There has been massive interest about how HSUK services can reduce the emotional and financial costs of the most common cancers. The early detection of cancer and educating people how to be the first line of defence against rising incidence has so many positive benefits:

• For the individual, knowing your cancer risk and how best to manage it dramatically improves prognosis.
• For the families of individuals affected, the emotional strain is lessened.
• For employers, the costs of private medical and other health related insurances are significantly reduced as are the absence costs associated with cancer only diagnosed in the later stages.
• For insurers, early detection reduces their cancer claims liability.
• For the NHS, the costs of treating cancer diagnosed earlier reduces financial pressure on cancer budgets.
• For the government, it supports their cancer strategy, Improving Outcomes.

We all seem to spend so much time discussing the increasing costs of treating cancer whereas we should be promoting every way possible to ensure early detection and self awareness. 

But it’s more than just about the financial benefits. Cancer screening saves lives.

It’s a great business to be involved with, supporting as it does the National Strategy on Cancer, Improving Outcomes   

For details please visit www.healthscreenuk.com/news  – more from me as it happens.

We don’t place enough emphasis on early detection. Breast Cancer does not just affect older women as the following statistics show:

The risk for women aged 29 and under is one in 2,000.

The risk for women aged between 30 -39 is one in 215.

The risk for women aged 40 – 49 is one in 50, yes one in 50.

The NHS Breast Screening programme does not start until women are aged 50, although there is some move to bring this down to 47.

The risk for women aged 50 to 59 is one in 22.

The risk for women aged  60 to 69 is one in 13. 

So what does this mean for employers?

Well, the risk of a female employee being diagnosed with breast cancer is higher than previously thought. 

Many employers are concerned about the rising costs of breast cancer, particularly those who provide private medical insurance.  But it’s not just about the direct treatment costs. The absence related costs and the strain on other ill health benefits are substantial.

Whilst helping their employees to reduce the risk factors through encouraging a healthier lifestyle, I can’t think of a better way for employers to address this issue than providing access to breast health awareness services and screening. 

Aside from alleviating one of the biggest fears for female employees, such low cost investment makes complete economic sense.   

If you want to discuss this for your own organisation, then please let me know.

There are going to be many cases where employees are away from work because of the conditions highlighted by the RCS. If the NHS is not going to fund their surgery, then who is?

Of course the counter argument is that there could be more cost effective ways of  treating each individual other than surgery. I’m not a clinician, but available evidence and my own experience tells me that this is no doubt true in certain circumstances.

It’s hard not to see vested interests on both sides. Surgeons will lose business as a result, whilst PCTs and in the future, GPs who commission services will be looking to make the most of their available budget.

This leaves employers in a bit of a no man’s land when it comes to understanding what the best way might be to get an affected employee back to work.  If they already provide private access to treatment then GPs will be more likey to refer for surgery as it is ‘off their books’. If employers solely rely on the NHS, then the non-surgical option will have more GP appeal.

I’m anticipating employers needing to spend more money on occupational health and second opinion services to see where they should be investing in their employees’ recovery and return to work. This need will grow in line with any deepening  division between those who commission healthcare and those who deliver it.

The first is that no reference is made to benefits that an employer has chosen to self fund, e.g. Healthcare Trusts for Private Medical Care. If such self funding arrangements don’t fall within the exception, then this has major implications on the cost of the healthcare risk for employees working beyond 65. I have yet to see any clarification on this point.

Secondly, whilst not having to include over 65s in health related insurances looks on the face of it like a cap on potential liability, employers need to understand the positive impact such insurances can have in getting sick older employees back to work more cost effectively.

This will be new territory for actuaries because as far as I’m aware, there has been no research into the potential costs of insuring the employed over 65s - there has been no previous need.

But with people living longer and currently having to work longer to fund their retirement, there will be a need for such actuarial analysis so that employers can make the right funding decisions.

Only 32% of employees surveyed said that there was stress management support or advice available in their organisation.

52% of employees said that their employer did not take any steps to help employees with five or more days of continuous absence back to work.

Even worse, 67% of employers admitted to not providing their employees with any measures to help them back.

Only 10% of employers had heard of the Business Health Check Tool. Only 5% had heard of their Regional Health and Wellbeing co-ordinator. Both initiatives from HWWB in the past year.

I don’t want to paint too negative a picture and I suggest that you read the report for all the survey results. But what I would say is that there is nothing in this document to tell us what HWWB are going to do to improve the situation, nor do they tell us whether the same indicators will be used to identify future trends or measure improvements by results.

I do have a sense that they felt obliged to get something out to show that they are still with us, whilst the government decides what to do with them.

The government calls on employers to provide better training for managers, forge closer links with occupational health and, wait for it, set up mini competitions / challenges between staff in activities such as cycling. This is hardly the radical approach that they refer to in the beginning of the document.

I don’t know who they consulted with before publication, but I don’t think they realise the significant investment that many employers already make in the health of the working population, saving much of the public purse. What would really galvanise employers are tax/financial incentives that reward them for making further investment.

There has been a long running battle between The Federation of Independent Practitioner Organisations (FIPO) and the two biggest insurers, Bupa and Axa PPP. The two insurers want to set fixed fee schedules for consultants services for a number of reasons. It would help the insurers assess their pricing if fee levels were consistent and possibly reduce their costs. It would ultimately help their customers avoid shortfalls in the payment of claims where a consultant’s fees exceed the insurer’s limit, an on-going source of customer irritation.

FIPO argue that fixing fees, coupled with insurers acting as some form of regulator, will erode patient choice and continuity of care. You can read their full argument on their website.

I can see the case of both sides, but the background against which this argument is taking place helps put things into context for employers.

Consultants can quite literally charge what they like for their services. At the same time, there is no accepted qualitative or quantitative methodology for assessing how good they are.  Consultants reputations are built on word of mouth – mainly from within their own profession. Employers really have nothing to judge whether their money is being well spent when they pay for private treatment for their employees.

This is not the fault of consultants, it’s just the way their services have developed. The real question for employers is what is being done in their best interests. Should they support the status quo and rely on the medical profession to do the right thing by them, or should they support insurer initiatives that are driven more by financial considerations? Which camp do you sit in?

The second issue debated by the Lords is around the way private medical insurers reimburse cancer treatment costs.  This has always been a thorny issue and insurers have been challenged many times on what they actually cover and how transparent their policy wording is.

Cancer claims are the biggest single financial cost to insurers and ultimately their paying customers, employers. This is before taking into account the huge social and emotional costs.

I have no issue with insurers who make it absolutely clear what they will and won’t cover from the outset so that a paying customer knows what they are buying. There is also a big responsibility on the part of any adviser involved to establish absolute clarity. 

There is a great deal of evidence to show that survival rates improve and costs reduce dramatically if cancer is detected and treated at an early stage.

The UK lags behind the rest of Europe in this regard. Greater investment and emphasis should be put on cancer screening and preventative services. What better way to reduce all the financial and emotional costs under discussion in the Lords at the moment.

Natalie-Jane Macdonald MD at the Bupa parent company, Bupa Health and Wellbeing, says the decision to sell allows Bupa to concentrate on healthcare products and services.

With protection and risk insurers increasing their focus on paying for treatment even earlier to reduce their liability and speed up a return to work, their products and services are getting closer and closer to the private medical insurance model. Prudential has already launched a hybrid protection and PMI product which I’m sure will not be the last. 

Which begs the question as to what Bupa are going to do with the cash raised.  How are they going to use it to concentrate on healthcare products and services when they have just sold some of them off to a sector of the market that is making a bee line for its traditional proposition?

It wouldn’t surprise me to see them buying a smaller PMI provider to help maintain their market share at a time when organic growth is proving very difficult.

The impact for employers will be less choice and higher prices. This reduced choice will have a knock on effect on intermediaries and continue to fuel the high levels of consolidation we have already seen in this sector of the market.

From first hand experience, I can tell you that Mr Parsa is not the first to question certain aspects of agreements between hospital groups and private medical insurers. It’s always been extremely difficult for smaller players, whether providers or insurers, to compete without the volume of business to do so effectively. It’s also not the first time the OFT have been approached to look into the issue.

Whether Mr Parsa will be successful in securing a proper review remains to be seen. If he does, then I don’t think this would do the industry, or its customers including employers, any harm in clearing up any suspicion. No one has really ever grasped the nettle to ensure that everyone’s best interests are looked after.

Interestingly, this comes at the same time as the launch of the new H5 private hospitals alliance comprising General Healthcare, Nuffield, Spire, Ramsay and HCA who between them run most of the private medical services market from over 200 hospitals.

One final point. I have a friend covered by private medical insurance who recently saw a consultant at the BMI Bath Clinic which seems to be at the forefront of Mr Parsa’s complaint. The consultant gave her a Circle brochure and told her to hide it from BMI staff as she left the building. Guess what. She had her operation at Circle. I have no idea what the consultant’s incentive was, but this is just another example of the type of practice that goes on.