With the private healthcare insurance market largely static where can future growth in private healthcare provision be achieved? Given that consultants, alongside patients, are providers’ principal customers, how can growth be achieved that delivers a ‘win-win’ to both the customer and the provider?
The clues lie in the specific factors identified by consultants highlighted in my last article – specifically two of these: at #5, is Individual Patient Choice and at #3 Patient Safety.
Choice is where independent hospitals score highly: for the environment, location, access and customer service. Indeed, this is why private hospitals are giving many NHS Trusts a serious challenge in delivering elective care at Tariff.
To the many NHS Trusts needing to reduce costs and/or improve productivity in order to remain financially viable the development of a mixed portfolio of payers including private patients can be a key part of that plan. Hence, in recent years, the rapid growth of NHS Private Patient Units (PPUs), perhaps over 40 by some estimates are presently engaged in plans for expansion or PPU start-ups.
Responding to the Choice opportunity and challenge needs to be a key component of a Trust’s financial plan, and requires a strategic as well as operational response. I have heard CEOs take the view that if local people have paid twice for healthcare (through taxes and PMI) why would their Trusts not want those patients to positively choose to use the Trust, with its’ often expensive PFI mortgage to pay for? Individual consultant and patient choices made lead to stronger patterns of referral – and the potential reputation enhancement can support specialist services strategies.
What is not quite so obvious is that private medical insurers are also generally supportive of NHS PPU expansion because of the increased confidence of knowing that access to the full range of clinical support infrastructure is available to their members, as well as a wider choice of location and often lower prices than the major independent private hospital groups.
So, in the increasingly mixed healthcare market I believe that there exists ‘win-win’ opportunities by emphasising and actioning Choice and Patient Safety. These ‘win-wins’ offer benefits for providers (Trusts as well as some private hospitals), insurers and their patients and also consultants.
The two relatively under developed market sectors are: affordable self-pay and non-elective admissions.
New self-pay products
The potential for the return of increased waiting times for NHS treatment and evidence of commissioning led restrictions on eligibility for treatment have not yet translated into increased take up of PMI. As self-employed numbers are at a 20 year high, with 4.2 million people registered as working for themselves, it seems an increasing number of people may be prepared to fund their own treatment to avoid lost earning time.
The CMA review is already provoking increased transparency in pricing and this is a market that NHS Trusts can enter. Many consultants, often the younger, newly appointed consultants who have yet to build up a regular private practice, may be increasingly happy to work with their Trust to use available capacity in evenings or at weekends.
NHS Trusts and private hospitals can all win from this better value and increased choice for the patient.
Trauma/Urgent insured patients
Most insured patients receive NHS non-elective treatment without accessing their health insurance. This prevailing situation has the hallmarks of a ‘lose-lose’ – patients do not access the advantages that their insurance premiums have paid for, Trusts deliver from stretched capacity and consultants miss out on fees potential. Insurance companies save on paying today, yes – but perhaps also lose out longer term as their members find they get NHS care and no direct benefit from their premiums.
From examples now starting we know that it is possible for Trusts to offer a semi-elective pathway that achieves early identification of those patients with insurance that wish to use it, followed by prompt request for authorisation by the health insurance company. Treatment, when the patient is stabilised, will then be chargeable. This enables Trusts to gain additional revenues while also freeing up NHS capacity, and for consultants to achieve real fees increase, while insurers gain reputationally – a key driver to premiums renewals.
So, in summary, there are opportunities for Trusts, insurers and consultants to work together stimulating the market through mutual ‘win-wins’. These are presently under exploited, but work is gathering pace!
Author profile: Philip Housden
Philip is a senior consultant with over 25 years industry experience. As Owner and Founder of specialist Housden Group healthcare consultancy practice since 2006, Philip supports corporate and niche operator clients across both private and public sectors to:
- Deliver turnaround in complex commercial situation
- Unlock strategic value and build sustainable and profitable growth
- Design and build innovative and winning service solutions
Housden Group has delivered successful projects for private sector and NHS clients, for both established and start-up businesses and organizations. These include NHS Trust Private Patient Units, GPs and hospital consultants working in ‘chambers’ groups and other clinically led organisations. He regularly works with clinicians and other health professionals on commercial development, complex service change, and has managed several major projects and organisational issues through business case approval and bid wins.
Philip co-chairs the Henley Alumni Healthcare Special Interest Group, has written extensively on healthcare commercial matters and until recently was consultant editor of the British Journal of Health Care Management.