Private health care is far from a cure-all

Interest-free financing is available, full-page announcement proclaims. But the advertiser doesn’t sell cars or sofas. This is Spire, one of the UK’s leading private hospital groups.

A growing number of Brits are turning to private health care as frustration over the country’s state health service grows. In its half-year results earlier this month, Spire said it expects “a significant increase in demand for health care” as the waiting list for NHS treatment has increased to nearly seven million.

Only about a fifth of Spire’s revenues come from so-called “self-payers”. Nearly half come from insurers who pay for treatment under private medical plans.

Many employers in the professions, including the Financial Times, offer private medical insurance as a job benefit. The employee is only subject to a benefit-in-kind tax and can often add other family members at an additional cost taken directly from the salary.

The Eley family is a repository of knowledge about this growing business. Unfortunately, there is a lot of diseases in my family. My wife has suffered from various life limiting autoimmune conditions for more than a decade and more recently both of my children have had serious health problems.

Well-meaning colleagues often ask if we are covered by the corporate health scheme, as if that coverage solves everything. We are. And on many occasions over the years he has saved us. But that’s not the answer to everything.

As with any other form of insurance, the first question is what is covered. This is dictated as much by costs and risks for the insurer as by clinical priority.

In very general terms, acute conditions are covered but chronic conditions are not. So for me it was great to do six physiotherapy sessions on a knee that I damaged while running (acute).

But my wife is not receiving any treatment for a connective tissue disorder that leaves her in debilitating (chronic) pain for weeks.

This is particularly frustrating because the NHS has an irregular history of treating chronic conditions, even if you decide to make them acute by reporting to your local emergency room.

Insurers often have an annual limit for outpatient care, dictated by the terms of the employer’s contract with them. Ours does not tend to change much every year, although unfortunately the fees of consultants change, and only in one direction. Inpatient treatment is less restrictive, probably because statistically you are less likely to need it.

Accessing private healthcare isn’t just about rocking Harley Street. If an insurer is paying, you will usually need a referral from your GP.

When you have seen your counselor, he will typically send a letter to your GP (like lawyers, doctors like to do things freehand) and any ongoing medication will usually be prescribed by your local practice. You never completely escape the 8am rush for a doctor’s appointment.

Seeing a private consultant is seeing how the other half lives. After a proper cup of filter coffee and a glance at the newspapers in a quiet, clean waiting room, get the undivided attention of a specialist for 40 minutes or more.

Hospital stays are equally pleasant. It’s a whole world away from the state sector with its long waits, often run-down facilities, terrible food, and overworked staff.

You will be brought back down to earth by diagnostic tests which usually follow a consultation. These can be extraordinarily expensive. Last year, my daughter unknowingly exhausted her entire annual outpatient budget in one visit to a Spire facility.

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We asked the hospital why they did not inform her in advance of the costs for the various tests and were told that this was not possible due to “commercial confidentiality”. Different insurers are charged different prices, so everything must remain hidden.

The same question was posed to the insurer, who told us it was the patient’s responsibility to ensure that all examinations are within the annual limit or to remedy the deficit.

Understood? The patient must ensure that he does not over order from a menu that has no prices. No one in the private care sector seems to think this surprising lack of transparency is a problem.

Sometimes it is possible to do blood tests on the NHS. But this requires the cooperation of both the counselor and the general practitioner and you will have to organize them yourself.

In fact, private care implies that you, the patient, are in charge of quite a bit of organization in general. Although bills are usually sent directly to the insurer, there are many other administrations. Just like in the state sector, everything moves at a slower pace and phone wait times for our insurer’s helpline currently rival that of our local doctor’s office.

There is also a certain degree of negotiation, given all the rules and limits. One morning, on the day of a rather heavy eye surgery, my wife was on the phone with the insurer discussing whether or not the anesthetist’s fee was included. She was, but not without a fight.

Private healthcare has been good for us and we cannot complain that we have not benefited from the annual cost (over £ 2,000, if one includes the benefit in kind).

But ultimately it is a for-profit service provided by shareholder-owned companies and, inevitably, that means compromises with clinical priorities. It fills some of the gaps in a state service that is perpetually resource hungry and subject to constant political interference. Just not all.

Jonathan Eley is FT’s retail correspondent. E-mail: [email protected]; Twitter: @JonathanEley

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