Skip to main content
The Actuary: The magazine of the Institute and Faculty of Actuaries - return to the homepage Logo of The Actuary website
  • Search
  • Visit The Actuary Magazine on Facebook
  • Visit The Actuary Magazine on LinkedIn
  • Visit @TheActuaryMag on Twitter
Visit the website of the Institute and Faculty of Actuaries Logo of the Institute and Faculty of Actuaries

Main navigation

  • News
  • Features
    • General Features
    • Interviews
    • Students
    • Opinion
  • Topics
  • Knowledge
    • Business Skills
    • Careers
    • Events
    • Predictions by The Actuary
    • Whitepapers
    • Moody's - Climate Risk Insurers series
    • Webinars
    • Podcasts
  • Jobs
  • IFoA
    • CEO Comment
    • IFoA News
    • People & Social News
    • President Comment
  • Archive
Quick links:
  • Home
  • The Actuary Issues
  • May 2012
05

Soapbox: Data analytics vs your GP

Open-access content Monday 30th April 2012 — updated 5.13pm, Wednesday 29th April 2020

Combining actuarial data with insurers’ clinical practice knowledge could improve health outcomes, says Adrian Baskir

2
Health insurance plays an important role in the UK healthcare system, providing some £4bn of care each year. But to be sustainable, health insurance must remain affordable and continue to deliver high-quality, good-value healthcare. So it is clearly problematic that medical inflation has been rising at a staggering rate, resulting in premium increases of 10% a year for most of the past decade.

—

Many models of managed care have been attempted around the world to optimise the scarce financial resources available for healthcare - health maintenance organisations (HMOs), network options, consumer-driven healthcare, to name but a few. But none seem to have definitively redefined the patient journey or achieved a sustainable dent in medical inflation.

For this reason, our review of the way in which patients are referred from primary to secondary care is particularly interesting.

Today in the UK, as in many other countries, accessing healthcare starts with a visit to the general practitioner. Traditionally, when GPs recommend that a patient sees a specialist privately, they provide a referral to a named consultant or local private hospital.

However, as research carried out by the UK's Office of Fair Trading shows, GPs often have limited information about a consultant's care practices, patient experience or private charges. This means when insured members need specialist care, they are often referred to a consultant based on 'informal' information, and sometimes experience unexpected top-up fees, because the consultant charges outside the health insurer's monetary limits, which the GP would be unaware of.

Conversely, health insurers have access to a wealth of data. We know how many patients have been to a particular consultant or hospital and where readmissions have occurred, because we provide members with pre-authorisation for consultations and treatments, and receive and pay the bills. We also have access to more objective data about individual consultants than is available to an average GP.

This led Bupa to introduce 'open referrals' in January, following successful testing with several corporate clients and our own employee health insurance scheme. Members ask for an open (as opposed to a named) referral. When they call us, they are given a choice of two or more consultants.

We use a simple algorithm based on patient and providers' postcodes to find convenient consultants, and match the patient's requirements in terms of the speciality, sub-speciality and even the type of procedure the consultant performs. We then provide members with a choice of convenient and relevant consultants who guarantee to charge within our monetary limits, meaning there will be no additional fees for their treatment, which is a frequent cause of complaints.

Customer feedback has been positive: we've seen a 27% uplift in customer satisfaction for those referred this way, relative to a control group who were not. There's a financial benefit too: initial premiums for corporate customers on this arrangement will be lower than for those on a traditional referral path, and further savings will accrue in subsequent years. As savings are incremental, the cost of delay is significantly more over the period.

Open referrals have also enabled us to respond to corporate clients, who tell us that they want their employees to receive quality healthcare but to not have to pay any shortfalls.

Savings are important, but the real opportunity is to ensure members have continued access to high-quality healthcare. Initial indications are that combining the data and statistical analysis available to an actuary with information about clinical practice available to the insurer will enable us to improve health outcomes - for example, reduced repeat admissions. But this is a longer-term aim. Getting the metrics and measurement right is critical - and complex.

As an afterword, a short personal anecdote: I was recently sitting in a GP's consulting room and he needed to refer me to a consultant. Unable to identify anyone from his Filofax, he turned to Google. Would you rather be referred by Google or via objective analytical information about clinical practice?

Adrian Baskir is head of pricing and actuarial, Bupa Health and Wellbeing
This article appeared in our May 2012 issue of The Actuary .
Click here to view this issue

You may also be interested in...

2

Editor's comment: Healthy options

Deepak Jobanputra believes actuaries have a vital role to play in informing stakeholders on the challenges of a developing healthcare system
Monday 30th April 2012
Open-access content
Sue Elliott Just Retirement

Healthcare: A long-term view on social care

Sue Elliott considers the changing social care landscape in the UK and how proposed reforms such as those set out in the Dilnot Commission report could stimulate demand for long-term care insurance products
Monday 30th April 2012
Open-access content
2

Healthcare: Dropping gender differentials on disability cover

Due to gender differentials in the UK disability insurance market being too high and masking more reliable rating factors, Sarah Bennett argues that the Gender Directive may be doing actuaries and policyholders a favour.
Friday 4th May 2012
Open-access content
2

Babies born in 2012 'won't get state pension until they're 77'

Children born in 2012 are unlikely to receive their state pension until they reach 77 as a result of plans to increase the state pension age in line with longevity, PricewaterhouseCoopers said today.
Tuesday 15th May 2012
Open-access content
2

28% of Britons over 50 'have no retirement savings'

More than one in four UK residents aged over 50 have no pension plan in place and are set to rely on the state pension in retirement, according to research published by LV= today.
Wednesday 16th May 2012
Open-access content
2

Rave reviews for Health and Care Conference

More than 175 delegates and speakers attended The Health and Care Conference 2012 at the Hilton Deansgate Manchester in May.
Tuesday 29th May 2012
Open-access content

Latest from Health care

yf

Animal crossing: the threat of zoonotic diseases

Prachi Patkee and Adam Strange discuss what the rising threat of climate-driven communicable disease means for insurers
Wednesday 30th November 2022
Open-access content
hb

Boiling point: the effect of rising temperatures on future mortality

As quantifying climate risk exposure becomes increasingly important, Dan Gill, Rajinder Poonian and Alex Harding investigate the effect of rising temperatures on future mortality
Wednesday 2nd November 2022
Open-access content
vb

Interview: Professor Paul Dalziel on changing the focus of economies from growth to wellbeing

Paul Dalziel talks to Alex Martin about the true purpose of economics and the lessons we can draw from the 2019 New Zealand wellbeing budget
Wednesday 2nd November 2022
Open-access content

Latest from May 2012

2

Letters to the editor - July 2012

In which actuaries discuss the AGM, the actuarial exam and defined benefits
Thursday 5th July 2012
Open-access content
ta filler

70% of FTSE 100 firms now offer diversified growth funds

The number of the UK's leading firms offering diversified growth funds as an option in their defined contribution pension schemes has increased by more than 50% over the past 12 months, according to Towers Watson.
Thursday 31st May 2012
Open-access content
ta filler

FSA unveils reduced pension projection rates

Rules which aim to give investors taking out a pension or life insurance policy a realistic indication of potential future returns have been published for consultation today by the Financial Services Authority.
Thursday 31st May 2012
Open-access content

Latest from formbuilder_item_removed

2

Implementing IFRS 17 Discount Curves: Theoretical and Practical Challenges

The International Financial Reporting Standard (IFRS) 17 requires liability cash flows to be discounted at rates that reflect the characteristics of the cash flows, including their liquidity
Tuesday 3rd September 2019
Open-access content
2

Profit Emergence Under IFRS 9 and IFRS 17: The impact of choice of liability discount rate

With the IFRS 17 accounting standard, insurers need to understand the patterns of profit emergence that arise under the standard, and how current business and methodology decisions affect such patterns.
Wednesday 10th July 2019
Open-access content
2

Whitepaper: Aggregation and diversification of the IFRS 17 Risk Adjustment

This paper forms part of a series of high-level papers designed to provide an introduction to different features of the risk adjustment that should be considered in advance of implementation.
Tuesday 29th January 2019
Open-access content

Latest from 05

Editor's comment: Time out

With exam season almost over, it is time to take stock and embrace a thrilling summer ahead, says Deepak Jobanputra
Wednesday 30th May 2012
Open-access content
2

Letters to the editor - May 2012

In which actuaries discuss disappearing DB and graduate grandads
Monday 30th April 2012
Open-access content
2

President's comment: To give and to receive

Jane Curtis looks at progress in member services and the importance of volunteers
Monday 30th April 2012
Open-access content
Share
  • Twitter
  • Facebook
  • Linked in
  • Mail
  • Print

Latest Jobs

Pricing Trading Manager - Contract

£700 - £1000 per day
Reference
148579

Head of Financial Risk

Flexible / hybrid working with minimum 2 days p/w office-based
£ excellent package
Reference
148578

Insurance Risk Leader

Flexible / hybrid with 2 days p/w office-based
£ to attract the best
Reference
148577
See all jobs »
 
 
 
 

Sign up to our newsletter

News, jobs and updates

Sign up

Subscribe to The Actuary

Receive the print edition straight to your door

Subscribe
Spread-iPad-slantB-june.png

Topics

  • Data Science
  • Investment
  • Risk & ERM
  • Pensions
  • Environment
  • Soft skills
  • General Insurance
  • Regulation Standards
  • Health care
  • Technology
  • Reinsurance
  • Global
  • Life insurance
​
FOLLOW US
The Actuary on LinkedIn
@TheActuaryMag on Twitter
Facebook: The Actuary Magazine
CONTACT US
The Actuary
Tel: (+44) 020 7880 6200
​

IFoA

About IFoA
Become an actuary
IFoA Events
About membership

Information

Privacy Policy
Terms & Conditions
Cookie Policy
Think Green

Get in touch

Contact us
Advertise with us
Subscribe to The Actuary Magazine
Contribute

The Actuary Jobs

Actuarial job search
Pensions jobs
General insurance jobs
Solvency II jobs

© 2023 The Actuary. The Actuary is published on behalf of the Institute and Faculty of Actuaries by Redactive Publishing Limited. All rights reserved. Reproduction of any part is not allowed without written permission.

Redactive Media Group Ltd, 71-75 Shelton Street, London WC2H 9JQ