Competition and Markets Authority Study in to the Independent Healthcare Market
CMA Announces Intention to bring into force the Fee Remedy and New Consultation Process – October 2016
Following the rejection of the FIPO appeal in the Court of Appeal the CMA has announced its intention to bring into force its Fee Remedy (https://www.gov.uk/cma-cases/private-healthcare-market-investigation).
This will take some time to implement and will be carried out through The Private Healthcare Information Network (PHIN). FIPO is working with a wide ranging representative clinical group to advise PHIN on how they develop the other part of the CMA ruling, namely the publication of information on consultant performance (the Quality Remedy). We are keen to ensure that any clinical outcome information made available to patients is both accurate and in a statistically reliable format.
FIPO does not object in principle to the Fee Remedy, provided this operates against a genuine and open competitive process where fees are not controlled or distorted by the insurers.
Following the Court of Appeal’s decision FIPO wrote to the CMA pointing that there has been a material change of circumstances since the CMA issued its report in 2014. These are well known to consultants and patients and involve control of fees by the insurer for new and many established consultants and various other restrictions and diversions of patients to alternative consultants, treatments and hospitals. This trend has been increasing since the CMA issued its report and it is on this basis that FIPO has asked for a further review of this matter.
The CMA has launched a consultation process and has invited comments from all parties to be submitted to them before 5 pm on the 10th November 2016.
Court of Appeal Judgement – July 2016
On the 29th June 2016 the Court of Appeal heard the FIPO appeal against the CAT ruling on the CMA report. FIPO has lost the appeal but will be taking further action with the CMA to inform them of various changes in the market that have occurred since the report in 2014. The Court issued its judgment on the 25th July 2016 and this can be seen here;
FIPO Launches New Consultant Survey – June 2016
FIPO has launched a new consultant survey in order to assess the current economic status and opinions of consultants in private practice (and those who for various reasons may not currently be in private practice). The survey also aims to review the relationship between consultants, patients, hospitals and insurers and to analyse the current economic position of consultants. This survey is open to all consultants. A letter explaining in detail about the survey for all consultants can be accessed here.
The link for the survey can be found is here but before embarking on the survey please consider our letter and the need for all consultants in any form of independent practice to prepare some information before accessing this link; https://www.surveymonkey.co.uk/r/FIPO2016
FIPO appeal to the Court of Appeal – August 2015
FIPO is appealing to the Court of Appeal about the CAT Tribunal decision. In order to do this permission has to be sought from the CAT itself and this was rapidly granted. For more information follow this link.
The CMA has entered a defence and the case will be heard in 2016 at a date to be confirmed. This appeal will depend on legal issues rather than the merits of the case although FIPO is aware of various changes in the market since the CMA issued its report.
Competition Appeals Tribunal Judgements – April 2015
The Competition Commission now called the Competition and Markets Authority (CMA) had three appeals against its report at the Competition Appeals Tribunal (CAT).
1. HCA has successfully appealed against certain aspects of the CMA report regarding their hospital divestments. The CMA has remitted this for further consideration.
2. The AXA PPP appeal against the CMA over Anaesthetic groups has been rejected. The CAT ruling has meant that the court found no issues regarding Anaesthetic groups or partnerships.
3. The FIPO appeal against the Fee Remedy was heard in January and the appeal was rejected by a majority decision announced on 29 April 2015.
FIPO has issued a Press Statement which can be seen here.
FIPO Appeal to Competition Appeals Tribunal - June 2014
FIPO has entered an appeal against the Competition and Markets Authority Report on behalf of the profession. This appeal has been funded by donations from the profession. Further donations are still requested (contact FIPO office for details). In addition HCA and AXA PPP have entered appeals. The summary of each appeal can be seen here.
Competition Commission Report April 2014
The Competition Commission Report has now been published and its main thrust has been the divestment of some hospitals by HCA in central London. The Competition Commission found no problems with anaesthetic or other specialist groups. Consultant incentivisation has been the subject of review and FIPO would agree with the broad conclusions of the Commission that such incentivisation should stop.
The Commission has explored the need for increased transparency of consultant fees and a complex system of monitoring of fee estimates by independent hospitals has been proposed. FIPO believes this will require some further clarification.
FIPO has supported the need for appropriate clinical quality outcome data, which the Commission has recommended. There are difficulties in obtaining relevant data but FIPO is committed to working with PHIN to develop appropriate audits and reports.
Overall, there is consultant disappointment that patient detriment resulting from various insurance strategies has not been addressed and FIPO will be considering its position on this matter.
FIPO has made three major submissions to the Competition Commission and has met with members of the Competition Commission Board. The Provisional Report by the Competition Commission has agreed with some of the points made by FIPO and the profession in particular our view that incentivisation for consultants was inappropriate (hospital inducements) and that doctors working in chambers or groups do not raise competition issues. The Competition Commission has largely ignored some of the changes induced by certain private medical insurers, in particular with regard to possible patient detriment.
One of the major queries to FIPO from the Commission was over Quality and Clinical Outcomes and alignment with the NHS. FIPO is now working with PHIN (Private Healthcare Information Network) to produce suitable data.
The Competition Commission has released its' summary report which can be found by clicking here: http://www.competition-commission.org.uk/our-work/directory-of-all-inquiries/private-healthcare-market-investigation
A meeting for consultants to discuss this has been arranged for 11 September 2013 commencing at 6pm. For more information please download the programme (Adobe PDF format) here.
FIPO has responded in the following press release which can be found here.
The Competition Commission will be taking further evidence and the FIPO will update as required.
The Competition Commission is continuing its detailed analysis of the independent healthcare market. Details can be seen here; http://www.competition-commission.org.uk/our-work/private-healthcare-market-investigation
The Commission has been taking detailed evidence from all parties and FIPO has submitted three formal statements which are on the website. Other professional groups have also reacted with submissions as have individual consultants.
The Competition Commission has published at the end of February 2013 an Annotated Issues Statement which can be accessed here:
This statement reflects current thinking by the Competition Commission and FIPO has responded and is due to meet with Commission in the near future.
The Office of Fair Trading has reported on its findings in to the independent healthcare sector with its final report in April 2012. FIPO, along with other professional bodies put in several submissions to the OFT Market Study and also attended the Round Table discussion in September 2011.
In essence the OFT found a number of matters which needed further analysis; the lack of information about the cost/quality of care was emphasised although the profession was at pains to state that generic information was available but not in the detail apparently requested by the OFT. The OFT raised concerns about the dominance in certain areas of some hospital providers and the difficulty of entry presented to new providers. Anaesthetic fees were singled out as an issue. The question of incentivisation was also raised. Overall, the report concentrated on the provider aspects of the market and did not include any major reference to the potentially distorting effect that some insurer's actions might have on the market.
THE COMPETITION COMMISSION
The Competition Commission has begun its work and details of its panel membership, timetable and rules of engagement can be seen at:
This Private Healthcare Market Investigation will take some 2 years to complete. There have been several initial submissions including a submission from FIPO.
OFT Market Study
The OFT have held two Round Table discussions with the profession and the hospitals, each of which was attended by other groups including the private medical insurers, patients' associations and various think tank and consumer groups. The thrust of the professional meeting was directed at "Asymmetries" in the healthcare market. The OFT is intent on defining the cost and quality benefits for subscribers (i.e. patients) when they are referred to a consultant. The professional representatives at the meeting were at pains to point out that the GP to consultant referral pathway and the particularly personal relationships between patients and doctors is not one that can be easily moulded into a simple economic transaction. Further discussions are taking place between the profession and the OFT.
Following detailed submissions by FIPO and other professional organisations including the Association of Anaesthetists of Great Britain and Ireland the OFT has announced a market study. There were other submissions about certain alleged restrictive practices from hospital groups such as Circle and from a newly founded patient group (Private Patient Forum).
FIPO was interviewed by the OFT in November 2010 as were one or two other groups and as a consequence the OFT announced its market study, details of which may be found at;
In January 2011 the OFT conducted a scoping exercise in order to set parameters of its study and FIPO along with others contributed to this. The final shape of the study is due to be announced and the OFT will commence its work in February 2011.