Retainer-based medicine is growing increasingly in the United States and in some jurisdictions constitutes at least 10%of medical care services.It is to be distinguished from primary care medicine in that it involves ...Retainer-based medicine is growing increasingly in the United States and in some jurisdictions constitutes at least 10%of medical care services.It is to be distinguished from primary care medicine in that it involves the regular payment of a retainer fee that allows the patient privileged and expedited access to providers and is associated with a decreased patient burden for the primary care providers who participate in such an arrangement.Purpose:To assess the current ethical issues associated with retainer-based care.A literature review over the 22-year interval since the concept was first identified assessing in particular the extent to which distributive ethics are impacted by retainer-based care.Estimates on the ultimate impact of the availability and distribution of primary care are also considered based on available demographic data.The impact of retainer-based care on distributive ethics are analyzed by relationship to utilitarianism,egalitarianism,libertarianism,and communitarianism.Retainer-based care while ubiquitous and in some fashion longstanding,is occurring increasing especially in the USA and annually its prevalence there is increasing to about 10%of all primary care.This has a major impact on the overall availability of access to primary care physicians.The ethical issues attendant with this do not affect autonomy or malfeasance so much as they do impact distributive ethics.The increases in retainer-based care in the US has spurred ethical studies.Retainer-based care does not affect libertarianism but has a profound impact on the other three aspects of distributive ethics:The exact demographic impact on primary care is difficult to estimate but If retainer-based medicine continues to grow in frequency,it will result in the continued shortage of care for communities with impaired access to primary care physicians,in particular those with indigent individuals.Additional ethical studies are needed to assess the impact of retainer-based medicine on society.展开更多
文摘Retainer-based medicine is growing increasingly in the United States and in some jurisdictions constitutes at least 10%of medical care services.It is to be distinguished from primary care medicine in that it involves the regular payment of a retainer fee that allows the patient privileged and expedited access to providers and is associated with a decreased patient burden for the primary care providers who participate in such an arrangement.Purpose:To assess the current ethical issues associated with retainer-based care.A literature review over the 22-year interval since the concept was first identified assessing in particular the extent to which distributive ethics are impacted by retainer-based care.Estimates on the ultimate impact of the availability and distribution of primary care are also considered based on available demographic data.The impact of retainer-based care on distributive ethics are analyzed by relationship to utilitarianism,egalitarianism,libertarianism,and communitarianism.Retainer-based care while ubiquitous and in some fashion longstanding,is occurring increasing especially in the USA and annually its prevalence there is increasing to about 10%of all primary care.This has a major impact on the overall availability of access to primary care physicians.The ethical issues attendant with this do not affect autonomy or malfeasance so much as they do impact distributive ethics.The increases in retainer-based care in the US has spurred ethical studies.Retainer-based care does not affect libertarianism but has a profound impact on the other three aspects of distributive ethics:The exact demographic impact on primary care is difficult to estimate but If retainer-based medicine continues to grow in frequency,it will result in the continued shortage of care for communities with impaired access to primary care physicians,in particular those with indigent individuals.Additional ethical studies are needed to assess the impact of retainer-based medicine on society.
