Open Referral doesn’t have to mean restricted choice

Published Monday, January 30, 2012

Healix's perspective on the issue of shortfalls in the private healthcare sector

There has been much debate in recent months about the introduction of open referrals by several big names in the private healthcare market, in order to manage shortfalls on cover.  There has been some concern that, by referring policyholders to specific consultants, rather than leaving the patient's GP to make the referral, this is restricting choice and may even compromise the quality of care provided.  However we believe this doesn't have to be the case.
Quality of care has to be the number one priority for any private healthcare provider and we don't believe that is being compromised by any of the recent initiatives introduced by some of the big names in the market.  However, what some of these organisations may not be focusing on - especially in helping potential clients and patients understand their approach - is the decision-making process to select the right healthcare provider for an individual.

Greatest choice
At Healix we have always focused on giving a client's employees covered by one of our Healthcare Trusts, the greatest level of choice, accessing quality providers.  Indeed, our early intervention in the claims process by Registered Nurse Case Managers means we can provide valuable support to employees and guide them through the process of seeking treatment, whether NHS or private.  Our Healix nurses' detailed knowledge and understanding of healthcare delivery means they can provide valuable guidance on the choice of specialists or healthcare providers available to the individual, based on their clinical need and availability of services in their locality.  Of course this is all done whilst keeping a close eye on costs which, of course, is crucial for the employer. 
But cost never influences quality of care.  Our claims processes have been designed to help the individual make an informed decision about their choice of specialist or other healthcare provider.  This includes finding out what the specialist's fees will be and what level of cover will be available to them prior to them receiving their treatment.  Whilst there may be times where a shortfall cannot be avoided, this approach has worked particularly well in reducing  the number of shortfalls experienced by employees covered by our Trusts, whilst enabling them to retain control over which provider they choose to seek treatment from.

Confidence in clinical quality
Of course cost is an important consideration for our clients, but more often than not for employees, knowing more about clinical quality provided by their healthcare provider and knowing the available choices is just as important.  And, in their view, this makes the entire process of choosing a provider a lot easier.
We also believe this approach has been successful because we recognise that the relationship between the patient and their healthcare provider is important. A 'one size fits all approach' may not be suitable for everyone and this is why our nurses can offer individuals guidance on all providers who may be involved in their care, thus truly offering choice by giving them the responsibility of choosing their healthcare provider.
The healthcare market is probably the toughest it has ever been, both for the private sector and the NHS.   For employers the need to continue to look after the health of their workforce remains high on their agenda. Getting the balance between commercial considerations and retaining a healthy workforce is, therefore, a challenge facing many organisations.  We believe, moving employee healthcare provision to a Trust is the first step towards an employer gaining some level of control on their healthcare spend in this challenging economic climate.


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