Leader of the pack

Dr Natalie-Jane Macdonald is passionate about healthcare and healthy living. As medical and healthcare purchasing director at BUPA, she is responsible for the company's business and clinical relationships with all providers of healthcare in the UK and divides her time between Manchester, Staines and London.

Since joining BUPA, Macdonald has been involved in spearheading many company initiatives. Over the last five years, she reveals, the provider has been trying to move away from being seen simply as a healthcare insurer to more of an informed decision maker on behalf of their customers ' a matter Macdonald stresses is vital in providing consumers with what they are paying for.

'When people go privately, whether as an insured patient or whether they are buying their own treatment, they have assumptions. They expect to get the best and they trust people like us implicitly to organise this for them. It was when I came across to membership that we decided we really needed to use this approach in our purchasing. We needed to look at what it was ultimately that our customers were getting for the premiums they were paying,' she says.

It is this approach that Macdonald and her team of 200 staff take when deciding who they will be working with, what the requirements will be and what delivery service levels need to be in place. As well as providing a call centre function to doctors and hospitals throughout the UK, the team makes regular hospital visits to ensure the facilities they are providing are what they should be.

'We spend more time and go into greater detail than anybody else with regards to what it is that our customers experience when they choose to buy from us. The team visits hospitals throughout the year. We look in clinical waste bags and we look at what it is our customers are getting when they need treatment because we try to be highly informed about our healthcare purchasing. As the market leader, the truth is where we go others will follow. It is not to say that other providers do not do this, but we have to do it first and we have to do it better,' she says.

BUPA is endeavouring to lead the way for innovation in the market with the launch of its disease specific Heartbeat Heart and Cancer plan, but Macdonald feels not enough is being done within the market to cater for the needs of consumers.

She says: 'Our Heartbeat Heart and Cancer is the first disease-specific plan available, but there is a need to be more responsive to the varying needs people have throughout their lives. A core product with variations around the edges does not meet people's needs. You have to be relevant to people and the big challenge is how you can make private medical insurance viable to people in an environment where costs go relentlessly upwards'

One of the ways private medical insurance (PMI) providers have redressed spiralling healthcare costs is to withdraw certain aspects of cover. AXA PPP healthcare's recent and highly-publicised decision to stop providing cover for caesarean sections ' because it could not ascertain which were elective and which were medically necessary ' has caused mixed views within the market.

Macdonald is not convinced PPP has taken the right approach and admits the issue around caesarean sections is illustrative of the dilemma there is in relation to PMI provision. She also reveals BUPA wants to offer more benefits around maternity cover in the future.

She says: 'While caesarean section cover may not be relevant to 65-year-olds, for women of a child-bearing age who are generally healthy, it is a pretty important benefit. At BUPA, we collect information from every doctor who performs the operation because that allows us to create an informed picture as to why the operation was performed and allows us to tackle any issues that may arise. What you do is tackle the issues; you do not take the benefit away.'

Macdonald is also keen to stress she disagrees with PPP's former medical director, Dr Adrian Bull, who in a Cover interview in February, commented on BUPA's relationship with specialists in the industry.

'I disagree that the reason we keep consultants sweet is because we have a hospital practice. I am as intolerant as anybody of poor clinical practice, but we have to face the fact we have to work with doctors to help create change. You cannot do that by aggressively antagonising and having a highly adversarial approach to specialists,' she says.

Looking to the future, Macdonald believes the healthcare industry and the PMI market are experiencing enormous change and is looking forward to the opportunities that will bring.

'The challenge to the industry is having products and services that are relevant to a whole variety of different customer groups and that does not just mean different levels of out-patient cover. That is not sophisticated enough.

'Healthcare is changing. New medical technologies, consumer expectation and the NHS all create a melting pot that we have got to keep on top of if we are to continue to fulfil our customers healthcare needs as well as being a successful business. It is quite complicated, but that is what makes it exciting.'