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Britains top Consultants fear for clinical quality and patient choice in the independent healthcare

(2 votes)

Tuesday, 06 April 2010

96.5 percent of consultants believe that private medical insurers are placing cost pressures on patients and consultants leading to reduced patient choice and affecting continuity of care.

These are some of the findings from a recent survey conducted by FIPO, the Federation of Independent Practitioner Organisations. It comes at a time when the presidents representing five of the biggest surgical disciplines and the Royal College of Surgeons claim that basic surgery is being denied to cut costs in the NHS.

This is the first and most comprehensive survey of its kind undertaken by FIPO and involved consultants representing a broad range of specialist clinical interests across the UK. It was prompted by reactions from FIPO members to reports of changes to AXA PPP’s patient pre-authorisation policy. In what is seen by FIPO as an attempt by the second largest private insurer to introduce a variable level of reimbursement to patients, depending on which consultant they see, AXA PPP is adopting a hard line strategy of referring patients to see certain consultants on the basis of price. This will financially penalise those patients who choose to continue to be treated by their consultant of first choice and the FIPO survey has shown that AXA PPP is targeting 20 percent of consultants.

Consultants were surveyed to identify how the patient-consultant-insurer relationship will be affected by new variable fixed fee schedules. Although all insurers cannot be bracketed in the same way over 98 percent of respondents felt that these current insurance strategies are being inspired by commercial considerations rather than quality considerations.

The survey revealed incidents where private medical insurers have forced patients to undergo procedures in certain hospitals which may not be the best equipped or most convenient for them. Patients are also being redirected to consultants who, while they may be of the same generic specialty, are not subspecialists able to deal with patient-specific needs.

Geoffrey Glazer, chairman of FIPO commented: “The survey results clearly show that consultants have a lack of confidence in the commitment of certain private medical insurers to maintain clinical quality. Almost a quarter of all consultants can cite instances where insurers have suggested referral of patients to an alternative consultant for cost considerations. This can destroy continuity of care as first choice consultants may already know the patient well and thus have a better understanding of the patient’s medical condition than a new specialist. This insurance tactic also undermines the long established referral pathway between GP and consultant as well as the patient-doctor relationship and places unnecessary pressure on patients who are sick, vulnerable and in need of medical care.”

Related Articles:

* FIPO Survey to Investigate Medical Insurer Pressures on Patients and Consultants (March 2010)

* Press Release from HMRC over Non-Compliant Consultants (January 2010)

FIPO has noted an increasing tendency for insurers to dictate clinical strategies and to engage in the “recognition” of consultants. The survey revealed incidents where private medical insurers have forced patients to undergo procedures in certain hospitals which may not be the best equipped or most convenient for them. Patients are also being redirected to consultants who, while they may be of the same generic specialty, are not subspecialists able to deal with patient-specific needs. This level of influence is of particular concern to consultants with more than 96 percent of those surveyed believing clinical guidelines should be developed by professional organisations, rather than private medical insurers, who have vested financial interests.

For Richard Packard, FIPO deputy chairman, the fault lines are clear: “Insurers are increasingly attempting to manage clinical care and thus non-clinical managers could influence clinical decisions that might compromise a consultant’s duty as a doctor and GMC obligations. This survey has shed light on serious concerns consultants have about being able to work in a patients’ best interests. Insurers must sit up and take notice at what is seen as a threat to clinical standards.”

FIPO: Federation of Independent Practitioner Organisations website

Notes regarding this Press Release...