Pre-print Summary from Hospital Doctor October 2005 of an article that subsequently appeared in slightly abbreviated format and sent to FIPO from Hospital Doctor on 11th October 2005
Bupa insurance is considering introducing clinical care plans for its hospitals. But it says its new guidelines, which will help develop standardised care pathways for patients, are not the same as US-style managed care based on an HMO (health maintenance organisation) model.
A spokesman said: ‘Given the changes in the provider market in all hospitals – both the NHS and private sector - we’re looking at developing clinical care plans. But this is not an HMO model.’ She said guidelines and standardised care pathways were necessary to ensure information given to patients by insurers is consistent with what is happening in hospitals.
Dr Natalie Macdonald, medical director at Bupa Insurance, said: ‘We get asked all the time by patients how long they will need to stay in hospital. We have to be able to give that information. That will not take the place of a conversation with a consultant but there must be consistent information.’ She added: ‘We would like to think that with prostheses used, for example, there is some sort of evidence of effectiveness. But we know from speaking to private hospitals that doesn’t always happen in practice.’
Dr Macdonald denied the plans would diminish patient choice and clinical freedom.’ ‘The last thing we’re doing is diminishing choice but we are also not offering a free for all,’ she said. ‘Practice should be evidence-based. Patients expect it.’ On the issue of clinical freedom she added: ‘Consultants and insurers and hospitals all have the same interest in maintaining a vibrant PMI market. To maintain PMI as financially robust, those sorts of arguments [about clinical freedom] should have really had their day.’
Mr Geoffrey Glazer, chairman of the Federation of Independent Practitioner Organisations, said: ‘We are in favour of evidence-based medicine and cost effective treatment. We are moving very much towards that with our medical advisory committee (MAC) guidelines, national clinical advisory governance group and other initiatives we are working on with the Healthcare Commission and the providers. BUPA are proposing a managed-care scenario and we reject the concept that an insurance company should control or influence clinical decision making. Our talks with all other major insurers have indicated that none wish to go down this path and they are all satisfied with professional controls at MAC level working in well-regulated hospitals.’
Julian Stainton, chief executive of WPA said: ‘We’ve never believed in managed care. There are some lessons that have emerged from the US - if you to try to intervene as an insurer to squeeze cost, the net effect is that it emerges elsewhere. Lots of people are impressed with the Kaiser Permanente model and for a group like BUPA, which runs hospitals, it would be a relatively easy step to move down that road. I would see that as the beginning of a contracting-out relationship from the NHS, in the same way that you can contract out of certain parts of the NHS pension. Whether or not the British public is ready for that I don’t know.’
A spokesman for Standard Life said: ‘That is one option for customers prepared to accept restrictions in order to receive lower premiums but we wouldn’t anticipate it would become widespread or spread into the public sector as we are in a very different position from health services in the US where there is more scope for investing in that kind of structure. As an insurer if we wanted to start operating as an HMO it would be difficult as unlike Kaiser Permanente we don’t own hospitals. From our point of view it’s important to keep the clinical lead in terms of treatment - doctors have the best view on the most appropriate treatment and any move away from that has to be carefully looked at – we would have certain reservations about moving away from that model.’