The HI Profile: Bupa's Tony Wood

As an outsider looking in, Wood was shocked in particular to see that not enough was being done to address the rising cost of private healthcare, which he says is significantly higher in the UK than it is in Australia and twice what it is in Spain.

“That is really concerning because in Australia we talked about the affordability and the long-term sustainability of the industry,” he continues. “It had never dawned on me before I came here that the UK was so much more expensive.”

As market leader, Bupa, Wood says, was conscious that in order to address the issue it would have to drive through changes, both internally and externally, itself.

“Everyone wanted to see the business be more courageous, be more innovative, really lead the market more strongly, be more consultative and really do something about the sustainability of the market,” he says. “That was one of the key messages I heard from people. That was a very common theme.”

OPEN REFERRAL

Of course, as market leader sometimes you can be damned if you do and damned if you don’t, but if nothing else Bupa cannot be criticised for failing to take the bull by the horns on the issue of price and sustainability. The introduction of “open referral” for its Corporate Select customers early this year, after a soft launch last year, has generated heated debate across the health insurance industry as a whole but it is nothing if not bold.

Open referral means that, instead of referring patients directly to a named consultant of their choosing, GPs will have to provide them with a referral for a procedure with no named consultant. The member will then call Bupa to preauthorise the diagnostic procedure or treatment they need and, provided this is covered by the policy, they will be provided with a choice of consultants at nearby hospitals. The member can then book their consultant appointment.

To the man on the street not used to PMI, this of course would seem quite straightforward. However, the introduction of open referral changes the very way the PMI market has operated for years. It has also come in for fierce criticism from some consultants and hospitals who argue that the new system is part of an ongoing Bupa initiative to direct patients to healthcare facilities who charge the lowest price rather than offering patients access to the best quality facilities and doctors – something which the insurer absolutely denies.

The disagreement between Bupa and some hospitals and clinicians was most keenly – and most publicly – felt when the insurer decided to delist over 30 BMI Healthcare facilities towards the end of last year. While the dispute is now largely resolved – only a handful now remain out of network – the fact that it spilled over first onto the pages of Health Insurance and then the pages of the national press was “disappointing” for the image of the PMI and private healthcare industries, Wood says.

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