The launch of a portal bringing together data from all five major private hospital providers has sparked a debate about the value of comparative information such as infection rates to private medical insurance (PMI) intermediaries.
Insurers and providers highlight the comparison in hospital-acquired infection (HAI) rates as a key differentiator between the NHS and private sector, driving an increasingly health literate public towards the latter.
But intermediaries question whether highlighting the comparison is a key element of their role, while regulators argue that the risks associated with NHS care have been exaggerated.
Dr Andy Jones, group medical director of Nuffield Health, Britain’s second largest independent sector hospital provider, is confident that the two sectors are “league divisions apart”, citing patient surveys as evidence that infection prevention is the “number one issue” for patients choosing independent care.
He claims that Nuffield hospitals had one case of MRSA and six cases of clostridium difficile (C-Diff) in 2008, while carrying out about 365,000 operations across the network.
This is precisely the sort of data Laurent Pochat-Cottilloux, commercial director of Standard Life Healthcare, believes providers must be sharing in order to grow the PMI market.
“I have never read in advertising that you are 12 times less likely to get a hospital-acquired infection in a private hospital,” Pochat-Cottiloux said at Laing and Buisson’s annual PMI conference last month. “We have been relatively coy about the benefits of our product.”
In fact, the major private hospital groups have done much to promote their hygiene standards. Spire Healthcare provides information at hospital level, enabling patients to compare HAI rates at each Spire hospital against the UK private hospitals average and the NHS average.
“We’ve always been really committed to putting relevant information out there and we’re ahead of the curve in terms of patients having confidence to use that information to inform their choices,” said Spire Healthcare’s clinical director Dr JJ de Gorter, who has been instrumental in establishing the sector-wide Hellenic Project described above.
He believes that concern about cleanliness is undoubtedly a “very relevant topic” and firmly repudiates any suggestion that the low levels of HAIs in the private sector are more easily achieved than they might be in the NHS.
“The simple truth is that is achieved through blood sweat and tears,” he said. “There are no reasons to suggest why working in private sector, would automatically mean that rates would be better. It’s attention to detail, a commitment and an obsession with infection control. We respond to the market and consumers tells us that it’s important. We over-invest. Is it proportional to the actual harm caused? Potentially not. Is it proportionate to the patient’s perception?Yes it is.”
Many of the tools deployed by the private sector to manage infection risks have since been adopted by the NHS, including pre-admission screening, and there are signs of significant progress.
Latest figures from the Health Protection Agency (HPA) show that between October and December 2008 there were 15,812 cases of C Diff (89.1% occurring in those aged under 2 or over 65), a 37% decrease on the same period in 2007. In the same 2008 period there were 676 cases of MRSA, representing a 38% reduction on the corresponding 2007 quarter. It is also important to note the differences in the case mix of patients in the NHS and private sector, with the former seeing a higher proportion of patients vulnerable to infection such as the elderly and emergency admissions. There are also signs of patients observing improvements.
The latest national inpatient survey reported that 95% of adult inpatients patients described their room or ward as “very” or “fairly” clean.
Nevertheless, there is a notorious distinction between patient experience and public perception and, according to Bupa, clean hospitals represent the biggest reason why people buy health insurance, motivating two thirds of all those taking out a policy.
Other insurers have mixed views.
“It[infection rates]does worry people but I’m not sure it’s a primary driver of why people want to take up PMI,” said Gerry Budd, operations director at HealthFund.
Fergus Craig, healthcare commercial director at AXA PPP healthcare, suggests concerns will vary according to a patient’s postcode.
“The NHS is inevitably a mixed organisation,” he explained. “There are no doubt places where it is never a problem, but if you live in Tunbridge Wells [where 90 people died as a result of a series of safety lapses at a local hospital] it will be top of the mind round there.”
Intermediaries, while aware of media-driven concerns, are similarly cautious about over-emphasising the significance of HAIs.
Stuart Scullion, sales and marketing director at the Private Health Partnership, does believe that the motivation of clients has changed.
“In the current climate, where people are looking to save costs, one of the things we try to do is actually talk through with them what was it that made them buy medical insurance,” he said. “And out of that conversation what you will often find to a certain extent is a fear of ‘what if I did need to have this type of procedure, what is the likelihood of me getting one of these quite nasty bugs?That I go in for what is fairly straightforward operation and I come out disabled?’”
Rohan Moore, managing director of Oxfordshire-based specialist intermediary Healthcare Quotations Ltd, says advisers must distinguish between the benefits of private sector treatment and the benefits of PMI as a financing vehicle for this treatment and discuss the former “with caution and moderation.”
“Advice must target principally the insurance contract itself,” he warned. “But different advisers engage to different degrees with the promotion of or advice upon the benefits of private sector healthcare.
“Ultimately, patients, consumers and insurance advisers alike rely on the same medical-sector regulatory bodies and critical journalism to gain a grasp of such issues of public and political interest, and the adviser’s authority over questions of insurance does not extend to questions over clinical performance.”