Bupa's open referral process has attracted criticism. In return, Dr Natalie-Jane Macdonald puts forward the case for Bupa
So with Open Referrals, members who require diagnosis or treatment will ask their GP for an open referral: it will no longer be necessary for GPs to specify a named consultant. Members then call the Bupa Helpline to authorise diagnosis or treatment and we will offer a choice of consultants who will provide the most appropriate care and charge within Bupa’s monetary limits under the member’s scheme.
We have been asked on what criteria we recommend consultants: Bupa has a unique level of information about consultants in private practice based on 60 years’ experience and our inhouse medical analytical capability.
We use our comprehensive database of consultants and hospitals to match the patient’s requirements in terms of the speciality, sub-speciality and the type of procedure that the consultant performs. We choose consultants who are convenient for the patient to see in terms of location, either close to their home or to their work – as they prefer. We also evaluate the data that we have about the consultant’s care practices.
Finally, we look at whether the consultant charges reasonable fees, or whether he has presented our members with additional and unexpected fees. We will also be incorporating patient satisfaction measures into our criteria as the volume and substance of this data builds up.
Better care, better satisfaction rates
By the end of this year, more than 30,000 patients will have taken advantage of the Open Referral service. The initial phase has delivered some excellent results with 93% of customers reporting that they were comfortable with Bupa providing guidance and choice on hospital and consultant. And we expect organisations with corporate health insurance schemes to see benefits due to the delivery of more cost effective health care.
The affordability of health insurance must be addressed at the same time as improving quality of service for customers. This is the first step on a journey.
Dr Natalie-Jane Macdonald is managing director of Bupa Health and Wellbeing
