Private healthcare in the UK is the most expensive in Europe. Stephanie Spicer asks whether we will see more people turning their backs on UK providers in favour of low-cost treatment abroad
CLIENTS PAYING for their own healthcare clearly have the option to go abroad. But demand in practice is questionable and, for many insurers, so is the need to offer treatment overseas.
However, a recent Mori poll commissioned by the British Medical Association found 42% of patients would travel outside the UK for treatment.
Some 26% said they would travel anywhere in the world and 15% said they would travel anywhere in Europe. This is if they were facing a long waiting list and the NHS paid for their treatment. The European Court recently ruled patients should be able to seek treatment in other EU member states if they were facing long waiting lists in their own country. The issue is not one of quality of care but that the problem of waiting lists doesn't exist in many European countries which generally have more beds free and enough doctors to treat patients.
The appeal for those seeking treatment abroad is two-fold: those in the NHS system avoid waiting lists and private individuals save money through cheaper costs. But insurers debate the latter.
'The reason people are going abroad is not for the specialism, but because they are on a waiting list in the UK,' says Suzanne Kelly, senior communications consultant for BUPA. 'But if you have PMI you don't have a waiting list. So we don't see the need for private patients to go abroad, we have fantastic specialist services here.'
Neil Armitage, marketing director of self-pay provider GoPrivate, agrees: 'We can usually get you in as fast as anyone abroad due to how we purchase treatments on behalf of our clients. If it is a timing issue, you are best not going abroad.'
False economy
Health insurance broker Medibroker has compared costs of self-pay treatment in the UK and abroad and found them higher in the UK. Medibroker estimates costs in BUPA or Nuffield hospitals for a hip replacement would cost between £7,200 and £10,000 or £6,369 and £7,600 respectively. The cost in Germany would be £5,248 in Belgium £4,645 and in South Africa about £4,900.
Insurers, however, dispute the cost savings of being treated abroad: 'It may be cheaper for a provider to source treatment abroad, but you would have to factor in travel costs and rehabilitation costs so under those circumstances I don't think it is,' says Kelly.
The main drawback of going abroad is not the treatment itself but the travelling, the aftercare patients need and the practical implications of being so far from home. 'Health tourism is not particularly good for your health,' adds Kelly.
'There are lots of problems around it. If you need a hip operation you will be in some discomfort, so sitting in an aeroplane or departure lounge for some hours is not the best way to start that treatment. It is easier to have people in their own country, near their homes and family, with the continuity of care they get from their GP and consultant. If they need physiotherapy after treatment, they go back to the same place where they have the patient's notes.'
David Morgan, a consultant surgeon and medical director of health website Medicdirect, says: 'I have mixed feelings about seeking treatment aboard. It's fine if everything goes well, but if there are complications when you return to the UK, the consultant you see here will not have a clue what has gone on or have access to your operating notes.'
Self-pay route
Another reason clients may seek treatment abroad is for the treatment of existing conditions not covered by their PMI provider. In this case, they may choose the self-pay route.
'Self-pay can accommodate people who have an existing medical condition that isn't covered by PMI,' says Armitage. 'A treatment sourcing organisation can get them best value if they have to pay for it themselves.'
But there are few cases where treatment is only available somewhere other than the UK. Morgan concedes there is a new form of specific radiotherapy available in just two centres in Paris and Boston. 'But cancer treatment is not a one-stop shop. Even after primary treatment you have to monitor patients in the first year, usually every eight weeks, carry out scans, do re-biopsies ' it's not like having a hernia fixed,' he says.
There are other circumstances, for example, with cosmetic surgery. Armitage cites the case of a cosmetic dentist based abroad who flies into the UK every month and performs teeth implants for £10,000. 'If you were to go to his hospital abroad, it would cost £3,500-£4,500,' says Armitage. 'He comes to the UK to take advantage of the fact that people don't know how to buy healthcare. We would advise clients to go to him as it won't cost £6,000 to arrange an airfare.'
But there does seem to be a consensus among PMI providers that going abroad is not the best thing to do and insurers don't anticipate a time when such an approach will threaten traditional PMI in the UK.
'We feel it is unnecessary and don't anticipate a circumstance where we couldn't get people treated here,' explains Louise Zucchi, spokesperson for Norwich Union. 'There have been high profile cases of people going abroad, but there are a lot of people who would rather not do that. You'd have to fly your family out, otherwise you are going to be alone, so we treat this with extreme caution ' we don't see it as the answer to addressing issues in this country. There are old people especially who don't want to travel.
'I would be surprised if this became a mainstream option from PMI providers,' adds Zucchi, 'It is much more an issue for people who have the money in the bank and just pay.'
Despite the reservations of providers there are organisations which package treatment abroad. Garden Route Medicare (GRM) arranges treatment packages in South Africa.
Health tourism
Packages comprise flights, accommodation, registration at the hospital and liaison between the patient and consultant. As an example of costs, GRM says a cataract removal which could cost R9,000 per eye, with the exchange rate would cost about £900. Accommodation costs vary from £15 per night to £80 per night, with flight costs between £350 to £550.
Another organisation, Health Enterprises, had seen a gap in the market for individuals to obtain cover abroad and set up packages to top-quality medical facilities in Thailand. While PMI providers will not provide cover abroad unless it is for emergency treatment or for ex-patriates, they may be able to advise on where to go.
'Exeter Friendly Society has 20% of its clients based abroad, so we are used to buying healthcare overseas,' says Armitage. 'If a client says, 'I will travel anywhere in Europe, give me the cheapest possible treatment,' thenwe would look at it. But we are not being asked that question to any great degree.'
As a basic rule, Medicdirect advises patients restrict their selections to hospitals in France, Germany, the Netherlands or Belgium in university-attached teaching hospitals which should guarantee good facilities and surgical skills. It is the standard of medical care in the UK that also makes providers reluctant to send patients abroad.
'British medicine is probably the most heavily regulated of any healthcare systems, despite what we see in the press,' says Morgan. 'The standards are pretty high. In terms of training and maintenance of specialists, we have far more stringent criteria than anywhere in Europe. In the US any person can start practising ' you don't have the regulation in terms of interviews and references when a specialist gets registration under the NHS.'
'We have a terrific healthcare system in the UK which is regulated, we have the Care Standards Act and the National Institute for Clinical Excellence which regulates which drugs are available,' says Armitage.
'Other countries may have access to drugs that are not available in the UK, but perhaps they have not been fully tested in the UK, or they are out of patent and not manufactured in the generic form. There are a lot of good reasons why drugs are not available in the UK. We also have some of the world-leading cancer specialists in the UK and the NHS caters exceptionally well for cancer treatment. I wouldn't be going outside the UK for that,' he adds.
Stephanie Spicer is a freelance journalist
