OFT report in-depth: tough words for hospitals and consultants

Market review supports insurers' complaints about lack of data

Bupa’s claim that GPs and patients lack the information they need to make informed decisions about where to refer patients has been upheld by the Office of Fair Trading's (OFT) review of the private healthcare market.

The OFT’s survey of 400 GPs found that only a minority believe that "all" or "most" of their information needs around private healthcare facilities and consultants are being met, in terms of both quality of care and pricing.

In a report which sides largely with insurers over private healthcare providers, the OFT describes the tactics used by insurers to control costs as "blunt and potentially distortive policies" but concludes that insurers have little alternative given the absence of transparency about quality of care and fees. It also reports that it has seen no evidence to suggest that the supply of consultants has been affected by fee caps. In fact, 58% of consultants surveyed have spare capacity.

Lack of informed choice

The OFT report heavily emphasises the role of choice in driving competition. It cites a recent report by the King’s Fund which found that 75% of patients thought choice was either "very important" or "important" and a British Social Attitudes Survey which found that 95% of people think there should be at least some choice over which hospital a patient attends.

It also highlights the importance of the GP's role in the patient pathway. Three-quarters of GPs surveyed told the OFT that they thought they were the most important influence on a patient's choice of hospital or doctor.

Although Bupa has claimed that a significant number of referrals it receives are "open", evidence submitted to the OFT indicates that around 85% of GP referrals for PMI-funded patients are to named consultants.

However, GPs reported that the main factor they consider when making private referrals is the consultant's reputation and the OFT warns that this reliance on "soft intelligence" may not result in an informed choice.

The OFT also reports that only a small minority of consultants offer their patients a choice between their main private hospital and another facility, further restricting choice.

Lack of data

Private hospitals groups have argued that they do publish information online, but the OFT believes that this is "too variable to compare easily". It also says that consultant-level data is "largely absent" so that patients rely on their GP's recommendation. It compares the sector unfavourably with the NHS, which publishes comparable data about hospitals on the NHS Choices website and also voices doubts about the Hellenic Project, often held up by private hospital groups as evidence of their commitment to transparency. Participants in the review voiced concerns, including whether the Project would enable comparison with NHS facilities.

The OFT also highlights that in a "significant number of instances", consultants are failing to provide patients with fee estimates before they undergo treatment. Its survey of 400 consultants found that less than half of consultants provided a fee estimate at the first consultation while GPs told the OFT that they "rarely" or "never" knew a consultant’s first consultation fee.

Insurers in the dark

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