Have you ever noticed how many posters there are in a doctor’s waiting room? It seems like there’s no point painting the walls of NHS surgeries, as they inevitably get papered over with everything from posters asking when I last had an STD check up, flyers for Afro-Caribbean Elders' Health Services, notices about the next young mums' ante-natal class, colourful pleas for me to stop smoking or take more exercise and the ubiquitous Aids warnings.
There’s no doubt that in a doctor’s surgery, there is a captive audience. People look at their watches and wait to be called, the beep of the doctor’s buzzer punctuating furtive glances over at the table of last year’s Hello! magazines and 1996 editions of Horse & Hound. Someone clearly thinks that advertising Health Services with posters in the waiting room is a good idea, something that increases take-up of services and saves money in the long term by catching problems earlier. For that reason, I’m not going to go into a long winded tome about the evils of excessive government advertising and PR (you can read one of my previous Platform pieces for that), but instead look at how we can use the captive audience of the doctor’s waiting room to improve the quality of care, promote healthy lifestyles, prevention and early detection.
Private medical insurers have long understood the importance of encouraging their customers to be healthy. Previously, this would have meant excluding the irredeemably unhealthy, not covering pre-existing conditions and hiking premiums for age and whether you smoke. That still goes on, of course, but many insurers are looking at ways to decrease the amount of claims made by their customers. Take PruHealth for example: they offer a scheme whereby customers can earn discounts on their premiums if they go to the gym, quit smoking or go for a medical. They even give out pedometers to let people upload how far they’ve walked and offer discounts if you buy healthy food at the supermarket.
Why is it that private companies are so good at encouraging such behaviour? Sure, they have an army of statisticians telling them that it’s better to charge someone £20 a month for being healthy than charge them £30 a month and have to pay for a £20,000 heart bypass at the end of it, but don’t the NHS know that too?
When you consider that most people with private medical Insurance pay around £20-£100 a month in premiums and only about 10% of the population have Insurance, you wonder if we’re missing a trick by not having private health insurers advertise to NHS patients. There is ample scope to have BUPA, AXA or Pru put up posters in surgeries. Many waiting rooms now have flatscreen TVs carrying adverts for NHS and local authority services, replacing the dog-eared posters I talked of earlier. Insurers could be charged to advertise in surgeries and hospitals. When my doctor told me I’d have to wait a month for a specialist appointment on the NHS, I told her I had cover. “Aaaaaah. Why didn’t you say so? Let me write you a letter and we’ll get you in tomorrow,” she said. Isn’t that a conversation millions of people, many of them considerably better off than me, should be having with their GPs?
What would the net effect of allowing private companies to pitch to NHS patients be? Higher private healthcare take-up? A lightening of the load on the NHS? Patients becoming more involved in their healthcare? More people adopting healthier lifestyles? Who knows? Does it really matter? What would be the cost to the NHS? Zero. Absolutely nothing.
In fact, the NHS would make money out of it, by charging for the advertising space. The government also collects 5% Insurance premium tax from those paying in. If 20 million took out some insurance, paying an average of £50 per month, that would yield an extra £600million per year which could be reinvested into community health projects, sports facilities and preventative programmes. That’s before we even start on the savings made by having insurers take up some of the slack and lighten the burden on the NHS and the effects of healthier living.
The drawbacks? Opposition from vested interests and unions? In this country, private doctors also do much of their work in the NHS and so the systems aren’t entirely separate, so there may be staffing and time issues due to the extra demand. Some will say that Insurers will prey on the insecurities of the sick and profiteer out of the public sector. Perhaps, but if left up to GPs to decide what goes in their surgery, exposure can be controlled in a way the GP knows will be acceptable to his/her patients. It’s by no means a finished policy and would need considerable work to iron out these problems.
The biggest advantage to this policy, as far as I’m concerned (at least politically) is that it requires only a material, or practical subsidy of the private sector by the state. By the time advertising revenues and IPT has been recovered, this policy would represent a net subsidy of the state, by the private sector, and, if the savings are reinvested into community health projects, a transfer of money and resources from the more well off to the less well off. Now that's an innovative compassionate conservative idea.