Patients need better care

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The Independent Online
WHEN you are facing a consultant who is telling you that he will 'have to take you in', the cost of the trip to hospital will probably be the last thing on your mind.

This is precisely why private patients need some protection over the fees that consultants and private hospitals charge.

Last week, the Office of Fair Trading asked the Monopolies and Mergers Commission to look at British Medical Association's Guidelines, which lists prices for 1,500 medical procedures.

The BMA claims that although the list says having your gall-bladder out costs pounds 630 for the consultant plus pounds 210 for the anaesthetic, or a hip replacement pounds 775 plus pounds 290, it is not a recommended tariff but the result of reviewing what consultants and anaesthetists are actually charging. But the OFT suspects that this list is being used as a tariff and is squeezing out price competition.

Would you seriously shop around, however, to shave a few pounds off the bill? Even the private medical insurers do not expect ill people to be acutely vigilant over charges when their life may be hanging on a suture.

The guideline prices rose by about 10.5 per cent in 1990 and by 16 per cent in the latest review published a week ago.

Once there is a recommended tariff, there will be a tendency for those charging less to increase their prices, but there will also be pressure on the high chargers to bring down their prices.

One medical insurer, Western Provident Association, says that 80 per cent of claims come with charges below the BMA rate. Many of those who charge more have run into complications.

Julian Stainton, the managing director of WPA, believes that the MMC should cast its net wider and examine the whole private medical field. He claims that some hospitals mark up drug costs by astronomical amounts and refuse to give itemised bills. A hospital bill of pounds 25,000 for a patient who died included pounds 430 for 'late discharge', because the body remained in the room beyond the normal discharge hour.

If he is right, there is a clear case for a wider look at the charging practices in the private medical field. But at least the BMA guidelines give GPs and patients some idea of the cost of the operation as they edge towards the theatre.

NO ONE could accuse the motor insurers of running a cartel.

Quotes for motor insurance are all over the place. This means that motorists can save hundreds of pounds by ringing around before accepting a quote.

Just calling one broker will not mean that you get the best policy on offer. They are unlikely to have surveyed the whole market and will certainly not have checked the new telephone operations that only deal directly with the public.

There are several reasons for the wide variations in quotes. For a start, cars are being rated more finely. A 20- band classification has replaced the old-style nine groups. Some cars are being rerated at the same time. For instance, Ford Escort 1.4s have dropped in the ratings while many hot hatches have been bumped up.

If you catch a company just before one of its annual (or more frequent) rate rises, you should get a better deal than you would from a company that has just put through a rise.

Companies are beginning to be more choosy about their customers, quoting rates to some motorists which in effect say 'go away', and refusing to quote in other cases. Journalists are among the 'no go' categories at some companies.

When I telephoned and explained that I was a desk- bound financial editor and not an ambulance-chaser, one broker said that it did not make any difference as I might be out in my car and see 'a story' and be unable to resist chasing after it . . .

To give an idea of the wide variations, my personal trawl of a dozen companies produced a lowest quote ( pounds 639 from Endsleigh Insurance) which was less than half the highest quote ( pounds 1,448 from Norwich Union). The AA's Autoquote service produced a premium for a Commercial Union policy which was pounds 455 more than the company itself quoted.

Some refused to quote at all, while another would only quote for third-party cover.

This was a fairly straightforward request: there was no recent claim, and no accidents or convictions to be considered.

I hate to think what it must be like for sports car owners with a black mark on their driving licence.

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