This is not the health care system most of us recognize: Internists who promise - absolutely guarantee - not to keep you waiting for more than 15 minutes.
Specialists who return phone calls within three hours.
A nurse who will arrange your kids' summer camp.
Surgery followed by private car service to the Boston Park Plaza Hotel or the Ritz-Carlton, where lavish room service and French Provincial charm aid your recovery.
But a crop of new health care companies that have sprung up in recent years, several of them started by Boston doctors, say this is precisely the sort of service many patients want - and will pay for. Counting on Boston's reputation as a home to some of the world's best hospitals and physicians, these firms are selling amenities and coordination of care to wealthy foreigners and Americans who can afford to simply forgo medical insurance or pay for the extras themselves.
Dr. Andrew Sternlicht, for example, left his anesthesiology practice at St. Elizabeth's Medical Center in Boston four months ago to start Hotel Recovery, a company that, as its name suggests, will arrange for patients who have had day surgery or have been discharged from a hospital to recuperate in style.
Working long hours in a rented office on the Park Plaza's fourth floor, Sternlicht's staff has been busy ordering boxes of sterile dressings, antibiotic ointment, and Craftmatic Adjustable Beds to help elevate patients recuperating from tummy tucks or knee surgery.
When Hotel Recovery opens for business at the end of March, it will provide 24-hour assistance from nurses or physician's aides at the Park Plaza, the Ritz, the Charles, and other high-end hotels, charging patients fees in the range of $800 to $1,200 per day. (Dark glasses and scarves will be included for plastic surgery patients.) Assuming there's even an HMO that would cover such services, Hotel Recovery will not accept insurance.
Massachusetts General Hospital and other academic medical centers have long provided special hotel-like floors and services to attract self-paying patients, particularly those from other countries. But executives at companies like Hotel Recovery believe the market for wealthy patients is underserved.
''Hospitals are focused on getting people out earlier and earlier,'' said Sternlicht, who stresses that his company does not provide medical care. ''We're offering the luxury of years gone by when you could arrive the night before your surgery and arrange your things and get a little pampering afterward.''
At Global Health Services, private-duty nurses will change bandages, arrange child care, and even accompany patients to tropical retreats for $50 to $100 an hour.
''Boston definitely has some of the best medical care,'' said Karyn Donga, a nurse who started the business two years ago. ''But international patients are getting more astute and shopping around in different cities. They're used to very good service. It's the same things with domestic patients - a lot of them are willing to go outside their health plan when they have the resources to get the best.''
One company, WorldClinic, which was started by emergency physician Dr. Daniel Carlin at the Lahey Clinic in Burlington two years ago, guarantees immediate access to top doctors anywhere in the world for its clients, including international companies and individuals who travel on business, not all of whom are well-off.
Because the companies are independent of any hospital or group of doctors, they can demand a high level of service or take their lucrative business to another institution.
Even if most patients will not be able to afford this gold-plated treatment, some analysts say cash for care has the potential to trickle down to middle-class employees covered by standard HMOs. There is growing interest, for example, in ''defined contribution'' insurance plans, wherein companies give their employees set dollar amounts toward their medical care. Workers decide where and how to spend it.
''Many employers and health economists think that the underlying cause of all the problems in health care is the divorce between consumer and provider,'' said Greg Scandlen, senior fellow in health policy at the National Center for Policy and Analysis, which has advised President Bush.
''So what a lot of people are now envisioning are programs that give the employee cash,'' he said. ''Once you're diagnosed with a condition you go out and shop for a provider. The question is, `Who is the customer?' And right now, the customer is not the patient.''
Even so, while employers may be willing to give their employees enough money to pay for annual physical exams, medically necessary surgery, and high blood pressure medication, few are going to include enough cash to cover amenities like post-op luxury hotel recuperation. That probably always will be for the richest patients only - and is one reason the wealthy tend to be in better health and live longer than average Americans.
It's not that the wealthy have sole access to Boston's best doctors and nurses, but they may be able to buy more time and attention from them.
Three years ago, Dr. Antoine Kaldany, a nephrologist at New England Baptist Hospital, formed WorldPath mainly to cater to wealthy patients from abroad. The company has grown steadily and now has 3,600 clients. Some are royalty.
The company holds onto its clients' medical records and hires doctors for them mostly in the Harvard and Yale medical school systems. Unlike most managed care insurance companies, WorldPath's clients agree to pay the doctor's full fee - no matter what it is.
WorldPath clients are buying expertise, but they're also buying service. And they sure do get it.
Physicians agree not to keep them waiting more than 15 minutes. Office visits can be no shorter than 45 minutes. Doctors are to return phone calls within a few hours and send summaries of visits to WorldPath within one week. The company arranges for limos and hotel accommodations and sends a patient advocate with the client to every doctor's visit.
''If you're getting 100 percent of your fee schedule you might want to call the patient back right away,'' said WorldPath chief operating officer Donald Cornuet. ''Because the next time we have a referral for your specialty you might not get it. It's pretty simple. The more responsive the doctors are the more patients they see. The patient is the center of every interaction.''
Health policy specialists say that the rich have always purchased better service. ''The question is are they taking the services that would have gone to someone else?'' said Herman ''Dutch'' Leonard, professor of public management at Harvard's Kennedy School and a board member for the HMO Harvard Pilgrim Health Care. ''Is the doctor making his HMO patients sit around and wait?''
Cornuet rejects the criticism. ''People say this is two-tiered medicine,'' he said, ''when in reality these people are helping subsidize the low payments from Medicare and Medicaid.''
Doctors who treat WorldPath patients bristle at the suggestion they give preferential treatment.
So even though Dr. James Rainville talked about stress with one rich patient whose cousin was costing their business millions, and squeezed in another who refused to see a female doctor, he says he'd do that for any patient.
''We don't go out of our way to do anything different,'' said Rainville, the Baptist's chief of physiatry, physical medicine, and rehabilitation. ''I will ask for favors, like getting them in quickly for an MRI scan, if they're only in town for a few days. But I'd do that for a person from Martha's Vineyard.''
Still, there's a high level of pressure from WorldPath for good service, and some doctors admit that keeps them on their toes.
At Hotel Recovery, Sternlicht believes his service will lead to more relaxed recovery, better surgical outcomes, and fewer hospital-acquired germs. ''We all know hospitals are not healthy places for healthy people,'' he said. ''Very few people go to the Four Seasons or the Ritz-Carlton and walk out with an infection.''
© Copyright 2001 Globe Newspaper Company.