UK hospitals can’t compare notes on the price of private care

Public hospitals in the UK are no longer able to compare prices charged for private care in their hospitals.

Eight hospital trusts in England have provided assurances that they will not exchange pricing information after a whistleblower complained that the hospitals were violating the UK’s Competition Act.

England’s public hospitals have been engaged in private health care delivery for some time, the average hospital taking in about 1.1 per cent of their revenue from private insurance and those willing to pay out-of-pocket. Some are much higher – The Royal Marsden Hospital, which specializes in cancer care at its London and Surrey locations, takes in nearly a third of its income from private care.

The hospital trusts had been under a cap that allowed no more private care as a percentage of their overall revenues than existed in 2003. This October the situation will dramatically change, the cap being raised to 49 per cent of a hospital trusts’ revenue. That could mean more than half a public hospital’s beds could be effectively privatized and leave NHS (National Health Service) patients lingering longer on wait lists.

The right has argued in the UK that the profit from private care clients would benefit NHS-funded patients by increasing overall hospital revenues. Few believe it.

Now that the Cameron government is putting the squeeze on health care, hospitals are being urged to take on more private business. The NHS is looking for nearly $31 billion (Canadian) in savings by 2015.

At the end of July a report was released by an independent watchdog suggesting health service trusts were “imposing pain and inconvenience” by making patients wait longer than necessary, in some cases as long as four months.

The delays meant patients removed themselves from the lists “either by dying or paying for their own treatment.”

While this may save money for the Cameron government, it doesn’t save money for citizens who may be required to pay twice to get timely care – once through their taxes to support the NHS, and again through private insurance.

With investments in the public system, the demand for private care in the UK has been shrinking in recent years. No doubt fiscal pressures on the public system and the subsequent longer waits will be a reversal of fortune for these private providers, but they may now find themselves in much stiffer competition with public hospitals for the same trade.

Here in Ontario the government is looking very closely at the price it pays for procedures, with much attention paid to eliminating those it says are not supported by evidence. Under its new hospital funding structure, it will look at its best-performing (read: “cheapest”) hospitals and orient its fee schedule accordingly. If a public hospital cannot work for these prices, they will be given a little friendly assistance, and if it is still not viable, they won’t do the work regardless of local demand.

At least Ontario hospitals will know what that price point is.

In the UK hospitals will have to rely on private insurance carriers to tell them what that point is.

Competition means not sharing best practices. For the UK’s hospitals, now that they are free to escalate their share of private care, they can’t legally compare notes any longer if it’s considered to effect competition.

What a strange world we live in.

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