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Who should control care, the customer or the insurer?

NHS logo

The NHS is moving, at least in the political rhetoric, to a situation where the patient will be able to choose which GP to use, which hospital to use, and which consultant to use.


The logic, even if it is flawed, is that the patient or as they are increasingly known by hospitals-the customer –is the best person to choose how, when, where and by whom they are treated.


The stated aim is to take control away from faceless non-medical managers and give it to medical staff and customers to decide jointly. It has great popular appeal, even though actually getting doctors or nurses to do more than nod and carry on as normal, will be a minor miracle.


Reality has little to do with the politics of NHS reform, but the impression of free choice is something health insurers need to think hard about.


Private medical insurance is often sold as giving the patient freedom of choice of where and when and by how they are treated.


Not only is the NHS reform cutting this ground from under them, insurers are doing their self-destructive best to make the damage worse.


For totally understandable reasons of cost control, more than one insurer is taking choice away from the customer/patient and their GP.So the insurer, not the GP, decides on which consultant is best. An insurer has often, with the use of hospital networks, already chosen which hospital or hospitals can be used. Worse still, some “faceless administrator at head office” takes the decisions.


Health insurers can shout me down until they are blue in the face; phone me up to explain, in the spirit of Alistair Campbell, why I am wrong; and place press articles and interviews explaining why they have taken choice away. But the simple matter is that as the NHS widens patient choice, some insurers are restricting it.


I understand the cost arguments, but that defence totally misses the point, it is all about the perception.


The perception of individual choice may be unreal in practice, but if the NHS is selling the cost cutting reforms with magic dust of free patient choice, for insurers to give the perception that "we know better than you" to the customer is a suicide mission. This is what doctors have said since time immemorial, and it is surely no coincidence that some insurers are run by doctors.


Even those insurers offering free choice will be damaged by the perception of less choice from major insurers. They will have to up their game to emphasise choice.


It is not as if PMI has been booming in the last decade, so what on this planet makes insurers behave in such a long-term self-destructive way? And why were the internal marketing and advertising experts unable to explain to the medical, underwriting and financial people the dangers of this approach when the NHS is offering free choice?


If the key marketing message of PMI is to emphasise individual choice, then you actually have to deliver that in the perception and reality of the product.   

Private medical insurance hot topic: December 2011