Private healthcare is far from a cure all

Interest-free financing is possible, the full-page advertisement announces. But the advertiser doesn’t sell cars or sofas. It’s Spire, one of the UK’s leading private hospital groups.

More Britons are turning to private health care as frustration with the country’s national health service grows. In its half-year results earlier this month, Spire said it expects a “significant increase in demand for healthcare” as the waiting list for NHS treatments has grown to nearly seven million.

Only about a fifth of Spire’s revenue comes from so-called “self-payers.” Almost half comes from health insurance companies that pay for treatments under private health insurance.

Many employers in the liberal professions, including the Financial Times, offer private health insurance as a perk. The employee is only subject to a benefit-in-kind tax and can often add other family members for an additional charge that is deducted directly from pay.

The Eley household is a treasure trove of knowledge about this growing business. Unfortunately, there are many illnesses in my family. My wife has been suffering from various life-limiting autoimmune diseases for more than a decade, and recently both of my children have had serious health problems.

Well-meaning colleagues often ask whether we are covered by company health insurance, as if everything were settled. We are. And on many occasions over the years it has saved us. But it’s not the answer to everything.

As with any other form of insurance, the first question is what is covered. This is determined by the costs and risks for the insurer as well as the clinical priority.

In general, acute diseases are covered, but chronic ones are not. So it was fine for me to have six sessions of physical therapy on a knee that I had (acutely) damaged while running.

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But my wife gets no treatment at all for a connective tissue disease that leaves her in debilitating pain for weeks (chronic).

This is particularly frustrating as the NHS has a patchy record of treating chronic conditions, even if you decide to make it acute by showing up to your local Accident and Emergency Department.

Insurers often have an annual outpatient treatment cap that is determined by the terms of your employer’s contract with them. Ours don’t change much every year, although unfortunately consultant fees do, and only in one direction. Inpatient treatment is less restrictive, probably because statistically you need it less often.

Access to private health care isn’t just a matter of rocking out on Harley Street. If health insurance pays, you usually need a referral from your family doctor.

When you’ve seen your doctor, he or she will usually send a letter to your GP (like lawyers, doctors like to do things by hand) and any ongoing medications will usually be prescribed by your local practice. You can never quite escape the 8 a.m. rush to a doctor’s appointment.

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Going to a private counselor means seeing how the other half lives. After a decent cup of filter coffee and newspaper in a quiet, clean waiting room, enjoy the undivided attention of a specialist for 40 minutes or more.

Inpatient stays are similarly pleasant. It’s all miles away from the government sector, with its long waits, often ramshackle facilities, terrible food, and overworked staff.

You will be brought back to earth through the diagnostic tests that usually follow a consultation. These can be extremely expensive. Last year, my daughter unknowingly used up her entire annual outpatient budget in a single visit to a Spire facility.

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We asked the hospital why they didn’t tell her the cost of the various tests in advance and were told that this was not possible due to ‘commercial confidentiality’. Different insurers have different prices, so everything has to remain secret.

The same question was asked of the insurer, who told us that it is the patient’s responsibility to ensure all tests are within the annual limit or make up the shortfall.

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Roger that? The patient must ensure that they do not over-order from an unpriced menu. No one in the private care industry seems to see this astounding lack of transparency as a problem.

It is sometimes possible to have blood tests carried out by the NHS. However, this requires the cooperation of the specialist doctor and the family doctor, which you have to organize yourself.

In fact, private care means that you – the patient – generally have to organize quite a bit. Although invoices are usually sent directly to the insurer, there are many other administrative tasks. As in the state sector, everything is moving at the pace of the slowest, and the telephone waiting times for our insurer’s helpline are currently on par with those of our local doctor’s office.

There is also a degree of negotiation, given all the rules and boundaries. One morning, on the day of quite serious eye surgery, my wife called the insurer and argued about whether or not the anesthetist’s fee was included. It was – but not without a struggle.

Private healthcare has been good for us and we can’t complain that the annual cost (over £2,000 if you add in-kind benefits) didn’t add value to it.

But ultimately, it is a for-profit service provided by shareholder-owned companies, and that inevitably means compromising with clinical priorities. It fills some of the gaps in a government-run service that is constantly short of resources and subject to constant political interference. Just not all.

Jonathan Eley is FT’s retail correspondent. E-mail: [email protected]; Twitter: @JonathanEley

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