THE British United Provident Association, BUPA, describes itself as a non-profit organisation with no shareholders and all surplus money ploughed back into the "business".
The chairman is Sir Bryan Nicholson, a former CEO and chairman of the Post Office and a past president of the Confederation of British Industry. In Britain, BUPA operates in a private health insurance industry worth £1.7 billion in 1995.
Between health insurance premiums and income from the hospitals it runs, BUPA had a turnover of £1.6 billion in 1995. The organisation, which was set up in 1947, says it pays out some £26 million a week.
Between 11 and 12 per cent of the population in Britain have private medical insurance (PMI). One-third of these are privately purchased, the remainder provided under employer schemes. For people aged 60 and over, tax relief is available on certain policies.
BUPA is the market leader, with a 45 per cent share. After a slight fall in the early 1990s, the market has stabilised, and is projected to grow by around 27 per cent by the end of the decade, covering some 8.25 million people.
Eighteen per cent of all elective (non-emergency) surgery is carried out in the private sector, including nearly 30 per cent of hip replacements.
New policies for longer-term needs are emerging. But the main exclusions appear to be long-term mental illness or handicap; maternity; accident and emergency cover; transplantation; primary care; and new AIDS cases.
National Health Service trusts are allowed to enter collaborative measures with the private sector. But the prospect of the NHS ultimately offering its own "private" health care system appears to be ruled out. Ministers have taken the emphatic view that that could not happen "without unacceptable risk to public funds".
According to the health department, those public funds last year provided for 9.2 million consultant "episodes", where patients saw a consultant in relation to a general or acute condition.
This represents a 33 per cent increase on the figures for 1990/91. And in 1995/96 there were some 41.1 million out-patient attendances, almost one million more than in the previous year.
Sources in the private sector confirm a pattern which sees patients use PMI, say, for an eye operation, while turning to the NHS for treatment of serious illnesses such as cancer. Also, the Accident and Emergency service is not something the private sector could, or would, aspire to provide.
So Britain will enter the next millennium with its one great post-war achievement intact. While it will seek to exploit its perceived advantage, it is unclear that a Labour government would seriously seek to reverse the Tory reforms. And the electoral air will be filled with assurances from John Major and Tony Blair that the NHS is absolutely safe in their hands.
