Shopping around

With the rising costs associated with individual private medical insurance (PMI), and growing waiting lists for the NHS, many people are finding themselves more open to the idea of paying for treatment in the private sector.

The self-pay market for hospital services is significant and growing fast. In 1997, 100,000 people elected to self pay for treatment in Independent Healthcare Association (IHA) hospitals, which accounts for around 95% of all private hospitals. It is estimated that 250,000 people opted for self pay in 2001, representing a 150% rise in five years.

People are now finding they do not need PMI in order to afford private medical care and it is not always the case that they are forced into it due to long NHS waiting lists. Increasingly people are demonstrating a willingness to self pay for a one-off procedure.

Many IFAs will have clients who might be shopping around for the right deal and hospital, but what should they be looking for? The main points to consider are the standard of care available, the cost, and the services offered for that price.

Top quality

The basic standard of care in any hospital is guaranteed to be high and meet minimum standards, as a result of a new act of Parliament, the Care Standards Act, which came into effect on 1 April. This lays down minimum required standards for independent hospitals, but it would be safe to say all independent hospitals were adhering to this anyway. Most hospitals either have accreditation through the Health Quality Service (HQS), or are in the process of applying for it.

Peter Fermoy, communications manager at IHA, says: 'The majority of hospitals will be beyond the minimum standard, but the minimum standards themselves are extremely rigorous anyway. The general quality of care in the private sector is as good as any NHS hospital. For the type of operations private hospitals specialise in ' such as acute elective surgery ' the care and treatment will match the NHS, and in some cases will be better. My recommendation for someone on the verge of self funding would be to ask if you can have a look around the hospital.'

Given the assurance of minimum standards, the question of whether all hospitals are on a par when it comes to quality of care and whether choice should be based solely on price, is debatable. Neil Armitage, marketing director of Go Private, a sourcing service for those looking to self pay thinks there is not a great deal in it.

He says: 'I would say private hospital care is much of a muchness. There may be specialities because they have a particular unit or consultant expert in that field, but as for standards I think they are all pretty much the same.'

Roger Hymas, director of Healthcare Navigator, another sourcing service, thinks the service is more personal.

He says: 'Despite the fact that there are objective standards, there is a huge amount of subjectivity that affects the individual consumer, so hospitals have to be sifted. Regardless of league tables or standards, at the end of the day it comes down to your condition and how it will be treated in a particular hospital by a particular group of practitioners. You might find the best hospital in the country with the best facilities, but you must still do some homework to ensure what you are getting is absolutely right for you.'

The cost of care

It is probably fair to say the biggest difference between hospitals, or hospital groups such as BUPA or Nuffield Hospitals, is price. Each hospital will generally offer the patient a fixed price, but the contents of the deal will vary.

Armitage says: 'Any package should include diagnostics treatment and a certain amount of aftercare should any problems occur. This takes for granted that the client will be looking for a fixed price deal. You should always negotiate a fixed price.'

Fermoy agrees: 'If a person was buying one operation for themselves, then fixed-price care would be a good idea. There are variations in packages from each of the hospital groups, but there is no one aspect I would say was better than another as the situation will always vary. It depends on how much aftercare or how many consultant visits you want included. The priority is not what you pay ' but the standard of care you receive.'

Having established the need to shop around for the right package with the best hospital how do you go about it? The first point of contact should always be the patient's GP. Other organisations may supply information the GP does not have, but none will replace the service they offer.

The larger groups could be contacted direct. BUPA Hospitals and Nuffield Hospitals, through Nuffield Hospitals Direct, both offer plenty of information and a direct service that can be accessed through their websites. This can result in the customer paying more, however, as it does not constitute shopping around.

Dr Foster, which can be found on the internet, is a public service supported both by business and the Department of Health. It tells you which private services are available and how good they are in comparison with each other. The site has hospital specific facilities guides and sample price lists and helps explain the choices and how to use them. The service is free and invaluable for those shopping for treatment alone.

For those who do not feel comfortable going it alone there remains the private healthcare sourcing services, such as Go Private and Healthcare Navigator. A subscription to these services costs less than £100 and they make a decent case for using their services.

Armitage says: 'I would express a caveat about shopping around in something that is not an area of competence. A professional organisation will generally get better value for money than an individual on their own.'

He adds: 'An individual would be wise to contact an organisation like ours because we know where to shop and are aware of the specialists that may have faster recovery times, for example. We buy healthcare en masse so we can often get better prices than an individual might get on their own.

'There is also the chance to take advantage of prices outside an individual's area. There may, for example, be a better price in Northampton than an individual may get in Bristol, and it might be possible to organise a private ambulance to take the client to and from the centre of treatment while still offering a saving.'

Hymas adds: 'To simplify, it is like buying a package holiday where parts of the holiday may not be right for you. It is important to offer a bespoke package ' we customise each of our customers' deals. There is nothing stopping an individual doing this, but we have several years' experience of understanding where the pitfalls and benefits are.'

Worst-case scenario

Should something go wrong there are a variety of mechanisms to resolve complaints. A complaints procedure was launched by the IHA last year, and all member hospitals of the IHA adhere to this code.

It is a three-stage process, the first being an internal investigation. The second stage is a review of the case if the complainant is not satisfied and third, if the case is still not resolved, access to an independent external adjudicator is also available.

Fermoy says: 'In the year the scheme has been up and running I think two or three cases have reached the external adjudicator.'

All private hospitals have an official procedure, as it is part of the new Care Standards Act. For those who have used a sourcing company, it is generally still the case that the patient is in contract with the hospital and must deal directly with that hospital should they have a complaint.

Hymas says: 'You should look at all your rights as a consumer. You are buying a service and that service has to be delivered in the spirit of the offer.'

Searching for a private hospital alone is not highly recommended, according to Hymas:

'People literally spend less time exploring solutions to their medical problems than they do in buying a new car ' they tend to be carried along by the system. Once you are in the supply chain of healthcare your GP may start by referring you to the wrong person, so as soon as you have a condition it is time for you to start doing your homework.'

Paul Robertson is a staff writer