A new era for insurance?

By Robin Stride

Doctors and patients are being invited to contribute to research for a major crusade by the Indep­endent Doctors Feder­ation (IDF) to address what it calls ‘restrictions on patient care’ by private medical insurers (PMIs).

The initiative aims to create ‘a path for improvement’ to ensure fair treatment of private doctors and avoid patient choice being compromised.

Organisers stress they want change through collaboration and are committed to working with all stakeholders to address concerns and improve patient experience.

Key issues identified by the campaign are listed as:

‘Limited treatment options: PMIs often dictate which treatments they cover and the associated reimbursement, potentially restricting doctors’ ability to provide the most appropriate care for their patients.

‘Reduced patient choice and derecognitions: Disagreements over fees can lead to derecognitions, where a doctor is no longer recognised by a PMI, limiting patient choice and potentially creating a two-tier healthcare system.

Lack of transparency and accountability: The current system lacks transparency around PMI fee structures and decision-making processes, raising concerns about fairness and patient well-being.

‘Stagnant PMI fees: PMI-assured fees have not kept pace with inflation, decreasing since the 1990s. This, coupled with rising practice costs and admin burdens, puts financial pressure on independent doctors, potentially impacting the quality of care provided.’

IDF specialist committee chairman Mr Andrew Roche said in the last decade he had seen private patients’ access to treatment being eroded with insurers increasingly determining who they could see and sometimes what they could have done ‘based on absolutely no clinical reasoning’.

The consultant orthopaedic surgeon added: ‘The companies also threaten or indeed do remove doctors from their provider lists if doctors try to put their fees up, even in line with inflation. This then removes patient choice over which doctor they want to see.’

He called the IDF’s action long overdue and hoped it would achieve ‘a far more transparent, medically regulated system with patients able to choose whomever they wish to treat them and doctors able to be reimbursed equitably and fairly’.

IDF managing director Ken Mackness said: ‘We cannot ensure insurers will respond positively to the campaign. However, we are hoping to work together to find a solution to the current issues.’

The IDF emphasised its goal was not simply to raise consultants’ fees but to ensure patients receive the best possible care. 

It wants ‘fair and sustainable fee’ structures implemented with regular adjustments for inflation and rising practice costs; an independent body to oversee insurers’ policies/fees; and ‘clear and objective derecognition protocols including a fair appeals process managed by an independent body’ .

IDF president Dr Philip Batty stated that excellent care required doctors and patients working in partnership to explore evidence-based treatment options and continuity of care. ‘Our members and their patients report increasing restrictions, poor triage and frustration with PMIs. It is time to challenge systems that compromise excellence.’

The doctors’ survey is open to all independent doctors in the UK. The Doctor Survey is at tinyurl.com/yr26fw2e and the Patient Survey is at tinyurl.com/efbbtnx4.