Conservative Drugs Access

In the run up to the general elections all the main parties are letting us know what they intend to do about the National Health Service should they get elected. One issue which has been of concern for both medical insurance companies and the NHS is how much can feasibly be spent on cancer treatments.

The conservatives state that they intend to raise £200m for cancer drugs by increasing the threshold for employers national insurance contributions. The extra money would make more drugs available for cancer.

According to a recent report by an independent health think-tank, The Kings Fund, the UK has widespread differences in how cancer is treated across different health trusts. The conservatives plan to change this by implementing a policy which will not deny patients any drug which has been licensed since 2005. Currently the National Institute for Health and Clinical Excellence (NICE) decide which treatments are available depending on their cost effectiveness. Currently even if NICE have sanctioned a drug a health trust may deny its use if it considers the treatment too expensive.

The cost of drug treatments is a concern not just to governments but also to companies that supply health insurance for cancer. Some companies only cover drugs that are passed by NICE and compared to the rest of Europe the UK uses only 60% of drug treatments available for cancer.

NICE has its critics who say that many drugs that are used to prolong life may be expensive but that to deny patients treatment that may prolong their lives is inhumane. Despite its critics the Kings Fund report says that NICE is one the NHS success stories. NICE is there to assess cost effectiveness. Some of the more expensive drugs it has declined only prolonged life by a couple of months.

Cancer Lottery

National Health Primary Care Trusts (PCT) are responsible for healthcare in their area. They individually control funding and this is the reason why NHS healthcare across the UK is very uneven. This is a contributory factor to why some people like to take out health insurance: they have a high standard of care no matter where they live.

PCTs are responsible for spending around 80% of the national health service budget. They work within the overiding rules of the Department of Health and there are 152 care trusts in England.

Cancer sufferers seem to be particularly vulnerable to the 'postcode lottery' as the situation has been coined in the media. According to the National Colorectal Cancer Audit 60% of patients have a major resection (where parts of the bowel are removed) but there are variations across the country from 20% to 80%.

Survival rates vary too. In Kensington and Chelsea patients have a 43.7% survival rate for lung cancer and only a 15.4% rate in Herefordshire. Breast cancer patient one year survival rates are 89.3% in Tower Hamlets and a 99% in Torbay.

In the private health arena there is a more standardised level of care. Bupa the private health insurance provider, for example, include Avastin in their range of allowed drugs but some NHS trusts do not. Avastin is a chemotherapy treatment used for metastatic or secondary cancer and it costs around £60,000 a year per patient. The drug does not cure cancer but it prolongs life.

If you are considering private medical insurance you may be deterred when you hear that the NHS is improving. This is true, there have been improvements in the NHS over the last five years. However the improvements are not standardised across the country. It still depends on where you live and which hospital you go to.

Health insurance for cancer is available from many private medical insurance providers although there is currently a great deal of debate in the industry about the high costs of cancer treatment and what the industry plans to do about cover for this illness in the long term.

Health Insurance for Cancer Glossary

Health insurance policies can be complicated and they vary a great deal from one to the other. When it comes to health insurance for cancer there are even more complications. Different policies offer varying degrees of cover. Becoming savy with the terminology of medical insurance policies will help you to choose the best cover for you.

The Association of British Insurers (ABI) which regulates the health insurance industry has a set of common definitions which I have replicated here. This is a good starting point but of course is not exhaustive. Each company will have refined definitions of their own.

Acute condition
'A disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.'

Cancer
'A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.'

Chronic condition
‘A disease, illness, or injury that has one or more of the following characteristics:

• it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests
• it needs ongoing or long-term control or relief of symptoms
• it requires your rehabilitation or for you to be specially trained to cope with it
• it continues indefinitely
• it has no known cure
• it comes back or is likely to come back.’

Day patient
'A patient who is admitted to a hospital or day patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.'

Diagnostic tests
'Investigations, such as x-rays or blood tests, to find or to help to
find the cause of your symptoms.'

Inpatient
'A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.'

Outpatient
'A patient who attends a hospital, consulting room, or outpatient clinic and is not admitted as a day patient or an inpatient.'

Pre-existing condition
'Any disease, illness or injury for which:

• you have received medication, advice or treatment; or
• you have experienced symptoms;

Whether the condition has been diagnosed or not in the XX* years before the start of your cover.'

(*this time scale varied between insurers)

Breast Cancer Screening

Leading health insurance company Bupa are trying to encourage women over the age of 40 to have breast cancer screening in order to detect the early signs of breast cancer.

Early detection of breast cancer is vital. It can save lives and also reduce the risk of the need for full mastectomies or reconstructive surgery. The NHS provides free breast screening every three years for women between the ages of 50 and 70 but the statistics show that more than 50% of breast cancers were found in women under 50. The government plan to extend the screening to 47 and 73 by 2012. Bupa have been offering breast cancer screening for the last 30 years.

Dr Janet Donaldson, lead physician at Bupa Wellness said:

'It is important for all women to be breast aware. We all lead incredibly busy lives and it is only too easy to ignore minor changes, when a simple check could make a difference. Breast screening from the age of 40 gives women the best opportunity to detect any abnormalities early and offers a much greater chance of successful treatment if any are detected.'

Screening takes the form of a mammogram which is an x-ray of the breast tissue. Mammographies can detect early abnormalities in the breast, before any changes can be felt manually. According to Cancer Research UK two pictures are taken during a mammogram and this increases the rate of detection by 25% - 40%.

The general advice is for women to regularly check their breasts for any changes. The Cancer Research Website suggest that you look out for the following:

• A lump or thickening the breast area
• A change in the shape or size of a breast
• Dimpling of the skin
• A change in the shape of the nipple
• A bloody discharge from the nipple
• A rash on the nipple or surrounding area
• A swelling or lump in the armpit

Prevention and early detection are the most important factors in dealing with cancer but comprehensive health insurance for cancer is offered by some health insurance companies including Bupa who offer cover under their Bupa Select Heart and Cancer Policy.

Reconstructive Surgery for Breast Cancer

Some women who develop breast cancer have to go on to have a mastectomy. For many women this is not just a frightening medical matter but one which affects their self image and self esteem. Reconstructive surgery is an option for many women but recent evidence shows that this is not always offered on the NHS. Alternatively companies that offer health insurance for cancer will give you the peace of mind that you can have reconstructive surgery if you wish.

Statistics from the NHS Information Centre and Royal College of Surgeons indicate that in 2007-08 only 48% of women with breast cancer were offered reconstructive breast surgery.

Dr Chris Caddy, consultant plastic surgeon at the Sheffield Teaching Hospital NHS Foundation Trust said:

'There is a shortfall in access to breast reconstruction. We’re carrying out the audit to find out what the level of service is and where the shortfalls are.

It’s partly down to a lack of resources, the information given to women, and the options offered by the breast- care nurses who help create patient-care plans.'

The 2009 National Mastectomy and Breast Reconstruction Audit showed differences between NHS and private medical care. In the Independent sector, for example women having mastectomies were treated more quickly and immediate reconstruction (those that take place straight after a mastectomy) rates in the independent sector were high.

Research also shows that there are regional variations too. Those with comprehensive health insurance for cancer however can get reconstructive breast surgery as part of their health care policy. Normally plastic surgery is not included in medical health policies but if you have a policy which includes comprehensive cancer care then this is not the case. In the UK Bupa, The Exeter Friendly Society and PruHealth provide this.

Bupa, for example offer reconstructive breast surgery after cancer in their Select Heart and Cancer Policy. Each policy is different however and the details need to be checked. The Exeter Friendly Society policy wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast'

The PruHealth wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast. For a Policy start or renewal date on or after 1 July 2009: We will pay for the initial reconstructive surgery to restore functional appearance following major trauma or cancer. Any subsequent related treatment will be covered if the treatment is intended to cure an acute medical condition'

One problem which can occur is that women can be uncertain as to whether they want reconstructive surgery or not until some time after their mastectomies but under current private health insurance policies they only have 12 months to make up their minds.

All Inclusive Cancer Care

Cancer is the biggest cause of death in the UK and one is three people are likely to develop it but getting health insurance for cancer it is not as simple as it seems as there are great variations in the level of cover that you get from different medical insurance companies.

As outlined in Health Information Insurance cancer care is expensive and companies appreciate that not everyone can afford the premiums that need to be charged for comprehensive cover.

Do you want unlimited cover so that you do not need to stop private treatment and return to the NHS?
Most companies do not offer treatment once your cancer becomes incurable. It is then treated as a 'chronic' condition which medical insurance companies do not cover. If you then need palliative care there are even less companies that will cover your care.

Only three companies offer unlimited cover: Bupa, PruHealth and The Exeter Friendly Society.

Exeter Friendly Society
This health insurance company works on a co-payment scheme where you can agree to pay a percentage of your treatment costs (which is capped) which then means that your premiums are lower. The insurance they offer covers all health problems. What is significant about them is that they offer full cover for cancer care as well.

The Exeter Friendly Society also cover you to stay with a child in hospital up to the age of 18. If you have children this is a very important point as most companies only cover you when your child is 11 or twelve.

Costs for a 42 year old, non-smoker of average weight
No Co-payment: £ 98.45
25% Co-payment: £ 87.25
50% Co-payment: £ 70.44
75% Co-Payment: £ 42.44

There are advantages and disadvantages to co-payment schemes which need to be carefully considered.

Bupa
Bupa offer unlimited cover on a specific policy known as their Bupa Select Heart and Cancer Policy. It has no restrictions other than a £500 allowance for physiotherapy a year and £60 only per ambulance trip to take you to treatment facilities.

Bupa only give quotes to individuals and do not provide online quotes. However offering this specific cover enables them to keep the costs of this policy down.

PruHealth
Pruhealth offers the most comprehensive health insurance for cancer on the market. They even cover experimental treatments and complimentary treatments which other insurers do not cover. Their policies are general health insurance products which cover all conditions not just cancer.

Costs
40 year old female
Core: £68.13
Essential: £82.17
Comprehensive: £101.17

40 year old male
Core: £63.64
Essential: £76.82

Comprehensive: £95.33