MORI Consultant Poll on Private Practice
- Methods, Analysis and Comments From FIPO
The MORI poll, conducted quite independently of FIPO, was a telephone survey of a random sample of 101 doctors in the UK carried out in February and March 2004. The sample was drawn from a variety of listings of consultants and stratified by specialty and alphabetically within regions.
The unadjusted response rate was 11 % and the adjusted response rate 15 %.
MORI estimates that the sample size is accurate to within plus or minus 10%, ninety five times out of a hundred. The sample size does not allow subgroup analysis with statistical reliability.
NHS v private work
Ninety seven percent of the consultants stated they had a NHS commitment and on average this involved nine sessions per week in the NHS and two per week in the private sector.
Funding of private patients
Eighty nine percent of consultants answered the question on the private medical insurance of their patients and gave a range of insurance cover from 40 % to 100 % with a mean of 70 %. In contrast, self-pay stood at an average of 26 % with three-quarters of the consultants stating that this ranged from zero up to 40 % of their private work.
New NHS Contract
There was a strong negative reaction to the statement that “the new consultant contract will improve the NHS”. Three in five doctors in private practice disagreed with this statement whilst only one in eight (13 %) agreed.
Overall there was a negative perception of the new NHS contract but there was uncertainty about the statement that “the new NHS contract will restrict their ability to treat private patients “. Forty percent agreed and half of these (19 %) strongly agreed however there was a very similar proportion (37 %) that disagreed. This may reflect differences, perceived or actual, in the way in which the new contract is being interpreted in different NHS Trusts.
Patient choice of the of the private sector for treatment
Consultants were asked about a series of insurance led activities and whether or not these would encourage, limit or have no effect on patients being treated in the private sector. Their responses were largely negative.
Half of the doctors thought insurance preferred hospital networks limit patient choice in the private sector, 10 % thought such networks encourage private sector work whilst a third state this had no impact at all.
A similar proportion (47 %) thought that insurance preferred consultant networks inhibit patients choosing private treatment but 44 % thought this made no difference and just 4 % said this would encourage patients to go privately.
There was a strong negative reaction from consultants in private practice about insurance definitions of acute and chronic conditions. Over two-thirds (68 %) though this limits patients from being treated privately but 22 % thought it made no difference. Only 3 % said it would encourage private practice.
In terms of the costs of private insurance, over three-quarters (77 %) of doctors agreed that comprehensive PMI is becoming too expensive for the majority of people whilst only 6 % disagreed.
Thirty eight percent of doctors in private practice were in a formal “partnership” with an insurance company. One-seventh have made some form of personal agreement with insurers involving fees but almost half (47 %) state that they are not in any form of partnership with a medical insurer. Of the thirty-nine participants in the formal partnership all report this to be with BUPA Insurance and six have partnerships with both BUPA Insurance and one or other insurer.
Changes in consultant private practice income and expenses
Consultants were asked if they had instituted any major organisational changes in their practice in the last five years and the majority (88 %) had not done so. During this period almost three in four doctors (72 %) have seen practice expenses rising and one-quarter (27 %) have seen no change. The average increase in expenses for those who have noticed the rise is 23 %. No doctors state that their private practice expenses have decreased.
It should be noted that 27% of consultants interviewed were anaesthetists and as this speciality generally has much lower expenses than the consulting specialities (medicine and surgery) these results on practice expenses may actually be masking a higher relative rise for the non-anaesthetic consultants.
In terms of gross private practice income 45 % of doctors said this had increased in the last five years. Around one-sixth (16 %) say it has decreased and 40 % state it has stayed the same. Of the forty-two doctors who say their practice income has increased the mean estimated value of this increase was 20 %. Of those who say it has increased (and this is a small base sample of only forty-two therefore the result must be interpreted with caution), 4 % say this is due to increased workload, 14 % say it is due to raising fees and 36 % say the increase is due to both factors
Overall there is a perception that private practice expenses (mean = 23 %) have increased by a greater amount than income (mean = 20 %) in practices where there has been no fundamental change in organisation. However these figures are difficult to interpret as the numbers are small and the doctors reporting a rise in income and expenses are not necessarily the same individuals.
Those with an increased gross private income were specifically questioned on this point and 52 % said the increase in expenses paralleled increase in earnings. A smaller proportion (28 %) stated that the expenses increase has been quicker than the earnings increase and a still smaller proportion (19 %) state that their expenses have increased more slowly than their income.
Fee Challenges by Private Medical Insurance (PMI) companies on
Over half (53 %) of private medical practitioners state that their fees have never been challenged by an insurers with 46 % saying that they have.
Those challenged by the insurers were on the following grounds;
- 34 % say the amount to be paid was the object of the challenge
- 22 % state that the query was concerning the different code levels and fees used by different insurers
- 17 % were challenged for allegedly over charging their patients
- 9 % were challenged due to the patient having insufficient policy cover
Perceptions of Private Medical Insurance (PMI) companies by consultants
Consultants were then asked to what extent they agreed or disagreed with a series of six statements for five PMI companies. The companies involved were BUPA Insurance, AXA PPP, WPA, Standard Life and Norwich Union.
Although a few of the results for the five PMI providers were significantly different from each other there were many similarities.
“Settling claims, easy to deal with and clinical freedom” are rated relatively highly. . “Patient friendliness” was rated lower with rating scores ranging from 24 % to 46 %. However, “value for money” was consistently rated lowest and the likelihood of “recommendation to patients” tends to receive relatively low ratings for all PMI companies but more so for the Norwich Union than for the other four. WPA and BUPA Insurance score best on this recommendation question.
The results of this series of questions are illustrated graphically below:
Satisfaction with PMIs
|Base: All respondents||