Hurst says: “I think it is difficult to say that over-treatment is taking place in the marketplace. I am sure if you look closely you may find instances where pathways could be open for debate or discussion between administrators, insurers, companies and individuals. But you do have to be careful because over-treatment can be a subjective area.”
Nevertheless, insurers and providers do appear increasingly to be recognising there is at the very least demand from employers for a more proactive and questioning evidence-based approach. In May last year, for example, Bupa announced it was reviewing the way it dealt with knee arthroscopies, as “some surgeons are three times more likely to perform a knee arthroscopy on Bupa customers than others”, including introducing a new medical review process to confirm eligibility for funding.
It also in January this year introduced a new “open referral” system whereby GPs no longer need to specify a named consultant, with clients offered a choice from a Bupa-approved network.
“What we are finding generally is that, while there is a lot of great healthcare being given, there is also often too much being given, which is a consequence of the UK’s private healthcare system being structured on a ‘fee for service’ basis,” explains Dr Natalie-Jane Macdonald, managing director of Bupa Health & Wellbeing.
“The more you do the more you get paid for, and that can lead to a tendency for there to be higher levels of intervention than may be necessary. If a GP believes someone needs to see a particular consultant then, of course, they should do so. But a lot of the time referrals are made on the basis of informal relationships or private contacts,” she adds.
Aviva, too, three years ago launched Back-Up, a rehabilitation service centred on managing back and neck pain but without the need to see a GP first, even though GPs are very much kept in the loop to assuage any issues they may have about inappropriate decisions being made, emphasises Reynolds.
“All information flows back to the GP and they are, of course, kept fully informed. If the individual is not getting the result they want they can always talk to their GP, but it is not a one-size-fits-all approach," he says.
Reynolds adds that insurance has in many ways lost sight of its direction and "become in too many cases just a bill payer".
"It has devolved the responsibility for looking at treatment pathways to the medical practitioners,” he says.
TRUSTS OR FULLY INSURED
So, is one answer corporate healthcare trusts? The difficulty with these is that while technically the employer will have more control, in practice it may be the insurance premium tax savings that can be accrued that may be more of a motivator for setting up a trust scheme in the first place, argues AXA PPP’s Hurst.
“Healthcare trusts are a very tax efficient vehicle, which is a significant driver for firms to go down that route, although some do also go the extra mile in terms of specifying the design of the benefit plan and any limitations,” he says.