PMI open referrals: Bupa speaks out

Bupa’s open referral process has attracted criticism. In return, Dr Natalie-Jane Macdonald puts forward the case for Bupa

In today’s tough economic climate, consumers and businesses alike have to make difficult choices about how they spend their money. As a result, they demand better value for money, greater choice and higher standards from service providers, who in turn have to work harder to attract and retain customers.

At Bupa, we have seen this in feedback from our customers: they value their health insurance, but cost is a significant issue – not only monthly premiums but also shortfall costs following treatment, which are the biggest cause of complaints. So members expect us to develop innovative solutions to improve the quality of care available to them – while keeping health insurance affordable.

These are challenging demands in any economic climate, but particularly at a time when we have seen medical inflation rising at a staggering rate, resulting in premium price increases of 10% per year for most of the decade, despite Bupa reducing its own costs. This creates the risk of health insurance becoming unaffordable for many who rely on it.

So, how are we at Bupa responding to these challenges? We have announced new products such as our Cancer Cash Benefit to give patients more choice and control over their healthcare. We are also tackling the causes of medical inflation to keep health insurance affordable, through our negotiations with hospital groups to prevent excessive price increases.

But I want to talk more about our most recent initiative: the introduction of our Open Referral process, which has been successfully tested with several corporate clients and Bupa’s own employee health insurance scheme during 2011 and will be a standard addition to our Corporate Select product from January 2012.

The facts about open referrals

Traditionally, when a GP recommends that a Bupa member sees a consultant privately, the GP provides the member with a referral to a named consultant, or sometimes advises the member to contact the local private hospital where they will be allocated a consultant.

However, as recent research carried out for the Office of Fair Trading shows, GPs often have limited information about a consultant’s care practices, outcomes, patient experience or private patient charges or end to end costs of care.

This means that when our members need specialist care, they are often guided to a consultant based on ‘informal’ information, and sometimes experience unexpected top-up fees from the consultant because they charge outside of Bupa’s monetary limits.