An Unpublished Letter to the Times
This letter was submitted to the Times by a senior consultant ophthalmologist on 4th December 2006 but not published. FIPO was sent a copy and we reproduce this here with the permission of the author who now wishes to remain anonymous.
Letters Editor
The Times
Sir
In your recent article (BUPA takes a stand, The Times, 2 December 2006) BUPA Insurance has tried to shine a favourable light on its proposed restrictive eye surgery ‘network’ and its new tendering approach to private health care. That light has more to do with assertion and sound-bite than fact.
The quality of ophthalmic surgery in this country is second-to-none. At about 1%, complications during cataract surgery by British consultant ophthalmologists are lower than reported international levels. The two ‘audits’ BUPA claims are absent are poor indicators of complication rates. One is posterior capsular opacification which, with modern intra-ocular lenses, occurs in a single figure percentage of patients some years after uneventful surgery and is easily dealt with by an outpatient laser procedure. The second, retinal detachment is also delayed by years after surgery and is a very rare event in normal eyes.
There have been many detailed independent audits in ophthalmic surgery and recent results showing ongoing improvements [see www.fipo.org/]. By definition, audit does not take place after each procedure, just as financial audits do not take place after every transaction. It is continuous clinical governance – a robust quality assurance process in every private hospital – that identifies and addresses the few abnormal outcomes This information allows the monitoring of clinical quality and the misinformed efforts of a financial services business seeking to control the clinical practice of consultants does nothing to enhance the process but seeks only to reduce its reimbursements to the patient.
Criticism of consultant charges is also misplaced. There is variation between consultants on clinical fees as a natural consequence of a free market. National guidelines for such fees were ruled illegal in 1992 by the Monopolies and Mergers Commission.
What is essential is an overall transparency of charges made by clinicians, hospitals and private medical insurers. In this respect, consultants are far less opaque than BUPA Insurance whose profits in 2005 were £95m. Subscribers have seen a 54% increase in their BUPA medical insurance premiums in the last five years, yet during this time medical inflation has been 18%. Meanwhile, the proportion of the total health care costs paid out for consultants’ charges has been reducing each year. It is, perhaps, time for a proper explanation of these anomalous figures.
For BUPA Insurance to suggest that its new restrictive clinical networks are in the interests of its subscribers is at best a manipulation of the truth; at worst, it puts profits before patients. BUPA subscribers will, increasingly, lose choice of consultant and hospital under these ‘network’ schemes and large corporations will and have moved to less restrictive insurers. Such a freedom is not so easily granted to the individual subscriber who is often locked in to their insurer.
A Consultant Ophthalmologist