Private healthcare is far from a cure all

Interest-free finance is available, the full-page advertisement proclaims. But the advertiser isn’t selling cars or sofas. It is Spire, one of the UK’s leading private hospital groups.

Growing numbers of Britons are turning to private healthcare as frustration grows with the country’s state-run health service. In its half-year results at the start of this month, Spire said it expected “significantly increased demand for healthcare” given that the waiting list for NHS treatment has swelled to almost seven million.

Only around one-fifth of Spire’s revenues come from so-called “self-payers”. Close to half comes from insurers paying for treatment under private medical plans.

Many employers in the professions, including the Financial Times, offer private medical insurance as a perk of the job. The employee is subject only to a benefit-in-kind tax charge and can often add other family members for an additional charge taken direct from salary.

The Eley household is a repository of knowledge about this growing business. Regrettably, there is a lot of illness in my family. My wife has suffered from various life-limiting autoimmune conditions for more than a decade and more recently both my children have had serious health problems.

Well-meaning colleagues often ask whether we are covered by the company healthcare scheme, as if such cover fixes everything. We are. And on many occasions over the years it has saved us. But it is not the answer to everything.

As with any other form of insurance, the first issue is what is covered. That is dictated as much by the costs and risks to the insurer as it is by clinical priority.

In very general terms, acute conditions are covered but chronic ones are not. So it was fine for me to have six sessions of physiotherapy . . . But my wife gets no treatment at all for a connective tissue disorder

In very general terms, acute conditions are covered but chronic ones are not. So it was fine for me to have six sessions of physiotherapy on a knee that I damaged while running (acute).

But my wife gets no treatment at all for a connective tissue disorder that leaves her in debilitating pain for weeks at a time (chronic).

This is especially frustrating because the NHS has a patchy record on treating chronic conditions, even if you decide to make them acute by turning up at your local accident and emergency department.

Insurers often have an annual limit on outpatient treatment, dictated by the terms of your employer’s contract with them. Ours doesn’t tend to change much each year though alas consultants’ fees do, and only in one direction. Inpatient treatment is less restrictive, probably because you’re statistically less likely to need it.

Accessing private healthcare isn’t just a matter of rocking up in Harley Street. If an insurer is paying you will usually need a referral from your GP.

When you’ve seen your consultant, he or she will typically send a letter in to your GP (like lawyers, doctors like to do things longhand) and any ongoing medication will usually be prescribed by your local surgery. You never fully escape the 8am rush for a doctor’s appointment.

To see a private consultant is to see how the other half lives. After a proper cup of filter coffee and a flick through the newspapers in a quiet, clean waiting room, you get a specialist’s undivided attention for 40 minutes or more.

Inpatient stays are similarly agreeable. It’s all a world away from the state sector with its long waits, often dilapidated facilities, dreadful food and overworked staff.

You’ll be brought back down to earth by the diagnostic tests that usually follow a consultation. These can be extraordinarily expensive. Last year, my daughter unwittingly blew her entire annual outpatient budget in a single visit to a Spire facility.

We asked the hospital why they did not inform her of the charges for the various tests in advance and were told this was not possible because of “commercial confidentiality”. Different insurers are charged different prices so everything has to stay hush-hush.

The same question was put to the insurer, which told us it was the patient’s responsibility to ensure either that any tests fall within the annual limit or to make good the shortfall.

Got that? The patient has to make sure they do not over-order from a menu that has no prices. Nobody in the private care business seems to think this astonishing lack of transparency is a problem.

Sometimes it is possible to get blood tests done on the NHS. But that requires the co-operation of both the consultant and the GP, and you will have to organise them yourself.

In fact, private care entails you — the patient — doing quite a lot of organising generally. Although the bills are usually sent straight to the insurer, there is a lot of other administration. Just as in the state sector, everything moves at the pace of the slowest, and the telephone waiting times for our insurer’s helpline currently rival those of our local doctor’s surgery.

There’s also a degree of negotiating, given all the rules and limits. One morning, on the day of some pretty heavy-duty surgery on her eye, my wife was on the phone to the insurer arguing about whether the anaesthetist’s fee was included or not. It was — but not without a fight.

Private healthcare has been good for us and we cannot complain that we have not had value from the annual cost (over £2,000, if one includes the benefit-in-kind charge).

But ultimately it is a for-profit service provided by shareholder-owned companies, and inevitably that means compromises with clinical priorities. It fills some of the gaps in a state-run service that is perennially starved of resources and subject to never-ending political interference. Just not all of them.

Jonathan Eley is FT retail correspondent. Email: jonathan.eley@ft.com; Twitter: @JonathanEley