Feature – cash plans
WPA’s MacEwan believes that NHS trusts may come up with a benefit schedule making it clear that treatments outside of this will have to be funded by patients. This might mean that patients have the option to pay extra for a more expensive version of standard procedures – such as hip replacements.
“Our job is to spot early on what the NHS isn’t going to do and to create and price a benefit so that we can offer it as a supplement or complement,” he says. There are plenty of examples from other countries of insurers filling in the gaps of state healthcare provision (see country case studies). Cash plan providers identify strongly with this.
“We have a historical role to complement and to bridge gaps,” says Jill Davies, chief executive of cash plan provider Westfield Health. “The current climate will open a whole load of gaps. I think as a consumer it is quite concerning when you think of the massive change going on but as a corporate provider of healthcare, it opens up opportunities.” Traditionally the treatments excluded from the NHS have been either low cost (dental care) or those not deemed to be effective, clinically or with regard to cost. Cash plans have thus developed to cover low cost, everyday healthcare, resulting in affordable pricing. But what about the more expensive gaps in the state offering that may develop? “Clearly we have to keep an eye on the
lists of what the NHS will and will not fund,” says MacEwan. “But we also have to think about what is affordable as a benefit.” This balance is illustrated in the design of WPA’s MyCancerDrugs benefit, an optional part of its NHS Top-Up cash plan, which is worth up to £50,000 but has restrictions on age of policyholder and excludes those with a family history of the disease.
“Funding expensive therapies associated with
treatment of cancers and other complex conditions would require an entirely different financial model,” says Medicash’s Weir. “That is not to say however that providers won’t be able to adapt and address market needs. Radical changes in healthcare are inevitable and providers will want to ensure that their products reflect market demand.” When it comes to filling gaps, flexibility seems to be as
important as evolution. For example, when WPA initially launched its NHS Top Up product if offered just £50 towards the cost of NHS car parking charges. Having reviewed the likely costs incurred by cancer patients, this group can now claim up to £300 a year.
COMPLEMENTARY INSURANCE IN FRANCE
The majority of the population (89%) is covered for healthcare by the social security system
92% of the population have complementary insurance
Complementary insurance reimburses patients for the cost sharing required by the mandatory social security system, as well as the cost of things not included in the system or only partially covered such as optical care and dental care
NEW BENEFITS
On the continent, insurance is not just about filling gaps, but giving patients the opportunity to access elements of healthcare not deemed core to the state’s offering, such as a private hospital room. Cash plan providers in the UK follow a similar model by funding benefits from complementary therapies to hospital inpatient benefit. Could these be extended further?
“The feedback I have had from the market is that their [brokers’] clients are asking for private GP or private maternity
41
Cost-sharing is the norm in France
Complementary insurance has a significant impact on how much people use healthcare – adults with complementary insurance are 86% more likely to visit a doctor within a one month period than those without. This means that complementary health insurance is at odds with the Government’s strategy to reduce healthcare utilisation and costs by introducing co-payments
Complementary health insurance is often provided through employers There is a public programme in place to subsidise the purchase of complementary health insurance by low-income groups
Source: OECD
COST-SHARING: In France you will be generally be expected to pay part of the cost of your care, with the social security system only reimbursing a set percentage: Consultation: reimbursed at a rate of 70% In-patient care: reimbursed at a rate of 80% Dental consultation: reimbursed at a rate of 70% Prescription: The level of reimbursement you are entitled to ranges from 15% to 100%.
As the UK’s largest cash plan provider, we know a thing or
two about delivering the best solution for your clients Contact us on 0800 294 7303 or
forintermediaries@simplyhealth.co.uk Your calls may be recorded and monitored for training and quality assurance purposes.
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Mag.indd 3 April 2011
www.hi-mag.com
24/03/2011 16:50 HealthInsurance
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