Open referral for healthcare: a way to control costs?

Open referral is a contentious issue. Seemingly contrary to its name, it allows those claiming to select from a list of approved practitioners, limiting their choice from the entire open market.

In this month’s protection spotlight, Sam Barrett looks at how the policy type is being used across the industry. In essence, it compels a GP to make a referral without naming a particular specialist, allowing insurers to limit the choice – and cost – of the GP or patient choosing who they would like to see.

Although this can be limiting for policyholders, it can result in a cost benefit, Ms Barrett says.

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“Having control over the specialist a policyholder sees means insurers are able to negotiate better deals, which can be passed on to policyholders,” she says.

“Just how much of a saving this can mean varies depending on the insurer and the type of business being written.”

A trend is developing towards insurers offering this type of policy in the face of ever-rising healthcare costs.

Opinion is divided on whether it ultimately benefits the policyholder, Ms Barrett says. Some believe the insurer should not be able to dictate how an individual received treatment, while others believe it is a valuable benefit that is misunderstood.

The protection spotlight looks in more detail at these issues and others concerning open referral for healthcare policies.