Healix backs PMI open referrals

Healix has voiced support for the use of open referrals within the private medical insurance (PMI) market but warned that insurers need to be more transparent about the process.

The healthcare trust provider denied claims that using open referrals restricted patient choice and could compromise quality of care.

However it noted that insurers risked alienating the important doctor-patient relationship if they only used cost as a reason to choose healthcare provider.

Bupa has been the most prominent insurer to use open referrals for patients requiring further treatment, but its decision has divided opinion among patients, brokers and doctors.

Sophina Gapare-Mburia, commercial manager of Healix Health Services, said that quality of care had to be the number one priority for any private healthcare provider but she did not believe this was being compromised by any of the recent initiatives introduced.

"However, what I think some of these organisations may not be focusing on - especially in helping potential clients and patients understand their approach - is the decision-making process to select the right healthcare provider for an individual," she said.

"Of course cost is an important consideration for our clients, but more often than not for employees, knowing more about clinical quality provided by their healthcare provider and knowing the available choices is just as important.

"And, in their view, this makes the entire process of choosing a provider a lot easier," she added.

Gapare-Mburia also recognised that disrupting the doctor-patient relationship with open referrals could be problematic and argued that the private healthcare market was "probably the toughest it has ever been".

"We recognise that the relationship between the patient and their healthcare provider is important," she continued.

"A one size fits all approach may not be suitable for everyone and this is why our nurses can offer individuals guidance on all providers who may be involved in their care, thus truly offering choice by giving them the responsibility of choosing their healthcare provider.

"For employers the need to continue to look after the health of their workforce remains high on their agenda.
"Getting the balance between commercial considerations and retaining a healthy workforce is, therefore, a challenge facing many organisations," she added.