The Office of Fair Trading (OFT) has confirmed that it will investigate the restrictions placed on practicing consultants by private medical insurers (PMIs) and healthcare providers.
However it appears the PMI sector will not be grilled over its use of networks to restrict treatment for patients to certain hospitals or doctors.
The OFT said its private healthcare (PH) review will consider the provision of PMI insofar as it affects the provision of private healthcare.
But it will not focus directly on issues arising at the point of sale of PMI, such as transparency of terms and conditions of PMI contracts, or whether the market for PMI is competitive.
Issues surrounding clarity of information provided by insurers regarding treatment and hospital networks for clients had been one of the major concerns raised by the Association of Medical Insurance Intermediaries (AMII) in its initial submission.
The OFT said this decision was necessary to expedite the process of the review and that much of it was outside its domain.
"In order to ensure that the OFT can deliver a suitably targeted market study in a timely manner, we will not include any issues arising at the 'point of sale' of PMI within scope," it said.
"This will permit us to focus on the 'point of referral', which is the start of the patient's access to PH. We also note that issues relating to transparency of terms and conditions at the 'point of sale' fall within the remit of the FSA.
"The OFT will direct concerns raised in this regard to the FSA," it added.
However, PMI will be included in the review relating to Barriers to entry and the role of consultants.
The review's full scope will be:
The nature of competition in private healthcare provision - in particular how private healthcare providers compete on the price and quality of treatment. This will include the NHS's role as a provider of privately-funded healthcare, for example through its private patient units.
Concentration of provision - whether concentration at the national, regional and/or local levels might be limiting the extent of competition in the market.
Barriers to entry - whether the relationships between private healthcare providers, PMIs, consultants and GPs may restrict entry and/or expansion, and whether there are other restrictions on the ability of providers to enter or expand into the market.
The role of consultants - whether restrictions placed by healthcare and PMI providers on consultants and other medical professionals limit choice and quality of care for patients, and the role of consultants more generally in determining how patients are treated, where they are treated and by whom.
Constraints on consumers - how consumers access and assess information about private healthcare providers, and how they exercise choice.
The OFT received over 100 consultation responses, from healthcare providers, private medical insurers (PMIs), consultants, medical professionals, professional bodies and individual consumers.
