OFT private healthcare study – AMII views

The Association of Medical Insurance Intermediaries (AMII) recognises that benefit fee limits and hospital networks are a necessity to maintaining a cost-effective private medical insurance proposition for consumers in its initial submission to the Office of Fair Trading (OFT) on the proposed market study into private healthcare due for a formal launch in the spring.

AMII believes the OFT should make a clear distinction between those broad-based hospital networks, where the private medical insurance customer has actively agreed to only obtain treatment at a selected list of hospitals in return for a lower premium; and the treatment networks where the insurer insists that for certain types of treatment (for example oral-surgery, ophthalmic conditions, certain types of cancer treatment) the customer must use specific consultants/hospitals, which may be more restrictive than the general hospital list that the customer has agreed to.

For treatment networks, the criteria that insurers are using to determine which providers are included on the treatment network should be clear to private healthcare providers, medical professionals and customers. When an insurer introduces a treatment network for specific medical conditions, customers should be given the choice to opt out of the network at a higher premium.  And insurers should share the quality data they are using to establish these treatment networks.

AMII would also like to see greater transparency around benefit fee limits for consultants and anesthetists - not just from those insurers that have them, but more importantly, also from the consultants and anesthetists themselves. In too many instances patients are going ahead with treatment without knowing the full cost of that treatment beforehand, so not knowing what, if any, shortfall there is going to be on their benefits.

Michael Payne of AMII says, “We welcome the OFT’s study and will support it in any way we can. There are some very important issues to be looked at and anything that provides greater transparency and clarity for consumers of private healthcare can only be a good thing at a time when NHS spending restrictions are likely to increase the importance of the private healthcare market.”


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OFT private healthcare study – AMII views
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