By Robin Stride
The Federation of Independent Practitioner Organisations (FIPO) aims to continue campaigning to persuade the Competition and Markets Authority (CMA) to investigate private medical insurer practices, which it claims distort competition and limit patients’ choice.
It wrote to the watchdog last month about the issue citing insurers’ threats of delisting if senior consultants’ fees were not reduced and the effects on patients’ ability to choose their specialist.
The CMA replied that FIPO’s information did not provide sufficient grounds for it to carry out a market study at this time.
FIPO called the response disappointing, but said it provided a window to accrue further evidence from consultants about insurers’ behaviour.
It is asking any consultants who have been treated in a similar way by any insurer to get in touch with it or its sister organisation the London Consultants’ Association (LCA). It said names would be redacted.
The doctors’ body said: ‘Insurers are there to re-imburse on behalf of their clients who pay premiums to defray the costs of private treatment. They, of course, have a maximum amount they will pay for a given service and many consultants choose these amounts for their fees.
‘We believe that the issue now is that many insurers are actually telling consultants what their fees should be. Some even have a so called ‘fee calculator’ available on their website.
‘FIPO finds this surprising since, in 1993, the BMA were told by the then Monopolies and Mergers Commission that suggesting fee levels in their guidelines constituted a complex monopoly.’
Increasing pressure from insurers on consultant re-imbursements meant that a situation the CMA had foreseen had come to pass, FIPO added.
It has been reminding the CMA, which published a Private Healthcare Market Investigation Order in 2014, of its own words: ‘If extensively and rigidly applied, fee-capping consultants could lead to distortions in competition between consultants and to reduced consumer choice.
‘Fee-capping – and derecognition of consultants who do not agree to abide by the insurer’s fee schedule – has the potential to increase the disincentives on consultants from setting fees to reflect their costs, experience, expertise and the local market conditions.
‘This distortion may potentially be increased, the greater the number of insured patients on policies that require open referrals from GPs, as policyholders are channelled to lower cost consultants.’
FIPO said if patients’ policies were for ‘fee-assured’ doctors only, then their choice would be very limited and generally to those consultants on the lowest re-imbursement rates.
‘Should these patients wish to go to a more experienced consultant or be given a tertiary referral to a non-fee-assured super-specialist by their original consultant, this may well be denied even if the patient wishes to top up.’