The adage that what starts in America ends up here is never more true than in medicine. One of the most noted examples of Atlantic hopping – and arguably one of the least desirable – is medical litigation. But another trend, which could turn out to be even more important, is self-paid private surgery. Britons are rapidly adopting the US practice of arranging private treatment direct with independent hospitals. Currently at least 160,000 people in Britain each year are thought to be paying for their own surgery, a rise of about a third in four years. Long NHS waits, advertising drives by individual private hospitals and a booming state hospital pay-bed sector all support the picture of people self-insuring.
The importance to intermediaries is clear. Self-payers spurn PMI and growth in their ranks could further unsettle an already wobbly insurance market. But self-payers are also potential candidates for high excess policies, which are being pushed with increasing vigour by the industry. Both ways, IFAs could get drawn in, either to advise on high excess plans or because a client wants to know how to go about fixing up their own treatment outside the NHS.
So how difficult is it for a patient, who may feel unwell, to negotiate the hurdles of finding appropriate treatment at a reasonable price?
Such questions have prompted the birth of two agencies aiming to steer people through the independent healthcare system.
Health Care Navigator, based in Godalming, Surrey, supplies information on medical conditions and has a price database of private medical and surgical procedures.
A similar service is offered by the Brighton-based Good Doctor. It charges around £100 to guide a patient to the most appropriate hospital. It may also recommend a surgeon and offers to negotiate a price on behalf of the patient and gives the latest details on treatment options.
IFAs can expect to hear more about both bodies if the agencies succeed in plans to tie in their operation with insurance companies and financial services providers.
Health Care Navigator chairman Roger Hymas says: “Some people are spending £2,500 a year on PMI they may not be using. They could be putting that into a medical savings account – formal or informal – in the hope that they are left with a positive balance.”
A medical savings account would encourage monthly savings, perhaps as a tax-free ISA, allowing withdrawals for healthcare. Flexible mortgages offer similar scope as repayments can be deferred or speeded up.
Both the new agencies have opted for what Hymas terms a “soft launch” in the expectation of gaining backing from an insurer. In exchange for a lump sum, an insurer providing high excess PMI or a medical savings account could offer its customers “free” access to the medical expertise gathered by the agencies. Inquiries show that at least one major insurer is looking very seriously at just such a scheme.
Hymas is a former managing director of Bupa’s insurance arm. He has held senior posts outside healthcare and has been researching his new project in the US and Britain for two years. He says, candidly, that people can do perfectly well without outside help – and without medical insurance. “There is nothing really sophisticated about this. If you work your way through the options, you will say I am an insurance person, I will take PMI. Others will say PMI is prohibitively expensive, I want a high excess policy.
“Others will say private healthcare is not as expensive as I thought. The average episode of out-patient care is £90. The average cost of insurance claims for in-patient procedure is about £1600. I can handle this myself. I will self insure.”
For £60 a year for a household, Navigator clients will be told:
the length of NHS waiting lists for the treatment needed
where private treatment is available at a suitable time and place
the best price.
A 24-hour helpline, staffed by nurses, offers help and advice to patients throughout an acute illness. The agency also claims to be able to identify an appropriate consultant and hospital for a specific condition.
Hymas stresses the importance of the patient learning as much as possible about their condition and the treatment options. These can be many. Prostate trouble, of which there are about 30,000 serious cases a year, provides a good example. Many people undergoing surgery will be unaware there are four main treatment options. They should ask if their doctor has picked the right one for them, or simply the one they feel most comfortable performing.
The internet offers opportunities here, as well as medical textbooks, self-help groups and the family doctor.
Research by Professor John Wennberg at America’s Center for Evaluative Clinical Studies, New Hampshire, suggests that informed patients fare better than those who simply follow their doctors’ recommendations.
This philosophy has now permeated Whitehall and underlies the creation of the National Institute for Clinical Excellence. The new body is set to throw light on just such issues as the prostate cancer alternatives.
The Good Doctor also stresses the value of evidence-based data, although medical director Dr Daniel Schapira, himself a former GP, thinks the family doctor remains central. “People can, of course, approach a private hospital by themselves and put questions direct,” he says.
“There are no hard and fast rules because it is such an expanding market. People should ring up a hospital, say they need this or that procedure and ask, `Do you have a fixed price and what are the details?”’ he says.
“Usually the hospital will come back with an all-in price, although the surgeon may have a role in what is charged. Even so, people may still be able to get their own surgeon and approach a hospital.”
Schapira emphasises that the patient’s GP maybe the best source of information in picking a consultant. “The GP is still a critical part of the loop,” he says.
Surgeons in America are used to being asked by prospective patients how may times they have performed a procedure, what results they get and what proportion of their patients suffer post-operative infection.”
Schapira adds: “Surgeons here may or may not be willing to divulge this sort of information. The profession is struggling to sort out ways which will give meaningful assessment.”
These pressures are sure to mount following cases such as the disgraced gynaecologist Rodney Ledward and the Bristol heart babies scandal. Although health policy experts are convinced that the profession must become more transparent, Schapira advocates some sensitivity in probing a doctor’s record.
No information source should be neglected, he advises. “The patient can ask the hospital who has the best reputation,” he says.
The most common self-pay operations where patients seek advice arise from chronic conditions where timing is not critical. Schapira says the most common are cataracts, hip replacement, varicose veins and haemorrhoids.
Unfortunately, independent hospital chains do not offer a central information clearing house by which patients willing to travel may learn of good deals or a sudden window in a theatre schedule where a willing patient can be slotted in at half price. It is a question of ringing round. But that maybe something else that Britons are increasingly willing to do.