Extracts from the LCA Newsletter to Consultants
June 1999

In the opinion of the LCA, some insurance providers in the UK are seeking to "Americanise" healthcare in a number of ways. Firstly pre-authorisation is with us now. Insurers can use pre- authorisation to control not only access to treatment but who will give it. More recently some insurers are trying to control what treatment is given - an even greater intrusion.

The LCA has recently received many enquiries by members about how they should react to pre-authorisation, particularly from insurance provider staff who are openly challenging the decision by LCA numbers to admit their patients to hospital for investigation and treatment.

Second, many of our American colleagues rue the day that they ever agreed to participate in preferred provider organisations (PPOs). These are the systems whereby hospitals and consultants may be de-listed it they do not contract in and comply with the policies set by insurance companies. Current "partnership schemes" should be considered to be the embryos of PPOs.

Third, many insurance providers are now trying to institute reviews whereby ongoing care is limited. An example of this is the continued questioning by insurance provider employees about the reason why patients' inpatient stays are longer than desired by them. The never ending demands on private medical reports justifying length of stay attest to these policies. Indeed some of the conversations reported by members of LCA about these enquiries almost defy belief.

Finally, we are seeing the development of protocol-led clinical practice. Our colleagues in America are already being faced with insurance companies attempting to dictate treatment methods. While we all accept the need to follow a philosophy of evidence based practice, few LCA members believe that such protocol-led practice should be dictated by insurers.

Office of Fair Trading (OFT)

Over recent weeks there has been a substantial uplift in the interest shown by the OFT towards the activities of certain private insurance providers, particularly in the selection of hospitals for their networks. A great deal of evidence has now been submitted to OFT by members of doctors' organisations and individuals. LCA have already submitted evidence outlining the concerns that we have about changes that are being proposed in the structure of private practice.

As an example, many of you will be aware of problems that the new London Heart Hospital has been facing in regard to their relationship with PPP. LCA has been keeping a close watch on these proceedings. While we cannot take sides in this dispute we do have an interest in maintaining the freedom of doctors and patients to use the hospital of their choice free of insurance company interference.

There are of course many other hospitals in London and elsewhere which have been de-listed by certain major insurance companies. This threatens their existence and if they are closed would further reduce the choice for patients and doctors. The fact that in some areas 30 percent of private patients are self funded means that this group are equally facing restriction of choice.

LCA Members Opinions

One of the earliest activities of the LCA was to canvass members about their views on a number of important issues.

Table 1 shows the results of the survey (204 completed questionnaires).

BUPA Insurance was the insurance company perceived to be causing the most problems for consultants.

Consultants Concerns

By far and away the most important issue was considered to be restrictions being placed on referral in private practice. There are also major concerns about restrictions on hospital usage due to "networks" and 50% of consultants are concerned with shortfalls and exclusions on patient insurance cover. Interestingly, the majority of doctors currently view pre-authorisation problems as being important rather than very important.

Respondents were less concerned about fee levels, confirming the view of the LCA, that while fee levels are an issue, the restriction on referral and hospital usage are more important to LCA members.

It should be noted that this review of consultants' attitude was conducted before BUPA Insurance announced changes to their pre-authorisation procedures (the BUPA Insurance hysterectomy issue).

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