People increasingly understand that they do not have to make an either/or choice between the NHS and private treatment. They can combine elements of both systems. For a sudden catastrophic illness or a serious accident, the NHS provides an unbeatable service. Similarly, private treatment is not generally used for long-term chronic illnesses and health insurance normally excludes such cover. Again, the NHS (which we all contribute to) is the only source of treatment.
In practice, private medical treatment is used for acute, elective surgery, that is conditions requiring a specific operation and where there is some discretion over timing. People who do not subscribe to health insurance schemes now realise that they can obtain private treatment on a one-off basis if the need arises and the NHS cannot respond within an adequate time period.
Many people are surprised to discover that the NHS is one of the UK's largest providers of private medical care. Many NHS Trust hospitals include a dedicated private patients unit, which offers private rooms with ensuite facilities and hotel services. In fact, NHS Trust private patients units offer a wider choice of locations (88 are listed in the CareHealth Directory) than any of the private hospital groups (the three largest have about 40 hospitals each). NHS private patient units tend to be smaller than private hospitals (they typically have ten beds) and the private hospital groups tend to offer more beds overall than NHS Trust private patient units.
Many of the largest insurance schemes tend to exclude treatment at NHS Trust hospitals' private patients unit, although there are exceptions to this. As indicated below, the self-pay route gives the freedom to choose an NHS Trust private patients unit if this is desired.
Continuing publicity about shortages of resources and waiting lists within the NHS has encouraged people who previously would not have thought of it to consider the option of private treatment. Concerns about the treatment of elderly people within the NHS have led those with aged relatives, who do not have medical insurance, to investigate the possibility of paying for them to be treated privately. Many older people are also now considering of paying for private treatment themselves.
A recent study commissioned by Age Concern showed that half of family doctors said they would worry if an elderly member of their family was admitted to an NHS hospital. Many said they knew that age-based rationing of treatment occurs. Sally Greengross, director of Age Concern said "the survey provides solid evidence that age based rationing is the scourge of today's National Health Service". More than 80% of the doctors surveyed had patients who had used private medicine for treatment "they would have expected on the NHS". See the following press release entitled Two-thirds of GPs back call for inquiry into ageist NHS for the results of the Age Concern survey. This link also contains contact details to obtain an Age Concern information pack.
There is dissatisfaction among some subscribers to private health insurance schemes on several grounds. Regular increases in subscription fees above the rate of inflation combined with escalating charges as people get older have led some people to decide that health insurance is too expensive or will become so when they are most likely to need it.
There is growing awareness of the restrictions and exclusion clauses in private health insurance schemes, which can mean cover is withdrawn if a condition requires several sessions of treatment, on the grounds that is now "chronic".
In the past a major reason for choosing insurance rather than self-pay for private treatment was fear and uncertainty about the size of the ultimate bill if treatment became necessary. Insurance companies rightly argued that worrying about the cost was not a prescription for a stress-free recovery from an operation. Private hospital groups now offer fixed price packages to self-pay patients where the total charge is agreed in advance, even if unexpected complications arise.
Insurers are responding to the reaction against high charges by offering policies with a variety of restrictions and lower premiums. One of the most common involves restricting the choice of hospitals which subscribers can use to a limited selection of "network" hospitals. These networks often exclude NHS Trust hospitals' private patient units. Many experts advise those obtaining private treatment to choose NHS Trust hospitals' private units on the grounds that they offer the best combination of medical resources and back-up and the convenience of private facilities.
Some private medical insurance groups are also setting limits on the fees consultants can charge for a range of operations. Some consultants claim that these limits prevent them from giving patients the best treatment. Self-pay patients can choose the best hospitals for their particular needs and have the reassurance of knowing their consultant is free to perform the most suitable treatment according to their clinical judgment rather than an insurance company's directive.
For some people it makes better financial sense over time to invest in their own health fund, in an ISA for example, and pay for any hospital treatment they need directly rather than paying insurance premiums. The vast majority of claims made on medical insurance policies are for less than £5000. While this is a significant sum, it is within the means of a high proportion of people who subscribe to private medical insurance.
Patients who pay directly often benefit from charges which are lower than those which hospitals bill to insurance companies.