growing trend of "boutique" or "concierge" primary care physicians who advertise "more personal care" can be viewed as an example of SID. Concierge medicine is based on an annual fee paid by the consumer. Proponents believe this model will increase the quality of care delivered to those individuals who subscribe to it. Opponents argue it creates a two tier system, with better care for those who can afford it. SID can be associated with Medicare fraud and can be a prosecutable offense for reasons that include conducting and billing for unnecessary medical procedures in patients who have little or no disease. Another ethical concern is the rise in healthcare spending that can be caused by SID. SID may also be influenced by moral hazard where consumption of healthcare services may be increased when an individual's responsibility for the cost of a treatment is low. Economics of healthcare reform The number of physicians entering primary care practice decreases, while the number of specialists increases. Thus, despite the growing number of patients who are demanding access to healthcare, there continues to be a greater supply of specialists, and fewer primary care physicians. This phenomenon leads to greater costs and strain in the system in terms of unnecessary procedures, less access and consumer apathy on cost of care within an already fragmented healthcare system. Additionally, many economists question whether or not doctors use their relationship with the patient for their own financial advantage by recommending and providing health services that the patient would have refused if well informed. This concept is referred to as supplier induced demand. Access to care challenges are exacerbated by the introduction of the baby boomers into the healthcare system. The aging boomer population is just now reaching the age of 65 and becoming eligible for Medicare. At the same time, fee for service reimbursement from the public payers, followed by the private payers is declining. Not only is the number of primary care physicians dwindling, but this decline in reimbursement causes many of these physicians to reduce the number of appointment slots for Medicare patients. This growing barrier to primary care physicians and the preventive care they provide means that more patients are being seen in less appropriate and less efficient venues of care (such as emergency rooms). However, the passage of the Patient Protection and Affordable Care Act (PPACA) and the recent SCOTUS affirmation of the individual