Every package needs a government health warning

BMJ 1996; 313 doi: (Published 23 November 1996) Cite this as: BMJ 1996;313:1337
  1. Trisha Greenhalgh

    She lives in a nice house in a smart part of town. When she comes to see me she wears high boots and a coat with a mink collar and sits primly in the waiting room reading Country Life. She and I have two secrets. One is her age (mid-90s) and the other her income (none but her state pension). The house and coat were bought before she was widowed in the war, and she reads my magazines because she cannot afford her own.

    She presented with a stiff neck (wear and tear, no doubt), so I referred her for physiotherapy. Six sessions cured her, but the problem recurred a year later, and the local NHS department did not have the resources to treat her repeatedly for a chronic problem. She was not disheartened. “Good job I've got my health insured,” she said. Unknown to me, she had been paying into a private scheme for the past nine years and was pleased to be able to make her first claim.

    A few weeks later she appeared in the surgery with a handbag full of forms and a receipt from a reputable physiotherapist for a figure equivalent to two months' pension. She had continued the treatment as long as had been necessary, paid the bill from her savings, and assumed that the insurance company would reimburse the full amount.

    Reading through her policy, I clearly saw that this lady was pouring money down the drain. She pays the cheapest premium option (a not insignificant amount, given the actuarial risks of approaching one's century), which allows her the occasional outpatient appointment, a selected menu of investigations and procedures, a contribution towards acute bed and board, and the same number of physiotherapy sessions that she received on the NHS. The small print of her policy cruelly excludes the one condition for which she might conceivably reap a benefit from her payments, since she had a precancerous lesion removed a few years back.

    Having broken the news that her policy covered less than a third of the cost of her recent course of treatment, I advised my patient to abandon the scheme and instead set aside some money each month towards any further physiotherapy bills. She could count on me, I promised, to fix the remainder of her medical care on the NHS.

    “Oh, no,” she said, “I couldn't stop the scheme. It's my security, you see, for when the government shuts down the health service.”

    A radio advertisement for private health insurance plays on this fear. For only so many pennies a day you can rest assured that your family's health will be protected, come what may. Politicians in their ivory towers who see private insurance as even a partial solution to the health needs of the elderly should visit the real world, where patients like mine turn off their heating and go without fresh fruit in order to pay for policies which are tailor made specifically to exclude their greatest medical needs.—TRISHA GREENHALGH, general practitioner, London

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