My last article for this journal looked at the role of the market and competition in the NHS in the UK. It concluded that, without access to accurate, unbiased and up to date information, patients cannot make effective decisions about their healthcare and the market cannot work. The NHS has made good progress in improving information available to patients through NHS Choices although further improvement is needed to realise the benefits of a market in the NHS.
Private healthcare has existed in parallel to the NHS since the NHS came into effect in 1946. Perhaps, therefore, the NHS can learn from the private sector about creating an effective market based on high quality information. However, it would appear that this is not the case.
Intuitively, you would assume that there is a wealth of comparative information available to patients on the quality (and cost) of private healthcare. However, this has not traditionally been the case. In 2014, the Competition and Markets Authority undertook an inquiry into the private healthcare market which resulted in the Private Healthcare Market Investigation Order 2014. The investigation found that there was not the same volume and quality of information available about private healthcare as there was about the NHS. Consequently, the Authority made the “Private Healthcare Market Investigation Order” which requires private healthcare providers to submit information to the Private Healthcare Information Network (PHIN) on quality information, such as infection rates, and will eventually extend to information on cost. In May 2017, the PHIN published 3 performance measures covering 149 procedures at over 200 hospitals (https://www.phin.org.uk/home). Whilst the Nursing Times described this as a “significant step” this is still only 3 performance measures which represents a lot less information than is currently available about NHS provided services. Information on cost is even more difficult to find, although this does exist with http://www.privatehealth.co.uk and bestcarecompare.com leading the way.
So, there is not a great deal of information available about private healthcare quality and cost. So what? Common estimates suggest that only 8% to 12% of the population use private healthcare, so what has this got to do with the NHS?
Firstly, if there is no comparative information available to patients then market forces can not improve quality and lower cost. If effective price competition existed then prices would become lower. If prices were lower, then more patients, who currently use the NHS, would use private healthcare. This would cost the NHS less and would reduce waiting times for patients still using NHS services.
Secondly, the NHS is having to make very difficult decisions about rationing services. A lot of services are being deemed as not clinically effective and more and more patients are being turned away from the NHS for basic diagnostic tests. Providing lower cost private healthcare, by encouraging market forces, will make these tests and procedures available to a larger number of patients. More importantly, making private healthcare more affordable will reduce the financial pressure on the NHS which will reduce the need for further rationing in the future.
The NHS is becoming increasingly unaffordable. Limited information about private healthcare cost and quality allows private providers to charge more than market forces would dictate. By improving the quality of comparative information available to patients, costs can be lowered and more patients will choose to use private healthcare. This will free up resources for the NHS and will lead to lower
waiting times and reduced rationing. Hopefully organisations such as The Private Healthcare Information Network and bestcarecompare.com will make this a reality.