How would you feel about shopping around for a hernia operation? What about haggling over the cost of hip replacement? If such a scenario doesn't fill you with dread, or you simply can't wait any longer for a routine operation on the NHS, it might be time to take matters into your own hands.
However odd it may seem for a generation brought up on the NHS, a small but growing band of Britons are now choosing to do just that and "self-pay" for treatment.
One big factor has been the big rise in premium costs over the past two years. A 55-year-old couple, whose children have left home, may pay as much as £4,000 a year to their insurer. The other big factor is that over the same period the "open market" in operations has grown dramatically.
Stung into action by hospitals abroad, and to some extent by the NHS reducing its waiting lists, private hospitals in the UK now make it much easier, and cheaper, for those who don't have private medical insurance (PMI), but want to have their ailment treated privately.
Bupa, Nuffield, BMI and Capio are among those organisations now offering fixed price operations. Gone are the days when customers wrote a cheque to the consultant and another to the anaesthetist - today they all offer a one-stop shop, and crucially prices are much more transparent.
While critics cite instances of poor care and facilities in hospitals, consumers can now ring up all the providers (including the NHS's own consultants working privately) and literally shop around for the best deal.
According to Roger Hymas, the prices vary enormously. He is the chairman of an independent agency called Healthcare Navigator (healthcarenavigator.co. uk), which for a one-off fee of £60, will find private buyers operation "slots" among the various private providers.
"The price for routine operations such as hernias and cataracts often varies by as much as 100% at different hospitals a few miles apart. We were recently trying to find a hip replacement operation for someone and were quoted £11,250 at a big private hospital in south-west London; we found the same operation literally five miles down the road at an NHS private patients unit for £5,600." He says that private buyers can bring the cost down even more if they are prepared to be flexible or don't mind travelling to other areas.
Prices for treatment don't only differ between providers but also within the same companies.
Peter Curtis, operations director at the Swedish-owned operator of private hospitals Capio, which recently won a big NHS contract, admits the same operation can cost different amounts depending upon which Capio hospital undertakes it. "The market is very regional and in certain areas, some operations are more competitive than others and the price naturally reflects this. Most clients don't ask whether they can get it done more cheaply by going 20 miles down the road as they generally prefer to concentrate on getting the first choice consultant, at a time that suits them best," he says.
"More of our clients are choosing to go down the self-pay route - particularly in areas where NHS waiting lists are coming down and hospitals have made it easier with simple price plans."
But many people are happy to remain with the convenience of a traditional insurance policy. Mary Edwards, 59 (not her real name) is currently recuperating after surgery to remove a benign tumour. She and her 60-year-old husband pay £3,800 a year for PMI. But she says the excellent and quick treatment she received still makes her a firm advocate of traditional insurance.
"The insurance company paid a lot of bills," she says. "There were x-rays costing a total of £271, an MRI scan costing £640 and an outpatient appointment with a consultant costing £135 - and that was before any of the bills for the specialist consultant she saw in London, the operation itself and the three nights she spent in the Lister Hospital in London, where she had her own room. The chief thing really was the speed and knowing I was going to an expert in the field."
But the same can be true of self-pay. The treatment will happen just as quickly, and she could have seen the same consultant, and been treated in the same hospital - the only difference is that she would have paid the bill herself. Even if the final bill for her treatment is £3,000, her insurer is still £800 up on the year assuming the Edwards don't make another claim.
For those unhappy with the idea of self-pay - and it does require a certain mindset - PMI insurer HSA (hsa.co.uk) may have come to the rescue. At the be ginning of next month, it is launching a plan that should appeal to those in their 50s. At £39 a month, it is very good value for those in the 50-60 age bracket because it doesn't load the premiums according to age or other circumstances.
Applicants have to be under 60 but will be covered as long as they pay the premium. Those who don't want full cover can decline certain modules and pay a lower premium. It also has the advantage of covering existing conditions two years after the policy is taken out, which could be worth a lot to some people.
A guide to private medical treatment
The full monty
There is no shortage of companies offering full private medical insurance (PMI) - albeit at a price. Bupa is the best known but most of the big insurers offer all singing, all dancing policies. In general, the youngest and healthiest pay the lowest premiums, but these rise alarmingly once you reach 50 - and much more once you get over 60.
Bupa says a 55-year-old doctor (the least expensive profession) and his homemaker wife will pay £174 per month for its most popular PMI product. Most couples in the 55-65 age bracket pay £200 to £400 a month depending on their profession, medical history, lifestyle and location.
The advantage is the insurer will organise the whole treatment from start to finish. However, some policies are more comprehensive than others, and they may demand a moratorium before they will treat an existing complaint. Others won't cover it at all. One of the best for value is HSA's new policy which sets one premium for all, according to the cover you want. Older customers are not discriminated against with higher premiums.
Discounted PMI
These type of policies are increasingly popular and oper ate in the same way as standard PMI policies except that they build in large excesses. With WPA you can can elect to insure 30% 50% or 75% of a claim - and pay a premium that reflects the level of cover.
In such instances, policy-holders might pay the first £1,000 of a £4,000 claim, with the company picking up the rest. This is a good half-way measure between full cover and self-insurance as the premiums are much lower, but you are still liable for your percentage of the overall bill.
Capped cover
These policies are the same as the above but offer cover up to a maximum cost of £100,000. The premiums are higher and the user is still required to pay a percentage of the claim, but the company (WPA again) will pick up the rest of bill. These are better if you like to limit your liability.
You'll still pay less than for full PMI plus you can sleep easy at night safe in the knowledge that if you suffer a very serious and expensive problem, you are covered and will only be asked pay your previously agreed sum.
Finance plans
HSA (and others) have long offered health plans that will move you into a private room during NHS treatment. For a £5 fixed weekly sum (you can invest more or less, and get the equivalent cover) it will pay you £64 a day while you are in hospital to cover the cost of getting a private room and more edible food.
These ease the burden of hospital but don't get you to the top of the waiting lists. They do pay out for other things such as dentists' bills and a range of out-patient therapies
Self-pay
If you eat lots of vegetables, take plenty of exercise, drink moderately and don't smoke this is the way forward. In fact, even if you don't do all of these things this could well be the best way of covering your family. Stick the equivalent of the premium in a savings plan and buy any treatment as required. Use the NHS service where treatment is offered quickly and use your savings where you face a long wait.
Start the plan early enough and you should, given reasonable health, end up with a "healthy" surplus. The only downside is that your plans could all go wrong if you have an expensive medical problem. It helps if you are the sort of person who likes to "do a deal" and are flexible about where you are treated.
