Are private patients being overcharged?

Questions included:

n Is the department deliberately overcharging private healthcare patients thousands of pounds in order to reduce its overspend?

n Is the department aware its private healthcare costs are nearly three times what they are in many private wards in the UK?

and importantly:

n How does the department decide what to charge private patients?

What does it matter if wealthy private patients are being charged a bit too much, you might ask?

Last month Island Global Research released findings from the Primary Care survey sponsored by the Committee for Health & Social Care. The survey tells us ‘there were notable differences in people without health insurance compared to those with’.

Worryingly, these results show that in the last year 48% of us had said that cost had stopped or delayed us accessing primary care, rising to almost 70% for those without health insurance.

These figures have disturbing implications. While there remains material inequities between the drugs and treatment options (not just Nice TAs) available under States contract, compared to that available to private patients, the inequalities built into our health system continue to grow.

In terms of our economy, what might this mean for future growth? Any attempt our government might make to improve our productivity (rather than growing the population) and/or increasing the working life of our population, must surely be impacted by a population already struggling to afford even routine primary healthcare services?

Too many of us place complete trust in their GP or consultant, assuming they will advise you of all the treatment options available. They don’t. In fact HSC instructs them not too. HSC’s policy document (G1033 Priority setting in Health & Social Care) says GPs, healthcare professionals, nurses and secondary healthcare practitioners must not introduce any new treatments or initiatives which will increase costs. HSC goes on to say: ‘Neither should they raise patient or client expectations about care to be provided, or refer publicly-funded patients for treatments or interventions, not currently funded.’

Simply put, too many islanders receive cheaper, sub-optimal drugs and treatments, which can lead to less favourable health outcomes, with our doctors strongly discouraged from telling you. If you say you can pay to go private then not only might you get treated quicker but you will now be told about all the treatment options available to you, without HSC restrictions tying clinicians’ hands.

As our surgical waiting lists continue to climb, hitting record levels, more and more ordinary Guernsey folk, living in discomfort, debilitating pain, or managing chronic illnesses, are being forced to decide whether to dip into savings, pension pots, sell assets or borrow money to self-fund a routine level of healthcare treatment, treatment readily available to those with comprehensive health insurance or deep pockets.

Health Equality for All has become aware of the plight of one particular patient who has been denied what would be the NHS-recommended treatment option for their cancer. The appeal against this decision was also denied, despite demonstrating what you and I would consider as quite exceptional medical and personal circumstances, leaving them with two choices – accept the free sub-optimal Guernsey treatment, or self-fund to receive life-extending treatment, but incurring costs that will consume a small pension and force them to sell their modest house.

This patient also made Heal aware that HSC, in addition to the charges it makes to recover the costs of this treatment, actually add a further 25% to the bill. HSC have confirmed this to be so, calling it an ‘uplift’ or ‘mark-up’ and applies it to all private patients.

To us it sounds like HSC are taking advantage of those least able to afford it, profiting in the worst possible circumstances, communicated to patients from HSC’s aptly-named private patient income management department.

Some might argue that taking a 25% profit from patients with limited financial means, in addition to covering costs, for a treatment or procedure routinely available in other comparable jurisdictions, is cruel and morally wrong. Heal would strongly agree with those people.

Since April Heal has been trying to establish the facts around HSC’s private patient charging policies, how they benchmark their health service charges against other jurisdictions and why a 25% mark-up is considered appropriate in all cases, regardless of one’s personal circumstances. Unlike other jurisdictions we like to compare ourselves favourably towards, we do not provide the same depth and breadth of treatment options, yet HSC appears to charge us as if they do, pricing in a 25% profit.

Unlike other jurisdictions, HSC’s private patient charging policy is not accessible to you and I, the Bailiwick folk who are impacted by it.

So how does a patient understand what they are signing up to and how do they appeal if they find the charges excessive? They can’t, is the simple answer.

After months of polite requests we were finally informed that HSC’s established private patient charging position is not actually set out in an operational policy document.

I’ll say that again.

HSC does not have an operational policy document to guide officers in their application of this policy or help the public understand the extent of charges, how they will be applied and for what (as the Medical Specialist Group does). Some might argue that this could be deemed as a gross failure or neglect under the Nolan principles of good governance. Heal would find it difficult to disagree.

Heal has written to all deputies asking that they approach HSC with the following requests.

1. In the first instance, immediately stop applying the 25% mark-up to all self-funding private patients (i.e. those without health insurance) until there is clear, publicly-accessible guidance on the range and extent of their charges on gov.gg, that includes a process of exemption or appeal from them.

2. Personally meet with the patient who, in the face of a non-curative cancer diagnosis and exceptionally challenging personal circumstances, has been brave enough to allow us to share their experience of our health system with deputies and attempt to improve it for others.

3. Make a statement at the next States meeting that commits the Committee for Health & Social Care to an urgent review and benchmarking process of our private patient charges.

Heal asks that those of you who have chosen to self-fund to tell us why you made that decision and what help or support you got to understand HSC’s charges.

We also ask everyone without comprehensive private medical cover to ask their GP or consultant at their next appointment, am I receiving the best possible treatment option or are there other options if I were to pay? And let us know their response.

MIKE READ

Chairman, Health Equality for All (Heal)