Limits placed by private medical insurance (PMI) providers on patient choice of treatment is adversely affecting patient outcomes and in some cases potentially risking lives.
This was the stark warning from Dr Susan Alexander, chairwoman of the Independent Doctors Federation’s (IDF) education committee in addressing delegates at Laing Buisson’s Private Acute Healthcare Cover Summit today.
Dr Alexander’s comments follow the IDF’s campaign to rebalance the relationship between medical professionals and private health insurers launched last month.
Research by the IDF among almost 500 of its members found private medical practitioners were overwhelmingly unhappy with insurers and how the market for private healthcare was operating.
IDF specialist committee chairman Andy Roche told Health & Protection he believes some insurers operating in the market are exhibiting anti-competitive behaviour and creating massive inequalities in how doctors are treated.
Treating shoulder injuries
Supporting her argument that insurer practices were harming patient outcomes, Dr Alexander cited three examples.
The first came from her work as a shoulder surgeon where patients come in with injuries limiting their ability to lift their hands, wash themselves or get dressed.
She explained that while these injuries were relatively easy to treat with an injection, patients faced a choice.
“We can either do it with ultrasound guidance which has 100% accuracy of needle placement or we can do it without ultrasound, which has about a 75% success rate. Which will you choose?” she said.
“For you to understand this, I would be keen to see if we have any volunteers who would be willing to put this banana on their head which is about the size of the proportion of the area that we’re trying to go for while I throw a dart and aim at the banana.
“But to make this realistic, what we’re going to do is I’ll be wearing a blindfold? Anyone? No?”
Knee injuries
The second example Dr Alexander put forward was the “super common” issue of knee injuries.
“What happens?” she continued. “They go and see their doctor who tells them to do physio.
“That’s [not] going to work. So then what happens? They go back and the doctor recommends more physio.
“That doesn’t work. What happens then? They say they’ll inject you, but they inject the wrong place.”
Dr Alexander revealed that she works with one of the top specialists in the country who can treat these injuries with a botox injection to the muscle.
“You switch the muscle off, you train the correct muscle,” Dr Alexander added. “And 75% of patients got better after the first injection. A staggering 85% got better after the second injection.
“But here’s the kicker. Perversely, some patients are not allowed to choose to see this specialist because he doesn’t charge within the fee rate.
“Secondly, if they do get to see him, they’re not allowed to have that treatment because it’s experimental.
“Despite being published in the top journal in 2016, over 500 patients have had this treatment, but it’s experimental.”
Critical illness
But Dr Alexander explained these limitations on treatment even extended to critical illnesses such as heart conditions.
“Last week, I was speaking to an eminent consulting cardiologist, who said to me: ‘Susie, you don’t understand. Patients come in with acute chest pain. They get admitted as a critical patient and on the ward they say they’ve got private health insurance,” Dr Alexander said.
“But this is the conversation that happens with the healthcare. They can either choose to go private and have the coronary angiogram that they need within 24 to 48 hours or if they stay in the NHS, they will get £200 a day from their insurance companies to stay in the NHS.
“My reaction is for goodness sake, it’s almost bordering on immoral. How can you justify that?
“What they don’t explain to the patient is that if they do have an event outside of hours, they’re not going to get the same level of care that they would have done had if they had gone privately.”
Patients lives potentially at risk
Consequently, Dr Alexander warned patient’s lives are potentially at risk.
“Now I know there are bad doctors. I know there are doctors that do scandalous things,” she said
“But the vast majority of my membership are deeply caring and personal. We want to do a good job.
“You look after us. We put our patients first,” she concluded.