With the number of people awaiting NHS treatment staying stubbornly above seven million people, demand for individual private medical insurance (PMI) has skyrocketed, and this past year has proven no different.
Insurers are responding to this growing demand by upping investment in digital services which has the added bonus of providing care to patients outside their area of residence for treatments traditionally carried out by the NHS.
While younger, wealthier people are driving demand for services, the over-65s are more mindful of the cost of treatment. But this is where guided care options are offering a potent solution.
And this demand is only set to continue as the Labour government continues to execute its plans for turning around the nation’s health service, with today’s official data showing the NHS waiting list at around 7.46 million people in December 2024.
Significant demand and technology
“PMI continues to experience significant demand, with customers wanting more from their policy than just having access to onward treatment,” Arun Thiyagarajan, CEO of VitalityHealth, tells Health & Protection.
“People are now looking for everyday health and wellbeing services like virtual GPs, physiotherapy, and mental health support.
“Last year, these primary care services made up two-thirds of all our member claims,” Thiyagarajan adds.
For Axa Health the use of technology and artificial intelligence (AI) are delivering more benefits for customers and businesses alike.
“We firmly believe in the benefits that good digital services can provide,” it said.
“As such, we’re supporting our members with faster, convenient access to online, specialist-led care, such as our dermatology service which enables members to receive a response from a specialist in as few as three days.”
Treatment outside area of residence
It also points out that one of the main benefits of online access is that patients are no longer restricted to clinicians and services in their area.
“Patients can be put in touch with clinicians anywhere across the UK, improving member experience, offering both speed and convenience and increased access to expertise,” it says.
“It’s likely that demand for digital services in healthcare will continue to grow, and we will seek to meet the needs and expectation of our members.
“However, we always offer a range of options for those who prefer not to use our digital services, and, whatever route a member chooses, there is always human interaction involved.”
But the provider has also seen an increased demand for their individual PMI offering driven in part by greater awareness of health and wellbeing and concerns about high demand for NHS services.
It adds that areas such as musculoskeletalhealth, mental wellbeing, and digestive health are in significant demand, with abdominal pain accounting for the second highest number of calls to its Doctor at Hand service last year.
But there has also been increased interest in PMI from younger families, with people prioritising the wellbeing of their loved ones.
Younger age groups driving demand
This increased demand from younger age groups is certainly a trend that advisers can attest to.
Kristian Breeze, director of healthcare at Ascend Health, maintains among current key growth demographics, self-employed professionals and higher-earning millennials are leading the charge.
“The surge in remote and flexible working has shifted the burden of healthcare provision away from employers, prompting freelancers and small business owners to seek individual PMI for security,” Breeze says.
“Additionally, younger professionals, once less engaged with private healthcare, are now opting for cover, recognising its role in maintaining productivity and well-being, if not offered as a work-perk.”
Demand from sole traders
For Marcia Reid, non-executive director at Sherwood Healthcare, self-employed sole traders are now aware of the impact that the NHS waiting lists could have on delaying treatment.
“This can have a serious effect on their ability to continue working and generating income,” Reid says.
“We are also noticing a continued increase in uptake of continuation options for those leaving company paid schemes either through retirement or redundancy as they have been accustomed to the comfort of private health insurance cover and feel exposed without it.
“We are finding particular interest among start-up owners who recognise that PMI is an essential part of their risk management strategy. These one-man start-ups often quickly expand to create SME schemes which is good news.”
But while Sherwood Healthcare continues to see greater interest in individual PMI, customers aged over 65, are often surprised at the cost, Reid says.
Mitigating costs
But guided care options continue to offer a compelling solution to cost concerns, says Graham Singleton, CEO of National Friendly.
“Guided treatments provide great value for those customers who are open to flexibility in their choice of specialist,” Singleton says.
“Apart from the benefit of receiving a lower monthly premium, these pathways provide a seamless experience – the claims team has real time access to book in appointments with a consultant, eliminating the hassle of searching for a specialist.
“This ensures speedier access to care tailored to the customer’s location and needs. In addition, customers who accept a consultant recommended by the claims team avoid the risk of shortfalls if the consultant’s fees exceed customary and reasonable limits.
“Given the sharp rise in medical inflation over the past year, this is an increasingly valuable benefit.”
Indeed, Penny Jackson, owner of the Insurance Boutique, says guided care is still proving to be “very” popular.
“Older clients who have been insured for a long time are less open to guided care as they like to have more control over who they see, particularly those who like to use top London hospitals,” Jackson says.
“Directed pathways are often the cause of claims issues when we are having to intervene, physio session have been reported to be 10-15 mins long, limited access to services and not being able to choose their own physio is proving to be an issue.
“When the physio hasn’t resolved the issue there doesn’t seem to be any direct help to get further treatment.”
For Vicki Mclean, distribution director at Aviva UK Health, directed, or guided care, networks and treatment pathways are instrumental to the insurer’s strategy.
“They deliver value for customers,” she says, “directing them to appropriate treatment at the right time and in the right place – while also driving value from the insurer’s claims spend.
“This in turn helps to keep premiums affordable and private healthcare accessible to as many people as possible.”
Increased demand likely to continue
Looking ahead, Mclean maintains increased appetite for private health insurance will likely continue while the government works through its review and strategy for the future of the NHS.
“Providers must look for ways to complement NHS provision, offering affordable solutions and added value benefits that appeal to the distinct needs of different demographics,” Mclean says.
“As demand continues, insurers will need to work hard to deliver value from their claims spend. This is where approaches such as guiding, pathways and networks have a key role to play.
“Customers can be confident that they’re getting the right treatment for their individual circumstances, while providers help control the cost of their healthcare.”
Predicting demand
But Mclean adds a key challenge is predicting this demand, understanding which customers it’s coming from, and putting in place the right infrastructure to support it.
“We know it’s coming and are working with our suppliers and internal teams, to capacity plan and put in place processes that give us the confidence that this increased demand can continue to be met,” she continues.
“Increased demand brings with it opportunities for us to guide more customers through our networks and pathways, to help deliver maximum value for the customer and from our claims spend.”
And Mclean maintains, speed of access to effective diagnostics and treatment will continue to be key drivers of future demand.
“Younger consumers will also expect value from their product through everyday health and lifestyle health solutions – at a time in their lives when they’re less likely to claim for treatments,” she concludes.
