Consultants' fees for private patients likely to be cut: BMA ordered to stop publishing guidelines on charges

HOSPITAL consultants face cuts in the fees they are able to charge private patients after the Monopolies and Mergers Commission yesterday ruled that the British Medical Association was, in effect, running a monopoly in private medical care.

The association was ordered to stop publishing guidelines on the fees consultants can charge. The guidelines have enabled doctors 'to charge higher fees than would otherwise be possible', Neil Hamilton, the corporate affairs minister, said.

Private health insurers yesterday welcomed the move, Norwich Union Health Care predicting that in time it could cut health insurance premiums by 20 per cent.

But there was sniping among the insurers over Bupa, the biggest provider of private health cover, being allowed still to publish its schedule of maximum fees per operation. The MMC found Bupa's list has 'had a restraining effect on consultants' charges' and should continue.

However, Tim Baker, commercial director of Norwich Union Health Care, said 'we would challenge that. If you look at the top 20 procedures there is no difference between the BMA and Bupa'. Allowing Bupa to still provide its schedule would slow any drop in consultants' fees and hence premiums, he claimed.

The BMA agreed to withdraw the guidelines, but attacked the MMC's decision as 'perverse'. Doctors and patients had found the guidelines 'a helpful source of information on the likely costs of treatment in the private medical sector,' a spokesman said. Even the MMC's own research showed that 70 per cent of the market was influenced by the fee schedules of Bupa and other insurers, the association protested.

The BMA drew up its guidelines in 1989 after complaints from consultants that Bupa was holding down fees. The fees recommended include pounds 90 for joint manipulation under anaesthetic, pounds 310 for removing a wisdom tooth, pounds 775 for a hip replacement and pounds 5,825 for a liver transplant - all with additional fees for the anaesthetist.

The ruling is likely to see consultants effectively advertising their charges to family doctors in order to win business. The BMA said it would give 'early consideration to what arrangements should be made for consultants to make their charges known locally to general practitioners'.

Peter Garrard-Cole, director of benefits management for Bupa, said it too was examining ways of telling GPs what its benefit limits were and how much consultants locally charged their private patients. Norwich Union already encourages patients to check their insurance will cover the fees and warns patients off when the consultant's charge is too high.

The MMC found that consultants used both the Bupa and BMA figures as tariffs, so that those consultants following them were acting to 'prevent, restrict or distort competition'. However, Bupa's figures were there to tell its policy holders the maxima it would pay, while the BMA's were those of a trade union, helping consultants 'increase their incomes above what they would otherwise be'.

Banning the BMA's guidelines 'may help stimulate price competition' between consultants, the MMC said, adding that while it understood fears that the quality of private care might decline 'we believe price competition is not inimical to quality'.

The Consumer's Association welcomed the report and urged patients to haggle over consultants' fees.

Private Medical Services; Cmnd 2452; HMSO; pounds 23.