Boutique medicine (also referred to as concierge health care, concierge medicine,or retainer medicine) was developed in the mid-1990s in Seattle, Washington. In this model, patients pay an annual or monthly fee to have improved access to health care services. All boutique medical practices are limited to 600 patients. Boutique medicine allows primary care physicians to spend considerably more time with diabetes patients to develop a comprehensive plan of care that includes: medical assessment; individualized education; close follow-up. Boutique medicine has raised mixed reactions. Services are not available to most patients.