Should GPs ask patients if they have private health insurance?
Dr Charlotte Alexander argues we need to try anything to create some slack in the NHS, while Dr Rebecca Jones argues it will create a two-tier system
I do not see anything wrong with asking patients whether they have private insurance if it helps to create some much-needed slack in the NHS. A recent scheme in Mid-Essex has seen private referrals increase by 6% since the start of the year, which suggests that health insurance is being underused. It may be that people forget to use it or have a ‘no-claims bonus’ attitude towards it, resulting in a pick-and-mix approach to the NHS. Whatever the reason, I do not think most would object if they were gently reminded that they could see the most senior person available more quickly if they did use their cover.
I know some people think this is an inappropriate way to try to save money, but with a dwindling pot can we afford to be so high-minded? Which is worse, trying to increase uptake of health insurance with those fortunate enough to have it, or having to save money by banning non-urgent procedures such as vasectomies, sterilisations and ear syringing?
Some people have said it puts unfair pressure on patients to refrain from using NHS services that are within their rights, but GPs could exercise judgment about who to ask. For example, for those who have used private healthcare before, it is not a huge leap to ask them whether they would like to again. Premiums may go up as a result, but the person will choose to pay it or not. It is not denying them care they are entitled to, it is offering them a choice to use NHS or other services, like the choice between a state or a private school for their children.
Some say that asking patients about their private healthcare insurance compromises the impartiality of the consultation. Actually, we already do that with the QOF, prescribing certain medications because they are cheap and having personal stakes in private companies providing NHS services.
People will also say that this approach lets the Government off the hook as it will continue underfunding the national system. This may be true, but what is the alternative when there is no extra money? While we are living in this time of unfettered corporatism and very high societal inequality I see nothing wrong with redressing this slightly by asking people to use their insurance if they can. The NHS is staggering under the weight of demand and cost cutting. Unless we do everything we can to preserve the cash flow, it won’t get up again, even after multiple infusions.
Dr Charlotte Alexander is a GP in Addlestone, Surrey
On the surface, asking patients about private healthcare insurance may appear to be a positive move; I am sure I’m not the only GP who finds themselves apologising for ever-increasing waiting times for outpatient clinics and elective operations. However, not only are GPs constantly apologising for problems that are beyond our control, we are now being put in the difficult position of asking patients to forfeit the NHS care they deserve as much as the next person. This could potentially put the patient-doctor relationship at risk, and could even jeopardise a doctor’s ethical or moral standing if the patient disagrees with the principle.
It could be suggested that encouraging patients to use their private insurance will take pressure off NHS waiting lists by filtering some patients out. But in reality, it creates a two-tier system, further broadening the gap between the rich and poor and exaggerating health inequalities. While those who can afford either private care or health insurance will find themselves being seen and treated quickly, others who rely on the NHS may be at risk of their health conditions deteriorating while they wait ever-increasing amounts of time.
Asking about private health insurance would also produce geographical health inequalities. Affluent areas will benefit more, not only from a larger number of the population accessing private care, but from the higher number of patients filtered out of NHS waiting lists, freeing up more appointments and improving services in the area. But conversely, in deprived areas, where fewer people have access to private healthcare, NHS waiting times will continue to remain above what is acceptable, further widening regional differences in care.
A final issue is that schemes such as this free the Government from the responsibility for their funding cuts. The NHS is currently in dire straits, and the solutions lie with our Government and the way it funds the NHS, not with alternative solutions such as pushing patients towards the private system. This merely patches up the system while the Government continues to slash funding to public services. It would be more prudent for local health boards or CCGs to fight for more enduring, appropriate solutions, rather than taking us one step closer to an unfair insurance-based healthcare system.
Dr Rebecca Jones is a GP in Hastings, East Sussex