Clinical excellence may become impossible in state provided health care.

NHSreality wants the now regional health services to succeed, but this is not possible in the current climate of denial by politicians, and distrust by doctors. Yes there have always been Perverse Incentives in either system, public or private, but as things get worse in the state provision, the temptation to go private will increase. So will the health divide. NICE knows the truth.. Clinical excellence may become impossible in state provided health care in the average DGH.

Paul Hobday for “open democracy” comments on the “Seven things the private healthcare insurance adverts won’t tell you”

The NHS financial crisis is being used by healthcare insurers to try and sell their products – but what are the risks?

Like any big business the UK’s £5 billion medical insurance industry has to sell its product to satisfy share-holders. An abundance of advertising and websites extoll the virtues of private health insurance. Their message can usually be summed up thus:

“You can jump queues, have a TV in your room, choose your specialist and appointment, and perhaps have treatment unavailable on the NHS”. What such messages fail to tell us is the following.

  1. Private medicine over-investigates and over-treats and you may get surgery that is not in your best interests. In the US it is estimated at least a third of all healthcare activity brings no benefits to patients. Every link in the chain has a financial incentive to do more to you and that can be dangerous.
  2. Private hospitals do not have the same level of scrutiny of safety as NHS facilities. In fact it is very difficult to get worthwhile information from them. As you cannot find out properly about safety and risk, what value is there in being able to select your specialist?
  3. Increasingly, you won’t have that choice anyway. Some companies are increasingly restricting the hospitals and specialists used. If you want your cataracts done, some companies now send you to Optical Express.
  4. The price of private health cover has nearly quadrupled over the last decade. And premiums rise even more sharply as you get older. But even with the most expensive policy, full reimbursement of all costs is not guaranteed. You might have to fight for it – not much different from insuring your car. New terms and conditions have been introduced that exclude policyholders from claiming, apply ‘excesses’ or co-payments, find excuses not to reimburse certain fees and limit how much can be claimed in a year. Complaints have surged.
  5. Companies will encourage you go for NHS treatment if your care is expensive. BUPA have been criticised for offering ‘bribes’ to policyholders to use the NHS rather than their private hospitals.
  6. Care can be very “fragmented” when it is vital that it is integrated well, for example with cancer care that requires a good team approach. Some companies boast of being able to supply cancer drugs – but the drugs only materialise if all NHS routes have been exhausted first, and patients often have to plead with your insurer to keep supplying the drugs longer than a year.
  7. Private medicine in the U.S.A. spends 36% on administration. The Institute of Medicine estimates that an astonishing $750 billion a year of healthcare expenditure is wasted through fraud, overcharging, unnecessary treatment and other leakages. 62% of US personal bankruptcies are due to medical bills – and of these, 78% had insurance (but it found ways not to meet their costs). Insurance companies control everything and often dictate who your doctor is. If you want to help push us in that direction, then support private medicine.

Private medical care is expensive – so the healthcare firms admit their big hope is a failing NHS. As Spire told its shareholders recently: “Growing NHS deficits will put increasing pressure on waiting lists and drive increased formal and informal rationing of NHS procedures, which will over time significantly grow demand for private care”.

In other words, the private sector is licking its lips at the idea that underinvestment in the NHS, bed closures, hospital downgrades and rationing of services will drives patients to private hospitals (either funded by insurance, or pay as you go).

And the NHS is paying them large sums, too, as government underinvestment forces NHS hospitals to ‘outsource’ patients to private hospitals to plug the gap between supply and demand. In West Kent, the new expensive PFI Pembury hospital has only one MRI scanner and so has had to “outsource” requests to local private hospitals. Mental health patients are now routinely sent long distances to private sector beds because there are no NHS beds available. The trend is only likely to increase as we face the worst NHS underinvestment in a generation.

If you want healthcare’s prime raison d’etre to be not a service, but a business making some people very rich, like in the USA, then you can help by taking out private health insurance. You can please the numerous MPs who have a financial interest in private healthcare companies. If you think a future where your health is looked after in the same way as your car is worth aspiring to, then sign up today.

If however you see the benefits of us truly all “being in this together”, helping each other, and want to support rather than run-down the most cost-effective healthcare system in the world, then forget private health insurance. Don’t waste your money, or risk your health – but demand politicians change direction back towards a publicly funded, publicly provided and publicly accountable health service.

NHS heads for catastrophic failure

Do as I do? NHS agency splashes out on private healthcare for staff

Do we all need to move to “private”? Nigel Farage: Choose private healthcare if you can afford it

“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

The risks of private care… overstated?

Paid for by the NHS, treated privately

The pride of ownership and self employment: Opening general practice to private providers ‘may have worsened patient care’. The partnership model has been killed off..

Michael Sheen, who lives in Los Angeles, and will have private cover, defends the (Welsh) NHS

Lets sell the family silver – abandon your Health Service to market forces and covert rationing

Will Wales’ professionals be tempted to take out group private medical insurance?

Patients are ready for privatised care, health chief claims

Private hospital ‘putting patients lives at risk’

GP private firms grab NHS cash

Private: Modernise or vanish, Google warns NHS

Charges are acceptable – at last the ideology of 1948 is challenged

Kent NHS ‘to send surgery patients to France’ – setting a precedent? Can the fragmented UK health services recover without some form of zero-budgeting and revolutionary reconfiguration based on overt rationing?”



This entry was posted in A Personal View, Perverse Incentives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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