Britons 'pay too much for private healthcare'

David Cameron at Salford Royal Hospital

The thrust of government health policies for the best part of 20 years has been to encourage greater participation of the private sector in the NHS and to stimulate competition within the NHS.

Successive prime ministers from Tony Blair to David Cameron have tended to argue that everything would be alright in the NHS if only it could be as efficient and customer-friendly as the private sector.

Which is why it is somewhat resonant (ahem) that the Competition Commission has this morning produced what will be seen as a damning indictment of the purely private part of Britain's healthcare provision.

The watchdog says there is inadequate competition inside the private health market and that private health providers are ripping off consumers to the tune of between £173m and £193m a year (which the watchdog describes as a "conservative estimate" of the detriment).

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It recommends forced sales of private hospitals”

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The commission says that private operators of hospitals in many areas face inadequate competition. It identified 101 hospitals outside London with too much market power. And in London, it concluded that the US's HCA Inc - which is the world's biggest private healthcare group - is too strong. HCA has eight market-leading hospitals and other facilities in central London.

The watchdog says private health insurers are paying too much for the services provided by these private hospitals. Which matters because 80% of all private healthcare is funded by insurance policies, sold by the likes of Bupa and AXA PPP.

The watchdog complains that far too little information is provided to consumers on the performance of private hospitals and consultants. Which makes it impossible for those seeking treatment to shop around in a proper way.

And it dislikes the incentives the hospitals give to consultants - cash or access to consulting rooms and secretarial support - for making referrals to them. These incentives encourage consultants to recommend hospitals to patients on the basis of what suits the consultants, not what is in the interest of patients, says the commission.

What would be the remedies?

Woman talking to a doctor About the same number of people have private health insurance as in 1995

Well, it recommends forced sales of hospitals where this would improve competition - and its preliminary view is that these divestitures should be by HCA in London and by BMI and Spire elsewhere.

Such mandated disposals would be fatuous where a hospital has a total local monopoly, in that this would simply transfer ownership of the monopoly. So it wants to limit the pricing power of the bigger hospital groups by forcing them to negotiate deals with insurers on a hospital-by-hospital basis, rather than nationally.

The commission proposes publication of useful information on the performance of private hospitals and consultants, similar to information that is gradually being provided in the NHS.

And it suggests a ban on most incentives for consultants designed to encourage them to recommend particular hospitals.

The thrust of these reforms can be seen as trying to alter the balance of power away from the private hospital providers and towards the insurers and consumers.

What is striking is that the profitability of the hospital groups has risen sharply over the past few years, and - according to the commission - the return they make on their investment is more than double the cost of that investment. (In the jargon, return on equity is well over twice the weighted average cost of capital.)

All of which is symptomatic of inadequate competition.

But perhaps as relevantly, the private health insurance market is the same size as it was in 1995, by number of people covered - which the insurers put down to the rising cost of what they have to pay for medical services and then have to pass on to customers in higher premiums.

So the commission's proposed reforms seem designed to give the insurers more muscle in negotiations with the hospital groups.

Robert Peston Article written by Robert Peston Robert Peston Economics editor

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  • rate this

    Comment number 179.

    With post-war mandate Old Labour secured for ordinary people access to medical diagnosis & treatment

    Hobbled by doctors, private practice dictating conflict of interest in clinical & political leaders, inadequate address of overload & queuing have led to recurrent widening scandal

    Confidence dented, morale drained, NHS patients become distractions from private practice, cheating doctors of fees

  • rate this

    Comment number 178.

    177 "Im somewhat lost." Too right you are.

    A story about private cartels, rip-offs, and the suppression of information confuses you and the solution is apparently 'the market'

    There IS no market, The companies involved will fight tooth and nail to ensure consumers remain misinformed. As they always do.

  • rate this

    Comment number 177.

    I'm somewhat lost. A private hospital is a business. It's there to make money by providing fee paying healthcare. The alternative, for most of us, is the NHS. Surely "the market" should decide how much profit a private hospital makes? If they charge too much people won't use them. The key thing is knowing how good they are - clinical outcomes and customer satisfaction. Make them publish details!

  • rate this

    Comment number 176.

    How much does private insurance cost in the UK and what is covered? Here in Switzerland there is only private insurance, but at different levels. This relates mainly to the level of comfort in hospital; basic (4 beds) semi-private (2 beds) or private (single bed). There are ~20 separate health insurance companies. 2 adults + 2 kids (kids costs capped at 10% self pay) is GBP650/month.

  • rate this

    Comment number 175.

    174.johval - "For nearly two decades government have pursued the idea that a better NHS will come about by having more managers ............"

    Where does this complete rot come from?

    The NHS is the LEAST managed health care system in the western worldl!!!!!!!!!!!

  • rate this

    Comment number 174.

    For nearly two decades government have pursued the idea that a better NHS will come about by having more managers and, as usual, paying big money to attract the best, rather than using the money to provide more doctors and ambulances. Time for drastic action to reverse this ruinous policy.

  • rate this

    Comment number 173.

    @ 164 Paul Google "amenity beds" and you'll find the NHS already offers the service you suggest.

  • rate this

    Comment number 172.

    Firstly: the private sector exists because the NHS, which absorbed a huge increase in funding under New Labour, fails to satisfy patients.

    It fails because is a monopoly that serves the interest of very highly paid doctors ahead of oatients.

    Nationally negotiated pay rates fro consultants and GPs are the root cause.

    The competition commission must stamp down hard on this in the private sector

  • rate this

    Comment number 171.

    Anyone slagging off the NHS and condoning private health care ought to watch the Michael Moore film 'SICKO' ........ by the end you'll want to puke !
    I can afford top notch private health care - but won't go for it on principle.

  • rate this

    Comment number 170.

    Who picks up the bill when private healthcare goes wrong the NHS.

    Anyone can run a Business if they know that there is someone going to pick up the costs if things do not go right and put it right at no cost to them

    If the NHS was over funded in such away the NHS and had another Business to pick up the costs when things go wrong

  • rate this

    Comment number 169.

    What could help UK private healthcare is for the UK government to learn from the USA's situation, to make sure we don't get into it.

  • rate this

    Comment number 168.

    There are TWO exactly the same topic Blogs online at BBC News Site as I write this---------so I have posted my comments on the other Blog.
    A bit of confusion here , BBC :))

  • rate this

    Comment number 167.

    There are serious problems with our NHS looking agter the NHS rather than patients.

    As example, the story here related to one of the planet's would be geniouses, begs the question, after 10 seconds consideration ~ how did life begin on Mars?

    I expect within my life time, to self diagnose and treat the most complicated ills.

  • rate this

    Comment number 166.

    Re 152 Dr Stel

    you are talking complete and utter drivel. I am an NHS consultant and my wage is £75,000 per year for 40hrs/week + 20hrs/wk overtime. If I was to move almost anywhere in the western world my wage would at least double. And it would rocket if I moved to the USA, Canada, Ireland, France, Scandinavian countries, Germany, Switzerland, Australia, NZ, HK, running out of characters...

  • rate this

    Comment number 165.

    How about you let us comment some more on the Syria story?

  • rate this

    Comment number 164.

    The NHS needs to become more commercialised (not privatised). Give basic healthcare for free. Have optional 'upgrades' for private rooms, better food, etc for those who can afford it, and the income from that can subsidise the service for those who can't afford it.

    But, that would not be allowed politically, so, even though it's common sense, it won't be done with the revered NHS.

  • rate this

    Comment number 163.

    US is going toward Gov health. How bad can it be. Wait the Democrats exempted goverment officials and their familiy members. Nancy Pelosi (D) said it, "you can see the bill once we pass it"..(talk about "let them eat cake") she and her generations of family members are exempt... The elite profes to be for the working class people..what a scam. No aggresive tort reform will kill it anyway.....

  • rate this

    Comment number 162.

    That's amazing, you would have thought after how honest, transparent and customer-focused the other privatized systems are that it would work like a charm...

    Oh wait....

  • rate this

    Comment number 161.

    It's nowt to do with the amount of dosh

    It's everything to do with that.

    If those that were hoarding this wealth ploughed it into research into stuff like Nuclear Fusion we'd be far further down the road to solving energy problems. Food can be grown (the food shortage is a red herring).

    But the wealthy elite don't want that, there's no profit in it for them.

  • rate this

    Comment number 160.

    Re 136 DrD:
    Spot on. Problem is that NO gov't wamts to do anything about it because THEIR snouts are one of the bigest in the trough.
    UK has too much administration, too much government which creates jobs for too many hangers-on.
    Scrap QUANGO's, Cut to 180 MP's with allocated one-bedroom flats (ex Olympic village ?), no seconf jobs and live by the same fiscal rules as most employees as a starter


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