How will this impact on the public and private sectors? What is the future for the medical insurance market? Suzanne Clarkson reports from a recent WPA debate
Doctors may quit the NHS and sell their services from chambers if the Government insists on pushing through its proposed NHS contract via the back door, according to industry experts.
An overwhelming majority of consultants recently voted against the Government’s new contract, which proposed tying 26,000 hospital consultants much tighter to the NHS. Acceptance of the contract would have inevitably meant much less time for private medicine.
The NHS contract, negotiated between the British Medical Association (BMA) and the Health Departments, proposed that the overall consultant salary would rise by 15%. But specialists would be tied to doing 44 hours a week for the NHS – in some cases 48 hours. However, the bulk of private work is not done by these doctors – so-called fulltimers – but by the 25% of consultants who are currently on part-time NHS contracts. And here is the problem. The new deal tells doctors that if they want to work part-time they can. But if they do so they will not get a pay rise for that year. They will effectively be removed from the “pay-spine”.
Despite the rejection of its proposals, the Government seems intent on instigating them one way or another. According to John Randle, executive director of the Hospital Management Trust, the Government’s next move will probably be to apply the new contract to newly qualified, or appointed, consultants. The Government also seems keen to import doctors from abroad who will probably be enrolled under the terms and conditions of the new deal, adds Randle.
Geoffrey Glazer, chairman of the Federation of Independent Practitioner Organisations (FIPO), said at a recent event organised and hosted by Western Provident Association (WPA), that consultants might react by developing chambers, which could, in turn, trigger a further change in the shape of future NHS and private healthcare delivery. For example, will purchasers and hospital providers (or the NHS) be prepared to negotiate with “chambers” groups or will they end up blocking them? And will consultant chambers lead to a mass exodus from the NHS?
Meanwhile, Glazer says, the gradual introduction of the NHS contract would effectively lead to a system of managed care in the UK – a type of healthcare delivery (originating from the US) which is controlled by an outside body in terms of access, clinical practice and funding.
But managed care is not the way forward, according to some industry commentators. Glazer cited a quote from a recent American College of Surgeons’ lecture by Dr Haile Debas, dean of the University of California, who said managed care in the US is finished as it is a “dysfunctional system with restricted access, dissatisfied patients, and an unhappy and undersized workforce”. Dr Debas said the future for those employers providing healthcare will be “defined contributions and higher employee co-payments”.
Where do we go from here?
So what does the future hold for the UK medical insurance market?
The medical insurance market has remained fairly stagnant thanks in a large part to medical inflation and the knock-on effect of rising premiums. But, according to Glazer, the response from medical insurers has been “generally unimaginative” with “few innovative insurance products”. He added that there had been an increase in “excess” policies which may be more market sensitive, but that the main tactic of insurers was to increase managed care and preferred provider networks and restrict benefits.
Perhaps not surprisingly, Julian Stainton, chief executive of WPA, advocates a “third way” – that of shared responsibility (or limited co-insurance) as the only way to keep costs under control while ensuring high standards of care.
According to Stainton, as a percentage of after tax income comprehensive cover PMI was less than 1% in 1975, more than 7.5% in 2002 and looks set to be more than 10% by 2010. He says that large employers face the same dilemma as for pension providers, with regards to rising premiums at least – and this is compounded by the effect of Insurance Premium Tax (IPT) and National Insurance.
He says that “the only way to contain healthcare costs and to increase quality, responsiveness and accountability is to ensure that the patient, as a consumer, bears some responsibility for the cost of treatment”.
Of course, cynics might argue that he is bound to say this because WPA pioneered the shared responsibility concept. However, he does have an interesting point.
If patients are sharing the responsibility for the cost of treatment they will be much more inclined to insist on getting value for money. They will be more likely to take note of the standards of service offered by hospitals and consultants and actively seek out and demand the best treatment at the most competitive price. This will, in turn, help to keep the cost of medical insurance under control because, Stainton believes, at present hospitals tend to artificially inflate the price of private treatment when the insurance company is picking up the entire tab. Definitely food for thought.