgFunding: not stated (news report)
- Becker's Hospital Review. Research points to concerns amid growing concierge medicine trend. June 2024. www.beckershospitalreview.comFunding: not stated (news report)
- Klemes A, et al. Personalized preventive care leads to significant reductions in hospital utilization. American Journal of Managed Care. 2012;18(12). Authors employed by or affiliated with MDVIP. www.ajmc.comFunding: none reported; authors report employment with or affiliation to MDVIP
- Morefield B, Tomai L, Slanchev V, et al. Payer effects of personalized preventive care for patients with diabetes. American Journal of Managed Care. 2020;26(3). Study commissioned by MDVIP; one author is MDVIP's chief medical officer. www.ajmc.comFunding: industry (MDVIP; authors were commissioned by MDVIP to evaluate)
- Alexander GC, Kurlander J, Wynia MK. Physicians in retainer ("concierge") practice: a national survey of physician, patient, and practice characteristics. Journal of General Internal Medicine. 2005;20(12):1079-1083. pure.johnshopkins.eduFunding: mixed: professional society (AMA Institute for Ethics), foundation (Robert Wood Johnson Clinical Scholars Program) and academic (MacLean Center for Clinical Medical Ethics)
- Zhu JM, Marsh T, Huntington A, Polsky D, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Affairs. December 2025. doi:10.1377/hlthaff.2025.00656. www.healthaffairs.orgFunding: mixed: federal (Agency for Healthcare Research and Quality, R01HS029467) and foundation (Commonwealth Fund; NIHCM Foundation)
- Johns Hopkins Carey Business School. Fee-based primary care is rapidly rising in U.S., hastening doctor shortages for the public. December 2025. carey.jhu.eduFunding: not stated (university news release)
- Milbank Memorial Fund and Robert Graham Center. The Health of US Primary Care: 2025 Scorecard Report. Summary via AAFP, March 20, 2025. www.aafp.orgFunding: foundation (Milbank Memorial Fund; The Physicians Foundation)
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- Concierge Medicine Today, LLC. CMT Patient Study: patient segmentation by satisfaction with current doctor and importance of insurance or Medicare compatibility (561 patients answering all four rating questions, 2018 to 2024). CMT Research Brief No. 9. Self-selected respondents. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
- Harrop C. Snapshot: reactions and responses to the growth in concierge and direct primary care (summary of Zhu et al., Health Affairs). MGMA. December 30, 2025. www.mgma.comFunding: not stated (MGMA summary; the underlying Health Affairs study was funded by AHRQ, the Commonwealth Fund and the NIHCM Foundation)
- Concierge Medicine Today. Media Desk: quotes from the Editor-in-Chief, FAQs and data. Accessed October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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