The Office of Fair Trading recently raised concerns that patients were suffering in the current private healthcare market because of a lack of information about the quality and cost of care in different hospitals with different consultants. It claimed that GPs were relying on "informal information" about quality in making referral decisions and that consultants enjoyed most of the power in the market, failing to compete on price or quality.
Bupa argues that it has "an unparalleled level of information to assess hospitals and specialists" and says that members will benefit from Open Referral by getting access to "specialists and hospitals that give a better level of care" and more choice of specialists, possibly resulting in faster access to care. It also argues that the process will mean members do not suffer shortfalls.
Paula Aitken, commercial manager at intermediary Private Health Partnership, had a positive reaction to these arguments.
"Any change within the industry which ensures the end user of private healthcare has access to quality care and at the same time is guaranteed no ‘shortfalls’ can only be a good thing," she said. "The customer still has a choice as he or she will be provided with this choice at the point of authorisation rather than the GP making this choice for customers."
Previous moves by Bupa to manage the patient pathway have been opposed by doctors and raised suspicions in the intermediary community that the insurer may be moving towards managed care pathways.
Alex Bennett of intermediary Bluefin described Open Referral as "a bold move".
"My concern for Bupa would be to what degree they have considered or understood that their members see freedom of choice within their peer group," he said. "If you think about the people that enjoy PMI they are high net worth individuals, who are well-connected and talk to each other about consultants and places to go for treatment. It is not too dissimilar for employees and I just wonder whether people are quite ready yet to be directed."
He warned that the process, based partly on clinical concerns, was "mixed up with economic reasons and commercial reasons" and that Bupa could generate the same "confusion and debate" as the National Institute for Health and Clinical Excellence, which uses both clinical and cost considerations to assess what the NHS should fund.
"The recent Bupa stance on cancer cover was playing to the strength of their brand and this runs slightly contrary to that," he said. Earlier this year Bupa decided to remove the option for corporates to place maximum annual limits on cancer cover.
Bennett said, however, that intermediaries would have "just about enough time" to educate clients about the change and, if necessary, switch insurers, before the January renewals season.
A trend in corporate healthcare
Open referral is not a new concept in the PMI market, although it has proved controversial. AXA PPP healthcare's Corporate Patient Pathways is a policy which gives corporate clients a discount of up to 15% in return for giving the insurer responsibility for choosing a provider to deliver the treatment recommended by the member’s GP (who must supply an open referral). However, unlike Bupa's Open Referral, this is not mandatory but one of several options corporate customers can choose from.