Freedom to shop around is needed
By Robin Stride
Privately insured patients should be able to benefit from ‘portability’ in their arrangements for cover, according to Mr Richard Packard, chairman of the Federation of Independent Practitioner Organisations (FIPO).
Speaking from the audience after BMA private fees committee chairman Dr Peter Holden’s well received call for doctors to ‘get real’ about what fees they charged, he suggested patients would find this popular.
Mr Richard Packard
Patients would be able to choose their consultant if portability was available for insurance schemes so they could take their benefit wherever they pleased.
And they should also be able to choose to top up the fees if they needed to, rather than have the current situation featuring ‘a great amount of so-called fee-assured arrangements where patients have very little choice where they go to’.
Mr Packard added that if portability was available, it would create a much more equal market for patients, who could then go where they felt they would like to rather than where the insurer told them to go.
Nathan Irwin, chief executive at Western Provident Association, responded that his company offered portability already. All their customers could choose whoever they went to and would pay the agreed amount for a particular procedure.
He said the reason WPA was not bigger was because a majority of the marketplace provided cover at a lower cost and so that was where most of the business was.
Mr Irwin argued that consultants’ re-imbursements should probably have risen by more than they had done if it was a perfect marketplace.
Large insurers’ dominance
But that had not been the case because of the dominance of the large insurers. They had artificially suppressed fees and that had probably kept premiums below where they needed to be.
He considered the market was in disequilibrium, a weakness characterised now by waiting times in the private sector and fee pressure.
So why did WPA not just put fees up? Mr Irwin said this was not in customers’ or doctors’ interests.
The market was so competitive that if he raised consultants’ re-imbursements, then he would have to put up the prices for his customers.
They would not leave the marketplace, but just go to one of his competitors where they could get a cheaper deal – ‘Which means you would see the same customer with the same condition but probably get paid less.’
He believed if there was transparency about the prices charged and a single price for a service, then insurers would have to compete on their product composition, on the benefits they cover and on their service levels – not on who could nail down the lowest price.
‘And I think the consultants would have to compete with each other on their expertise, and their skills, and their experience and perhaps also their availability. Consultants could then be fairly rewarded for the skills and expertise that they bring.’
Unless consultants were fairly rewarded for their skills and expertise, there was not the incentive for current consultants to expand their capacity to meet their waiting times or indeed the next generation of consultants to enter private practice.
But Mr Irwin said there was now the chance to make that change because waiting times had created the opportunity for change.