Choosing wisely

The UK healthcare sector continues to fuel great debate in the national press, as lengthy NHS waiting lists have prompted many individuals to seek healthcare services in the private sector. Some opt for private medical insurance (PMI), while an increasing number are choosing to pay for their private health needs independently.

With a significant growth in the number of people opting to self-pay for their healthcare, private hospitals are being utilised more than ever. However, while private hospitals do offer faster access to treatment, choosing a hospital to suit each individual's needs is not as simple as opting for the hospital nearest to home.

Suiting your needs

Instead, decisions should be dependent on the facilities available at each hospital and how each establishment caters to the needs of the patient in question.

While many hospitals offer a range of facilities throughout the UK, researching what treatment is required and whether the chosen hospital can cater adequately for the patient's needs is essential. Facilities and prices in particular vary widely throughout the country as well as between each private hospital provider.

Aside from the NHS, which offers private patient units (PPUs) in NHS Trust hospitals, the five other private hospital organisations in the UK are BMI Healthcare, BUPA, Nuffield Hospitals, Capio Healthcare UK and HCA International. In total, these six establishments represent almost 300 private hospitals ' including PPUs ' throughout the UK.

Although the number of NHS PPUs stands significantly higher at 93 hospitals, than any one of the main private hospital groups, the overall number of beds in PPUs is actually less than standalone private hospitals. Currently, the number of beds per NHS unit stands at around 10 to 12 beds.

Each of these units is dedicated to private patients and is often part of the larger district hospitals. In contrast, hospitals operated by private organisations offer a greater number of beds, typically between 40 or 50 beds.

In total, there are approximately 11,200 private beds in the independent hospital sector in the UK. BMI Healthcare leads the market with 21% of the total number of beds in the private sector, followed by BUPA and Nuffield, both with 16% of the overall number of beds in the private hospital sector.

Acute hospitals offering planned surgery such as operations and investigative treatments are more prevalent in the private healthcare sector. While there are also specialist psychiatric hospitals, overall, there are fewer of these in the UK.

In addition to the main players, there are also approximately 40 smaller independent organisations in the UK, some of which are widely known in the sector. An example is Abbey Hospitals, which has six hospitals in total, mainly situated in the north of England.

In terms of numbers, BMI Healthcare has the highest proportion of private hospitals after the NHS PPUs, with 44 standalone hospitals. Nuffield Hospitals follows closely behind with 41 hospitals and BUPA behind that with 34 private hospital establishments. Capio Healthcare, part of Swedish company, Capio AB, is slightly smaller than the other market players with 22 hospitals in its network.

Although HCA International is the smallest of the prominent hospital groups in the UK with six London-based hospitals, it is perhaps the most distinctive of the private hospital groups. Its six acute hospitals in London include The Portland, The Harley Street Clinic and The Wellington Hospital.

The Wellington is one of the largest private hospitals in the UK and has 266 beds including15 for intensive care patients and 11 operating theatres. It also has an extensive range of cardiac facilities. Similarly, HCA's Portland Hospital is also distinctive in that it is the only private London hospital dedicated to women and children and is renowned for its obstetrics facilities.

Most of these private hospital groups have facilities located nationwide, which means that all consumers throughout the UK have reasonable access to private hospital care near their home. However, there are fewer hospitals in the north of England and in Scotland than there are in the South East, so choice may be limited for some people living outside London and the home counties.

Similarly, in some areas, usually cities, hospitals tend to sub-specialise which means that one hospital may focus on orthopaedics and another on cardiac surgery. While this is ideal for those patients needing this type of surgery, it can perhaps limit access to other procedures.

Hospital facilities

Another major factor in the private hospital sector is the fact that because of size, many private facilities do not have an intensive care unit. While this may not be an issue for any investigative procedures that take place at the hospital, it should perhaps be an important consideration for any major surgery from which complications may arise.

'People need to know what facilities are available if something does go wrong during or after the medical procedure,' says Dermot Cox, managing director of CareHealth.

'For relatively simplistic procedures such as the removal of varicose veins or cataracts, an intensive care unit is not a main consideration. However, operations like hip or knee replacements can go wrong and the smaller private hospitals would not have an intensive care unit to cater for this. Instead the patient would be taken to the private patient unit of an NHS hospital,' he says.

Cox stresses that people paying for their own healthcare who may have concerns about emergency facilities if the operation goes wrong should consider NHS PPUs as opposed to a hospital owned by an independent provider.

'NHS private patient units should be a consideration for self-paying customers. They are probably cheaper and can provide peace of mind if there are concerns about the emergency facilities. It's a well kept secret that people can be treated on the NHS as a private patient,' he says.

There are also a number of factors regarding the facilities and locations of private hospitals that PMI holders need to consider when choosing their insurance policy - particularly when they opt for a policy providing access to a network of hospitals, says Cox.

'People do not realise how significant the network aspect of a PMI policy can be if they need treatment. Consumers may find that many of the excellent specialist London teaching hospitals may not be covered in the network because they are more expensive, and this limits their access to treatment at that facility.

'They need to know whether the insurer would pay out if they require treatment in a hospital, particularly an NHS hospital, that does not come under the scope of the insurers' network. For those looking to save money on private medical insurance, my advice would be to take out a high excess rather than restrict the number of hospitals available,' he says.

The introduction of hospital networks came about as a result of the growth of the private healthcare sector and the subsequent decline in the uptake of PMI.

Throughout the early and mid-1980s the number of private hospitals and private wings in NHS hospitals increased substantially due partly to the rapid growth in private healthcare and the range of services that could be provided privately.

However, the take-up of PMI grew very little in the 1990s, and the result was considerable over-capacity of private hospital facilities. In 1998 alone, the average occupancy of private hospitals across the country was under 50%.

Therefore, to cut costs, insurers opted for a network of selected hospitals from which PMI holders can choose to be treated. While concerns may arise about the restrictions this may place on customers using the service, insurers are adamant that networks offer patients a full range of services, as David Quick, head of partnership development and quality at BUPA Insurance, points out.

'We only select hospitals to be in BUPA's network if they are capable of undertaking the 95% of procedures BUPA pays for most often. We do not include single-speciality hospitals in the network.

'For BUPA members, network products are entirely optional and members are perfectly free to opt for other products that offer them use of any of the 660 hospitals on our participating hospitals list,' he says.

Insurers are also keen to highlight that in the case of a patient needing treatment outside the range of hospitals on offer, each case is judged on individual merit.

'If a patient needs to have an operation and for some reason or other, the consultant feels the procedure needs to be done in another hospital, then we will look at granting an exemption,' says David Costain, medical director at AXA PPP healthcare.

'However, this is quite rare and accounts for only 2% of all cases, for example, when there is the need for a complex surgical procedure which is only offered in a few medical centres. Similarly, if a patient cannot get a bed in an allocated hospital, we will also make an exemption in this case. A patient will never find they are unable to get the care they need,' he says.

Meeting demand

With six main organisations and 40 smaller independent companies in the private hospital market throughout the UK, there are plenty of private healthcare hospitals to meet consumer demand. Some hospitals specialise in a certain type of procedure, while others may deal with all aspects of planned surgery. Due to the size of many private hospitals, the majority do not have intensive care units and rely on the NHS for these facilities.

Clients taking out PMI should be fully aware of what would happen if they needed treatment in a hospital outside of their insurers' network. However, while networks can on some level restrict access to certain hospitals, each case is judged individually and may not result in the non-payment of a claim.