Enter the ‘fees for all’ era

By Robin Stride – May 2015

magnifying glass feesA landmark judgment from the Competition Appeal Tribunal (CAT) paves the way for all consultants’ fees to be compulsorily published.

Prices – and performance – will be shown alongside those of private hospitals they work from on a website databank run by the Private Healthcare Information Network (PHIN).

Fee data is tipped to go live following the failure of an appeal by the Federation of Independent Prac­titioners Organisations (FIPO) against rulings arising from the Competition and Markets Author­ity’s long-running inquiry into alleged curbs in competition in private healthcare. The CAT dismissed FIPO’s appeal on all seven grounds of its challenge.

PHIN boss Matt James responded: ‘We’re glad this decision clears the way for the publication of fee information alongside quality measures so that consumers have the full
picture.’

He told Independent Practitioner Today: ‘Consumers considering private healthcare want to find the best treatment and to know how much it will cost. If they’re insured, they want to know that their insurance covers the treatment they’re looking for with the consultant they want to see.

‘That’s pretty simple. What is more complicated is making sure the publication of information represents all parties and options fairly, and that’s what PHIN will be working on, with FIPO and others, over the next couple of years.’

FIPO said it was ‘disappointed’ with CAT’s two-to-one majority judgment backing the CMA’s view that private medical insurers’ power had no adverse effect on competition. It would pursue ‘all options available’.

Barrister Mr Aidan Robertson said FIPO could take the case further with permission from appeal authorities, but he told doctors at the BMA private practice committee conference it would have to show an error of law in the judgment and he saw no prospect of the case re-opening.

In a lengthy statement available on our website, FIPO welcomed a strong dissenting opinion from the tribunal’s non-lawyer member, economist Dermot Glynn.

FIPO agreed with his conclusions ‘that because there is no real price competition between consultants vis à vis the policyholders, the imposition of a fee information remedy on consultants (the remedy adopted by the CMA) cannot do anything to improve the competitive outcome.

‘Indeed, FIPO agrees that providing this information may well facilitate tacit collusion, encouraging smaller private medical insurers to follow the Bupa or AXA PPP benefit schedules, leading to further loss of competition between consultants.’

FIPO had also challenged the CMA’s view that there was an adverse effect on competition arising from the lack of independent publicly available performance and fee information on consultants.
The CMA said this should be remedied by requiring healthcare operators and consultants to publish information about specialists’ fees and other aspects of their practice –the ‘Information Remedy’.

FIPO challenged the CMA’s ‘Private Medical Insurers’ Decision’ on six grounds and the ‘Information Remedy’ on one issue.

There was no ruling on costs.

The Independ­ent Doctors Feder­ation (IDF) was also disappointed at the ‘complex judgment’. Spokes­man consultant physician Dr Brian O’Connor said: ‘The dissenting opinion given by Dermot Glynn was highly critical of the CMA. Indeed, his reasons for dissenting reflects the view of the IDF.

‘We have always said that fee capping and prevention of flexible pricing restricts patients’ choice, leading to an adverse effect on competition. Patients are not necessarily directed to the best available consultant.’

He said the IDF, which sits on FIPO’s board, would be commenting more fully on behalf of members.