Pre-Christmas is a good time to look ahead at what might be on the horizon for next year's PMI sector, Richard Walsh investigates.
An area of particular interest for PMI insurers and brokers is how three different but linked pieces of work pan out.
All three cover both the private and public sector although their emphasis on each varies.
They also link to the future of how open referral schemes are likely to develop in the future.
The ultimate prize could be much better information systems on individual clinical practitioners and the local health systems in which they operate.
First off is the Office of Fair Trading (OFT) inquiry into how the private provision sector (and also to some extent the NHS end of it) operate.
This issue has been covered before and its scope is wide - from barriers to entry to potential price fixing.
The key underlying issue though is the lack of information available to individuals and insurers to enable them to make valid decisions on quality of care and value for money in hospital settings.
The open referral system is an attempt to crack this - but it is based on the information widely available (which is dire) and that based on individual insurers' experience (which is often more useful but still has big scope limitations).
Hopefully the OFT makes concrete recommendations to go towards addressing this information gap.
The next two are less well known in the insurance sector.
The Kings Fund produced a report earlier this year drawing attention to ongoing work by the Inquiry (the Francis report) into the Mid-Staffordshire NHS debacle.
Having looked at the local situation the inquiry has now expanded to examine more general issues and is likely to propose far-reaching changes at all levels of the system, including to the external organisations that regulate quality.
And some of these organisations are already under a lot of scrutiny.
The Care Quality Commission has been subject to both a parliamentary inquiry and a performance and capability review by the Department of Health and the Nursing and Midwifery Council has been subject to severe criticism of its performance by the Commission for Healthcare Regulatory Excellence and the House of Commons, Health Committee.
The Francis report was due out last October but has been put back to early next year.
As with the OFT inquiry, having good information to be able to regulate properly and transparently is likely to feed into the information that is available to insurers to make decisions on who and where to contract with.
Finally we move to the Law Commission who consulted earlier this year on proposals to simplify and modernise the law and establish a streamlined, transparent and responsive system for regulating health care professionals.
It expected to produce firm recommendations next year. The issues it is addressing include the registration and renewal of registration of professionals and how regulators oversee the quality of pre-registration and post-registration education and training. For doctors, this will also include revalidation.
The law in these areas is currently very complex and based accumulations of provisions onto a nineteenth century base.
They plan to simply it and add new responsibilities for example requiring regulators to make rules on approved qualifications, education institutions, and programmes.
These rules would be supplemented by a duty on the regulators to publish a list of approved institutions and publish information on their decisions on approvals.
Taking all three pending reports together we can expect to see a slowly changing landscape in which PMI operates - from one where information is patchy to one where evidence based open referrals will be clearly superior on quality grounds and easier to sell to customers.
Richard Walsh is a director and fellow of SAMI Consulting, www.samiconsulting.co.uk
