Relative Values Review (RVRs)

The level of an appropriate fee for a given medical service is difficult to compute and charges will vary according to the complexity of the case, the seniority of the consultant and the geographical area of the country in which the patient is treated. Fees may be higher where practice expenses are higher.

In 1994 the then Monopolies and Mergers Commission ruled that the BMA guidelines on fees was illegal. Since then no professional listing of fees have been made and patients therefore have little idea of what their fees might be. Over the years, despite no increases, some patients have come to believe that the insurance reimbursement rate represents the true scale of charges. Consultants are not, however, obliged to adhere to these charges particularly as there has been no increase in fee reimbursements in the last ten years.

FIPO holds to the traditional view that the consultant's contract is with the patient both in the professional clinical and financial sense. The financial contract implies that the patient is responsible for the consultant's fees. FIPO believes that wherever possible consultants should give a fair estimate of anticipated fees in advance of treatment. It has to be understood that in many cases clinical outcomes and outcomes of treatments cannot be predicted and thus fees may be hard to estimate.

Patients should also appreciate that other consultants may be required - these may include "service consultants" ie. Anaesthetists, Radiologists and Pathologists. These consultants will likewise have the right to submit fees for their professional services.

Fee remuneration, and the level of, to patients by the insurer varies between companies. This fee remuneration has not altered significantly in the last 8 to 10 years despite significant rises in medical inflation, insurance premiums paid by the patient and hospital charges. FIPO does not stand for high or unreasonable charges but patients should recognise that shortfalls may occasionally occur and in that event they are responsible for the fees.

Anomalies and deficiencies in fee remuneration have been recognised by many insurers and this led in 1999 to a review of fee remuneration sponsored by the major insurance companies undertaken by an independent consultancy (Newchurch & Co.) producing the Relative Values Review (RVRs). However new reimbursement rates to patients for consultants fees have not yet been implemented.

Furthermore, an OFT inquiry was instigated into the whole RVR process (Financial Times, 29th January 2002) with the complainant (PPP) suggesting that this whole process would be anti-competitive and therefore illegal. This has been rejected by the Offive of Fair Trading.