Going private

A day rarely passes without the NHS hitting media headlines. Reports on continued Government funding, staff shortages and lengthy waiting lists have helped catapult the NHS into the limelight. While this media focus may not necessarily be for positive reasons, it has certainly helped to raise public awareness on healthcare services and its provision in the UK.

Previously, many consumers felt the public and private healthcare arenas presented an either/or situation, with those who could afford private medical insurance (PMI) opting for the private sector leaving those less well off with the services of the NHS.

However, continued press coverage has brought healthcare and its provision to the fore and an increasing number of consumers are beginning to realise that they do not need to decide between the two sectors, but can indeed combine elements of both systems to meet their needs.

Consumer awareness

Increased consumer awareness has also led to a rise in the number of uninsured people opting to pay for their own healthcare. Many have begun to realise that when it comes to a sudden or severe illness, the NHS can still provide a satisfactory service. Similarly, many have also begun to acknowledge that the private sector can be accessed for one-off treatments should the need arise.

So, with the number of people electing to self-pay increasing, what should consumers be looking for in terms of quality and treatment in the private sector? More importantly, what do advisers working in the healthcare industry need to know about the self-pay market and how it may impact on their business?

Les Curson, managing director of The Healthcare Management Company, believes the growth in the self-pay market is a good business opportunity for advisers, but emphasises key factors a consumer needs to take into consideration before embarking down the self-pay route.

'Self-pay has developed radically over the past few years, and I think this offers business potential to advisers working in the healthcare arena as they can advise those clients who do not want PMI cover on other investments to help them build a healthcare fund. However, it is not as straightforward as offering advice on whether to self-pay or take out PMI, it is simply not as clear cut as that,' he says.

Curson points out that advisers need to highlight the financial implications presented by the self-pay market, stressing the possibility of soaring costs when medical treatment gets more advanced and complex.

Similarly, Dermot Cox, managing director at CareHealth, an independent company providing a guide to private healthcare, says the majority of self-pay services are for corrective and investigative treatments such as cataract removal, hip replacements and endoscopy.

'Finding a hospital, a consultant and arranging to have treatment would be the last thing a person needs on their mind when they or a family member are seriously ill,' says Curson, 'it is simply increased hassle at a time when the main priority for all concerned is to get better.'

Cox agrees and is keen to stress that people are fully aware of how the system operates before getting involved. 'Those customers who are thinking of opting to self-pay rarely decide to go it alone out of the blue. They will have already seen their GP who will have recommended a consultant so the process has usually begun before they start to think about funding the treatment themselves,' he says.

At this point, says Cox, the decision to self-pay will stem from a combination of the client having no PMI cover and a lengthy waiting list on the NHS. If the customer has already seen a consultant through the referral process and is happy with the planned medical procedure, they can arrange to be treated by that consultant in the private sector. If the client wishes to shop around before making a final decision, there are a number of steps to follow to ensure the right decision is being made.

Know your stuff

Firstly, clients should ensure they have all the possible information on their condition, says Roger Hymas, chairman at Health Care Navigator. 'With some conditions, such as prostate cancer for example, it is important to understand the condition and the treatment variations.'

'It is more likely that a man will die from something else before the prostate cancer will kill him so he can watch and wait ensuring he has regular check-ups to monitor the development, or he could opt for radical surgery which does come with an abundance of side effects. The problem is, advice from GPs and consultants will vary across the nation, so it is important to know all the possible options,' he says.

For clients who do not know where to start in order to research their condition, there are a number of self-pay advisory services available throughout the UK, such as Health Care Navigator, Go Private and Medical Care Direct. These services usually charge an annual fee and offer advice on the best way of obtaining treatment.

Once details of the treatment or procedure have been clearly laid out and the customer understands what it will entail, obtaining an Office of Population Censuses and Surveys (OPCS) code from a consultant for the treatment is vital. This will enable the customer to contact a range of consultants, surgeons and hospitals and obtain a quote on how much the procedure will cost.

As costs vary between consultants and hospitals, this will allow those opting to self-pay to gain a better understanding of the likely cost of treatment. Increasingly, hospitals are offering a fixed price, which means the cost is guaranteed so no additional cost can be added once the procedure has been completed.

The next step is to find a consultant who is an expert in your condition and specialises in the treatment needed. Hymas says compiling a list of questions before speaking to the specialist will help the customer ensure all their questions are answered.

'A customer will need to choose a consultant with a track record in their condition. Ask them how often they perform the procedure and when they last performed it to gauge how well rehearsed they are. Asking a GP to speak to the consultant about the outcomes of his treatments, such as success rates, what may have gone wrong, any infections that may have come about is just as important as knowing how many operations he may have performed,' he says.

Once a customer has settled on a consultant, choosing a hospital is the next step. There are currently six organisations dominating the UK hospital market, the NHS and the five private hospital groups of BMI Healthcare, BUPA, Nuffield Hospitals, Capio Healthcare UK and HCA International. There are just under 300 private hospitals and private patient units in NHS trust hospitals throughout the UK.

When choosing a hospital, it is important the customer knows what they are looking for and what questions to ask. Calling up a private hospital in advance to arrange to look at the facilities is common and it will give the patient an idea of what is on offer. As well as comfort, it is vital to relate the hospital services with the treatment that may be required.

'If the customer is going to have an operation for a serious condition that poses some risk, then choosing a hospital with an intensive care unit and an excellent emergency facility is vital. Not all small private hospitals offer this, so it is important to know what you can get. However, for more frequent and less serious procedures like varicose veins removal, an intensive care facility is not as important,' says Cox.

While the number of people paying for their own treatment continues to rise, being well informed about the private healthcare sector is essential. Deciding on a consultant and hospital is a lengthy and detailed procedure and with medical inflation continuing to spiral upwards, treatment costs are also set to increase. Establishing a healthcare fund and seeking advice on what is available is crucial before any decision can be made.