The movement toward concierge care has exploded in recent years.

Or is concierge care contributing to the growing gulf between the wealthy and everyone else?

As with all luxury items, consumers should purchase concierge care with their eyes wide open.

Some want the convenience and extra service found with concierge care, while others are satisfied with the traditional practice of medicine.

This is not the case in medical oncology; there is no "concierge care" in cancer.

Letters have gone out to tens of thousands of patients across the country in the past few years, solicitations from doctors shifting to concierge care.

All Americans could then shop for the health plan that best fits their needs and resources, from basic insurance with a deductible to premiere concierge care.

What's more, members receive personalized attention from a Concierge Care Coordinator who guides them through the entire surgical process.

The special services and pampering provided by doctors for the added fees is called various names: concierge care, boutique medicine, retainer practice or platinum practice.

With concierge care, patients can obtain same-day appointments, extended office consultations, more extensive evaluations, and often 24-hour direct phone and email access to their physicians.

But Jon Ellefson, the president of Concierge Care, said the first 30 residents of the Concierge were not from "superwealthy" families.

Senator Bill Nelson, Democrat of Florida, has tried - and failed - for years to ban Medicare payments to doctors who charge extra for concierge care.

When you spend tens of thousands of dollars to get into the Betty Ford Center and other posh in-patient drug addiction programs, you are getting concierge care.

"Concierge care is like a new country club for the rich," Representative Pete Stark, Democrat of California, said at a joint economic committee hearing in Congress last year.

He is the founder and a co-owner of Concierge Care Nursing Centers, which is based in Greenwood Village, Colo., and runs the Houston home.

In the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the Congress directed the GAO to study concierge care and its impact on Medicare patients.

Despite the attention being lavished on health reform, none of the proposals now in play is likely to change the way doctors are paid, which is the key to actual overhaul, according to Weil, the concierge care analyst.

The Society for Innovative Medical Practices recently reported that more than 5,000 primary care physicians have made similar choices, adopting a range of models from concierge care (where patients pay a set fee each month) to fee-for-service.

While boutique and concierge care have been sold to patients for their benefits to those who pay extra, Caplan said, they have eroded the care that other patients receive, particularly the ability to get the doctor's ear for a few minutes.

But proponents of direct-pay and concierge care say the new models are the result of frustrated doctors defecting from a broken medical system, one that forces physicians to see too many patients for too little pay and with too much red tape.

“These practices exacerbate a fundamental problem in our health care system, which is this health care chasm between the haves and the have-nots,” said, Laura Weil, director of the health advocacy program at Sarah Lawrence College in Bronxville, N.Y., and an analyst of concierge care.