Clinical guidelines in the independent health care sector

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7046.1554 (Published 22 June 1996) Cite this as: BMJ 1996;312:1554
  1. Gillian Fairfield,
  2. Rhys Williams
  1. Senior registrar in public health medicine Professor of epidemiology and public health Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL

    An opportunity for the NHS to observe managed care in action

    Ever since Aneurin Bevan “stuffed the consultants' mouths with gold” the place of private medicine in the provision of health care in the United Kingdom has been much debated. With over six million lives insured—over 10% of the population—and with numbers forecast to rise,1 the independent sector is an increasingly important provider of health care. The activities of the private sector have the potential to influence the NHS and cannot be ignored. Indeed, the private sector might act as a test bed for measures, such as clinical guidelines, that the NHS would like to see widely implemented.

    Eighty per cent of private health care bought in Britain is funded by insurance. To keep premiums low, insurers must contain costs, and one perceived mechanism is evidence based medicine. Some of the larger insurers are therefore introducing clinical practice guidelines into their business. BUPA, for example, has set up clinical consensus panels to develop professionally led guidelines that will “encourage the delivery of the very best health care…both in terms of appropriateness and quality of outcome.”2 The clinical guidelines being developed or in use cover mainly high cost, high volume elective surgery, which constitutes the bulk of private medical insurers' business, but psychiatric and medical guidelines …

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