The Private Alternative

Britain's National Health Service offers free medical care from cradle to grave, but increasing numbers of Britons fear they may be in their graves before they reach the end of the interminable queues for services. Seeking an alternative, 2,000,000 Britons now pay for additional private medical insurance. The number has doubled in ten years, and private insurers predict that 5,000,000 people, a tenth of the population of England and Wales, will eventually be covered by their policies.

For this fiscal year the cost of the distressed Health Service is estimated at $4.5 billion, more than 5% of the national income. But N.H.S. has far too much to do and too little money, facilities and manpower. Almost half of the 2,500 N.H.S. hospitals in England and Wales were built before 1891. Despite a $615 million building program, many patients will continue to be hospitalized in converted 19th century workhouses for years to come.

Often, their patience is sorely tried. There are more people on the N.H.S. waiting list for hospitalization for non-emergency procedures than there are beds (468,000). Genuine emergencies get prompt attention, but the average delay for a tonsillectomy is 22 weeks, and many patients must wait a year for other elective surgery.

Two-Way Benefits. For these reasons, Britons are turning to the private alternative. When a patient pays his own bills, he can set the date for his operation and count on getting the surgeon he wants. He will recuperate not in a bustling ward but in one of the 4,398 private beds that N.H.S. sets aside in its hospitals for those willing to pay. He may also receive as many visitors as he wants; in an N.H.S. ward the limit is two at a time for an hour a day. Many privately insured patients undergo operations at the expense of N.H.S., then convalesce in paid-for comfort in one of its private rooms or at a private hospital or nursing home.

By providing attractive services, Britain's three private medical insurers have developed a booming business. The largest, British United Provident Association, controls 14 nursing homes containing 464 beds, offers nine different hospitalization plans to its 1,500,000 members, and now takes in $30 million a year. Like the two other private firms, the company offers coverage for private medical care, hospitalization, nursing and surgical services.

Every British jobholder pays a weekly N.H.S. tax of 46-c- per man, 38-c- per woman and 26-c- per child. The added expense of private coverage, a minimum of $58 a year for a family of three to a top of about $166, once made it accessible to only a small minority. No longer. Roughly 70% of Provident's recent business has come from company group policies. Once limited to top executives, these policies are being extended to more and more employees.

Despite the growth of private medical care, the 21-year-old National Health Service is in no danger of extinction. There have been bitter complaints (most recently over increased charges for false teeth and eyeglasses and imposition of a 30-c- prescription fee), but the British know that the program has served them well. In a recent survey, 95% of those interviewed rated N.H.S. good to excellent. Moreover, nine out of ten people who have private hospitalization plans still use their government-paid general practitioner as a free family doctor.

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