FOOL'S EYE VIEW
Paying For Private Medical Insurance

By Jane Mack (TMFJane)
December 2, 2003

Accident and emergency situations aside, we generally have three main options when we're ill - the National Health Service, Private Medical Insurance or we can pay for treatment ourselves as and when necessary.

The problem with the first option, of course, is waiting lists. Healthcare via the NHS may be 'free at the point of delivery' but if you've been diagnosed with a fairly serious heart condition, then the idea of waiting, say, 12 months for a bypass operation might not exactly appeal. And if you require an operation for something non-life threatening but which has a serious impact on your lifestyle – such as a knee replacement – you're not going to want to wait for months on end when you're in considerable pain.

The second option, Private Medical Insurance (PMI), is valued highly, mainly because of the speed of treatment and it's a perk that is sometimes offered by employers as part of an employment package. Companies can often get group PMI cover much more cheaply than individuals so if you're not offered it in your current job, it may be worth suggesting.

Try paying for a comprehensive PMI policy yourself though and you'll find it expensive. Certain incurable (chronic) conditions are often excluded from policies anyway and, the more illnesses you're covered for the more expensive your monthly insurance premiums will be.

You can get PMI budget plans that limit cover or where you contribute to a proportion of the costs of treatment on a percentage basis. Alternatively, you could pay the first £x of treatment – an excess in other words - just as you can with a car insurance policy.

The third option is to pay for your treatment yourself and it seems a large number of people are prepared to consider this. Standard Life Healthcare's annual 'Attitudes to Healthcare' Survey recently revealed that 72% of people would consider paying for their own medical care to avoid NHS waiting lists. The trouble is, the survey also revealed that most of us don't have a clue about what treatments cost.

For example, a heart bypass operation typically costs £14,500. A knee replacement is usually around £9,500. It's a lot of money but if you're in chronic pain, you might be prepared to dip into your savings or borrow against the house in order to get treated faster.

So, the options are that you can get treated free if you're prepared to wait for, perhaps, a considerable length of time or you can get treated almost immediately if you're prepared to pay, whether via PMI or by paying for it in full yourself.

That was certainly the case until two months ago when a fourth option became available following a landmark court case. If the waiting list is long, make your local health authority pay for you to have treatment abroad.

Back in July 2001, the European Court of Justice ruled that all patients in the EU have the right to be referred elsewhere if they face "undue delay" in getting treatment in their own country.

Unfortunately, they didn't define the meaning of 'undue delay' so the Government's view of the phrase was that it was anything over and above the official waiting time for any particular treatment.

However, earlier this year a 72-year-old woman in need of an urgent hip operation took her local NHS Trust to court after being told she'd have to wait for up to a year for it. Not surprisingly after launching the action, the hospital reassessed her clinical needs and moved her up the waiting list so she only had a wait of three to four months. But she was in such pain she went to France to have the operation anyway and continued the action so she could be reimbursed.

The judge ruled at the beginning of October that, in her particular case, he didn't consider three to four months to be an 'undue delay' but that an acceptable waiting time was certainly 'very much less than a year'. She, therefore, lost her own case but won the argument for the rest of us.

Nothing is as simple as it seems, of course. If you were told you had to wait a year for treatment you might think that desperate times called for desperate measures and you might be prepared to do your own research to find a good hospital on the Continent and to travel there to get free treatment sooner. Or you might pay for PMI so you didn't have to do that sort of thing.

As always, whenever you're considering whether to pay premiums for any kind of insurance product, you need to weigh up whether it's worth it and what the alternatives are. The main reason for looking at PMI (or paying for treatment yourself) seems to be the NHS waiting list for most people. If there's a way around the waiting list (depending on what illness you get and no-one can second-guess that), you will, at least, be better informed when considering what sort of PMI policy to buy - or whether to buy one at all.

Find out more about Private Medical Insurance; Common Sense On Private Medical Insurance