Not every NHS is created equal
As we update our hospital reports on HBI Intelligence, it becomes increasingly clear that not all NHS systems are created equal. While some systems incentivise the private sector to muck in and help out, in others, private hospitals are seen as costly alternatives to the NHS run by avaricious groups. Take the following four diverse countries:
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Spain
Spain’s private hospitals have a very mixed relationship with their NHS. On the one hand, the Valencian regional government tanked the public private partnership Alzira model. On the other, dirt-cheap PMI premiums mean dirt-cheap PMI tariffs, which in turn means often private hospitals are actually better off working with the NHS.
Of course, PMI premiums are (we hear) set to rise at some unspecified point in the future – so this may all be old news within the next few months. Something, we are told, has to give. We see no sign of it yet.
Spain is also divided regionally when it comes to healthcare governance, so this affects the relationship between authorities and the private sector. In Madrid, successive centre-right PP (Partido Popular) governments have secured the future of the private sector. In Valencia the left-wing government has done the opposite. In Catalonia some hospitals which seem to be private are simply autonomous public sector facilities.
Italy
Italy’s private hospitals are heavily reliant on the NHS. For San Donato, the biggest provider, the Italian NHS accounts for 85% of its payor mix. But funding for accredited private hospitals has been whittled away by inflation for almost a decade, and the Italian sector was the worst financially hit by Covid in the EU5. As such – in contrast with Spain – groups are looking for more private pay to shore up their funds.
Like Spain, however, Italy is also highly regional. As such the affluent and largely right-wing north has more private hospitals than public ones – albeit not more beds. This means, as one operator tells us, Italy essentially has 21 separate NHS’, all with their own attitudes to the private sector. No wonder it’s so difficult to consolidate!
Portugal
From speaking to the top three Portuguese operators, it’s clear that Portugal rivals Poland for having the most hostile private-public relationship. There the attitude seems to be that the public sector isn’t working very well and the private sector is an alternative – and they point to the growing number of people insured either through PMI or the civil servant insuring ADSE.
Portuguese operators plan to expand into as yet untouched regions of Portugal to take advantage of the crumbling NHS, and providers are much more involved in healthcare sectors which go beyond orthopaedic surgery.
One told us: “I think nowadays we have covered around 70% of the population, but there are some areas where there are no private clinics or hospitals at all. Our strategy is we will grow organically where it makes sense to.”
UK
Finally in the UK waiting lists have ballooned to encompass over 12% of the population of England (the largest of the four constituent countries). While the Government has attempted to reach out to the private sector to help lessen waiting lists, so far this has done very little to help, possibly due to perceptions that the right-wing Conservative Party is trying to privatise the NHS by the back door. Despite the reluctance to publicly do anything which might be seen to dismantle any part of the NHS, many patients in need of treatment are agnostic of or simply disinterested in whether their provider is actually an outsourced private provider.
And there are plenty of outsourcing opportunities, and revenue for for-profit groups is on the up. Spire, one of the largest hospital groups, is seeing huge increases in self-pay revenue. And, while the UK NHS is known as an elective care, hip and knee replacing sausage factory, as members can read elsewhere, HCA UK has shown this week how private players could also expand into complex acute care for UK citizens.
We would welcome your thoughts on this story. Email your views to Joe Quiruga or call 0207 183 3779.
