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Sunday, 21 November 2010 15:52

The Gap and Private vs Free NHS Provision

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In the UK, an individual is likely to weigh up what is available to them for free on the NHS compared to what is not available for free.

Consequently, the closer the free provision comes to the non-free provision (i.e. the smaller the gap), the greater the relative cost of “going private” is seen to be.

This will mean that private providers have to offer more to increase that gap in order to justify the difference in cost. But what they offer has to be something of value to the individual making the choice, and such “extras” will never be as important as the core reasons why someone seeks out hearing care.

The more evident the gap between private provision and free NHS provision, the easier it is for an individual to justify going private; they need to be able to demonstrate to themselves and to others what they are getting in return for their investment.

When something is free, there is no risk, so it reduces the need to justify the decision process: the individual thinks, “What have I got to lose? No harm in trying it first.”

The better the “free” experience, the less likely they are to find the need to go private. This is where convergence kicks in: the two providers appear to be equal in terms of their proposition – so what stands out is the “cost”.

The Negative Gap

If any of the propositional factors becomes better through the free provider than the paid-for provider, a negative gap occurs: people are effectively paying for something that is inferior to what they can get for free.

All that needs to happen for this to occur is for NHS technology to be better than the majority of hearing aids purchased privately, for waiting times to be similar in length, for the same styles to be available on the NHS as privately, and for the reputation of the NHS to be perceived as better than the reputation of the private sector.

When this point is reached, either the system needs to change in order to create a level playing field across providers or a way to restore a positive gap needs to be found by the paid-for provider to justify its existence.

Can the Positive Gap be Restored?

There are two ways a positive gap could theoretically be restored. One is if the “free provider” deteriorates in enough of its propositional factors. The second is if the “paid-for provider” is able to improve their own propositional factors or add extras to their proposition.

The first way is a very negative approach: it relies on hoping for another provider’s failure. If the patient is at the centre of what hearing care aims to achieve, then should we be looking to take away good provision from them?

The second way is a fragile approach. Firstly, it only requires that the free provider copies what paid-for providers are doing, and the gap is closed once more. Say, for example, the private sector begins offering auditory rehabilitation as standard and claims that this is one of the reasons why people should go private. All the NHS has to do to maintain that negative gap is to offer auditory rehabilitation too. And if they did it better…

Secondly, it assumes that the patient actually wants those “extras”, when in fact these are secondary to the core proposition, which is to hear better.

For example, if the private sector were to try differentiating itself by offering an integrated TV Listening Package, do (all) patients actually want this? And if they did, is “the cost of going private” simply to get such a proposition really justifiable to them when they could achieve something similar with a £100 home loop system purchased online?

Those who propose offering such “extras” need to be able to answer these questions. Unless they can, the positive gap cannot be restored: convergence has come too far. Either the “free provision” needs to deteriorate in its offering or the system needs to change to create a level playing field.

The Gap Within A Level Playing Field

Once the system has been modernised to cope with convergence and a level playing field has been created, the Gap Principle still applies. But now it is applied across all providers equally, with each one differentiating themselves by improving their own propositions. Service-users are no longer having to weigh up the benefits of paying for hearing care versus free provision.

Once convergence has taken place, the creation of a level playing field provides the right conditions for an upward trend of constantly improving service across all providers.

Read 3662 times Last modified on Sunday, 20 January 2013 23:25
Curtis Alcock

Curtis J. Alcock is Founder of Audira » Think Tank for Hearing.

He was involved in design and marketing for 12 years before making the transition into hearing care nearly 12 years ago. He now runs an independent family-run hearing care practice in the United Kingdom and has spoken internationally on shaping the future of hearing care.

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Recorded at the Copenhagen Opera House, Denmark in August 2012 as part of the 5th International Oticon Conference