Comment: Why Bupa is right to challenge the doctors


There's one over-arching factor behind the high cost of PMI that's virtually never mentioned in public

Just why is private medical insurance (PMI) – the cornerstone of this publication – so expensive? After all, you don't need to commission an opinion poll to know that clients fail to buy individual PMI because of cost rather than an ideological attachment to the NHS. Most will embrace it when it is at low or no cost as part of a workplace remuneration package.

It's not a question that is often put, and even to pose it risks being seen as some sort of idiot. Those in the industry that would even bother to respond would take the questioner to one side, pour them a cold drink and explain in words of one syllable that it's dear because doctors and hospitals charge a lot.

They'll rub in the point by highlighting fast inflating costs which are due to the growing complexity of procedures, increasing demands on medicine, and our desire to live longer and healthier lives. They'll also show how NHS costs are escalating with much the same line on the price graph. And much else besides.

Some insurers will also say that they are offering better than ever value thanks to no claims discounts and improved risk assessment, although these could mean some pay more to cross-subsidise supposed healthier customers.

But there's one over-arching factor behind the high cost of cover that's virtually never mentioned in public and certainly not in polite society. And that's the extreme expense of the medical profession and of the facilities they use.

A century ago, George Bernard Shaw said “all professions are conspiracies against the laity”. It's still true even if some professions have been opened out to competition. Lawyers still have power and high charges but have long since lost monopolies on will-writing and conveyancing to para-legal firms or to do-it-yourself law.

But lawyers never managed to convince the public they were arbiters of life and death – unlike the medical profession which has replaced the previous stranglehold of the clergy in mortality. Just as past generations did not countenance criticism of the church, nowadays you have to be very brave or foolhardy to criticise the doctors' establishment and their cost structure. So let's do that.

Take a look at the recent furore over Bupa's claims that some orthopaedic surgeons carried out unnecessary knee arthroscopies on patients. This is a procedure used to treat inflammation or injury, or to repair damaged tissue and cartilage. It is performed through small skin cuts, using a arthroscope (a form of microscope) attached to a video camera. Pay as you go customers need to fork out around £2,400 a time for this – what Bupa pays is clouded in commercial confidentiality but it won't be far distant.

Bupa says this procedure is twice as common among its customer base as in the NHS. And it alleges some doctors carry this outpatient operation three times as much as others. Bupa cannot explain these discrepancies. It wants pre-surgery checks before approving payment.

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