Health

Private healthcare is far from being a cure for everyone

Private healthcare is far from being a cure for everyone

A full-page advertisement announces interest-free financing. But the advertiser does not sell cars or sofas. It is Spire, one of the UK’s leading private hospital groups.

A growing number of Britons are turning to private healthcare as frustration grows with the country’s state-run health service. In its semi-annual results at the beginning of this month, Spire said it expected a “significant increase in healthcare demand” given that the NHS treatment waiting list had swelled to nearly seven million.

Only about a fifth of Spire’s revenue comes from so-called “self-propelled payers.” About half come from insurance companies that pay for treatment under private medical plans.

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Many employers in professions, including the Financial Times, offer private medical insurance as a feature of the job. The employee is only subject to a tax fee in kind and can often add other family members for an additional fee that is collected directly from the salary.

The Eli family is a repository of knowledge about this growing business. Unfortunately, there are a lot of diseases in my family. My wife has suffered from several life-limiting autoimmune diseases for over a decade, and recently my children have had serious health issues.

Well-meaning colleagues often ask if we’re covered by a company’s health care plan, as if that cover fixes everything. we. He has saved us on many occasions over the years. But it is not the answer to everything.

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

Read:We are punished for taking a burden off the NHS – and it has to stop

In very general terms, acute cases are covered but chronic cases are not. So it was fine for me to have six sessions of physical therapy on a knee that was damaged during a (acute) run.

But my wife receives absolutely no treatment for a connective tissue disorder that leaves her in debilitating pain for weeks at a time (chronic).

This is particularly frustrating because the NHS has an incomplete record of treating chronic conditions, even if you decide to make them acute by going to your local accident and emergency department.

Insurance companies often have an annual limit on outpatient treatment, dictated by the terms of the employer’s contract with them. Our fees do not tend to change much each year although unfortunately consultant fees do change, but only in one direction. Inpatient treatment is less restrictive, perhaps because you are statistically less likely to need it.

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Access to private healthcare isn’t just a matter of shaking up Harley Street. If the insurance company pays, you will usually need a referral from your GP.

When you meet with your counselor, he or she will usually send a letter to your GP (like lawyers and doctors like to do things by hand) and any ongoing medication will usually be prescribed through local surgery. You can’t quite escape the 8 a.m. rush to get a doctor’s appointment.

To see a private counselor is to see how the other half lives. After a proper cup of filter coffee and flicking through newspapers in a quiet, clean waiting room, you’ll be given full expert attention for 40 minutes or more.

Likewise, inpatient stays are acceptable. It’s a world away from the state sector with long wait times, often dilapidated facilities, terrible food and overworked staff.

You will be brought back down to earth with the diagnostic tests that usually follow a consultation. It can be extraordinarily expensive. Last year, my daughter inadvertently blew out her entire annual outpatient budget in one visit to the Spire facility.

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We asked the hospital why they were not informed of the various test charges in advance and were told that this was not possible due to ‘commercial confidentiality’. Different insurance companies charge different rates, so everything should remain calm.

The same question was asked of the insurer, who told us that it was the patient’s responsibility to ensure that any tests fell within the annual limit or made up for the shortfall.

Understood? The patient should make sure not to over-order from a list that has no prices. No one in private care seems to think this staggering lack of transparency is a problem.

Sometimes it is possible to have blood tests done on the NHS. But this requires the cooperation of both the consultant and the GP, and you will have to organize them yourself.

In fact, private care requires that you, the patient, do a lot of organization in general. Although bills are usually sent directly to the insurance company, there are plenty of other departments. Just like in the state sector, everything is moving at a slower pace, and the phone waiting times for our insurance company’s helpline currently rival those of our local doctor’s surgery.

There is also a degree of negotiation, given all the rules and boundaries. One morning, on the day of her severe eye surgery, my wife was on the phone with her insurance company arguing about whether or not the anesthesiologist’s fee was included. It was – but not without a fight.

Private healthcare has been beneficial to us and we can’t complain that we didn’t have a value out of the annual cost (over £2000, if one included in-kind charges).

But it is ultimately a for-profit service provided by shareholder-owned companies, and that inevitably means compromises with clinical priorities. It fills in some gaps in the state-run service that is constantly under-resourced and prone to endless political interference. Just not all of them.

Jonathan Ealy is the Financial Times’ retail correspondent. E-mail: [email protected]; Twitter: Tweet embed

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