Nearly one in three privately insured patients in England undergoing hospital treatment have it provided and funded by the NHS – despite being eligible to claim from their policy. At the same time, emergency procedures and cancer treatment worth hundreds of millions of pounds is being provided on the NHS to people who have private cover. These are the findings of an analysis of private healthcare insurance usage undertaken by health economists Laing & Buisson on behalf of private hospital group HCA International.

The report, which models 2011 government statistics for England, shows:

  • The NHS spends up to £609 million a year to pay for emergency medical/ surgical hospital treatment for people with private medical cover – approximately 489,250 emergency admissions.
  • An estimated 254,500 planned operations and medical procedures for patients with private cover were undertaken on the NHS over the period at an estimated cost of £359 million. Compared with an estimated 607,870 elective admissions to private units.
  • Of these planned and emergency admissions, cancer care to the value of between £80 million and £125 million is estimated to have been delivered on the NHS to patients with private cover.
  • In total, healthcare worth an estimated £968 million a year is currently provided and paid for by the NHS to patients who could be eligible to claim their treatment privately from an insurer.

The report does not examine the reasons why this private medical insurance benefits worth nearly £1bn a year goes unclaimed. But the analysis demonstrate that NHS waiting lists could be shortened and a significant contribution made to the £20bn worth of efficiency savings the NHS must make by 2015 if more policyholders made full use of their cover. Anecdotal evidence suggests many GPs do not commonly ask patients whether they are privately covered on referral for treatment.

In addition insurance policy restrictions (such as for pre-existing conditions, specific treatment exclusions, and minimum NHS waiting), high excesses, cash benefits, and the likelihood of higher future premiums (on claiming) are other reasons for NHS usage.

Keith Biddlestone, Group Commercial Director at HCA International, said: “Private healthcare is about choice and many patients choose to move between private and NHS care – but these figures certainly show just how hard private medical insurers rely on the NHS to maintain profitability. Many private insurers provide “NHS Cash Benefit” options in their premiums where they pay patients a cash sum to opt for treatment on the NHS rather than use their private entitlement.

In emergency care, NHS hospitals with Private Patient Units (PPUs) have an opportunity to free up NHS beds, save costs and generate income by identifying those with cover and providing opportunity to use it. In the case of cancer care, private hospitals are frequently first movers in adopting the latest treatments before the NHS and these patients could be missing out on treatment options to which they are entitled.”

Copies of the report are available upon request.