More reaction to the OFT's private healthcare report

Doctors group says OFT 'undermines insurers' claims'

The Federation of Independent Practitioners Organisations (FIPO), which represents doctors practising privately, has welcomed the proposal by the Office of Fair Trading (OFT) to refer the private healthcare market to the Competition Commission.

In a statement issued today, FIPO said it would urge the Commission to "involve the major private medical insurance providers directly and fully", describing the OFT's engagement with insurers as "narrow" and on an "arms length FSA linked basis". Although it is the Financial Services Authority and the Association of British Insurers (ABI) that have pledged to work with insurers on the issue of clarity around shortfalls, the OFT held roundtable discussions with all the major PMI providers as part of its review of the market.

Richard Packer of FIPO said: "The issue of short falls on consultant fees can only be properly reviewed if the data from all the insurers is used in a full investigation. FIPO believes that actual average shortfall is insignificant, around 1.5 per cent, and that the lack of transparency at the point of sale for PMI policies has some bearing on the issues that arise."

Insurers give a range of estimates on the percentage of claims that involve shortfalls but some, including Bupa and Aviva UK Health, have told Health Insurance that shortfalls remains a significant cause of concern for members. Although one outcome of its review was the move by the FSA and ABI to ensure insurers are clear about the potential for members to suffer shortfalls, the OFT has also concluded that consultants are failing to be upfront about their fees with patients and that, without data on quality of care, patients are unable to judge whether it is worthwhile paying a shortfall. FIPO's own survey of its members found that more than 30% of consultants do not give fee estimates.

The OFT did acknowledge the importance of the GP in helping patients make decisions about which consultant to see, which has been welcomed by FIPO, which has also agreed with the OFT that it is important that there is "adequate and comparable" information available to aid choice.

FIPO has also highlighted the OFT's finding that insurers, like GPs and patients, lack the information necessary to make recommendations about which consultant members should see.

Intermediary reaction

The Association of Medical insurance Intermediaries (AMII) has also welcomed the OFT's report.

AMII chairman, Andrew Tripp said today that the organisation was in favour of greater transparency around benefit fee limits for consultants and anaesthetists.

Although it recognises that benefit fee limits and hospital networks are necessary to control costs for consumers, AMII argues that there should be a distinction between hospital networks - where policyholders agree to go to a selected list of hospitals in return for a lower premium - and treatment networks - where the insurer insists that certain treatments are only funded if carried out by particular doctors or at particular hospitals. It says that in the latter case, insurers should publish the criteria they are using to determine who is included in the network and policyholders should have the option to "opt out" in exchange for paying a higher premium.



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