Optimal Care

For tifgroup, access to the best available care for our customers in a medical emergency has and will always come before convenience, comfort or cost. The convenience of a medical facility right by the customer’s hotel or the comfort of a private room with British satellite TV cannot be the criteria for choosing where to seek emergency treatment, quality of care must override all other considerations.

The UK Government states (on the FCO country advice page for Spain) that “if you need hospital treatment in Spain you’re more likely to receive appropriate care in a public healthcare facility”. So why are public healthcare facilities more appropriate than private clinics? There are three main reasons.

Firstly, a customer who is worried about any symptoms he or she has developed will usually go to A+E. The doctor who assesses the customer in A+E will be a generalist rather than a specialist, so will not know in many cases what the problem is or what the treatment should be. However, a good generalist will know who to ask so that the problem can be correctly identified: a cardiologist, neurologist or endocrinologist, for example. As a general rule, in Spanish public hospitals specialists are available to give input on any emergency around the clock every day of the year, however this is generally not the case in private clinics, the reason being that the cost of providing such extensive on-site specialist care is extremely expensive and only viable in a facility funded by the state.

Secondly, public hospitals in Spain are regulated by the Government and, crucially, this includes the standard of medical care. Because of this, it is virtually impossible for a doctor in a public hospital to be working in a field for which he or she is not qualified. There is no such regulation in place in private clinics.

Thirdly, in our experience, it is common to see customers receiving unnecessary care in private clinics. Customers are referred to hospital when they don’t need to be, they are admitted unnecessarily and, once in the clinic, receive investigations and treatment which are not necessary. This is not just wrongful, it can be dangerous for patients to receive treatment that they don’t need. Treatment in public hospitals is driven only by the clinical needs of a patient.

This all begs the question: if public hospitals are more appropriate than private clinics in Spain, why do the majority of British tourists find themselves in private clinics and how do they get there? We have long had concerns about arrangements in place in high volume tourist resorts to direct people to private rather than public facilities. We are aware of the particular circumstances in which some of our customers ended up in a private rather than the more appropriate public facility and we believe those circumstances reflect widespread practice throughout the major Spanish resorts. The circumstances involve a payment in cash or kind by the private inpatient facility to those referring tourists to these facilities and as such, in our view, constitute nothing short of patient trafficking. We object in the strongest possible terms to the practice.

We often ask our customers to tell us what happened when they were sent to a private clinic and the responses are sometimes disturbing. In one case in Palma Mallorca, the hotel staff called an ambulance after one of our customers had hit his head on the wall of the hotel swimming pool. The gentleman’s girlfriend told the ambulance crew that they wanted to go to a public hospital but were instead taken to a private clinic. Palma Mallorca is home to the Son Espases University Teaching Hospital, which any reasonable person would agree is the best place on the island for emergency treatment, so there was no valid reason not to comply with our customer’s wishes.

When our emergency assistance division is notified that one of our customers is in a private medical facility in Spain, we explain that the best place for emergency treatment is the closest public hospital and that the policy doesn’t cover private treatment. In the majority of cases, our customers will arrange to attend A+E at the nearest public hospital where they receive excellent care. In a very small number of cases, customers choose to ignore our advice and freely accept treatment in the private facility; in these cases, unfortunately, we have to advise the customers that they may not get their claim for the medical costs reimbursed.

We are not alone in this. In a recent internal review of UK travel insurance schemes, we found that a large majority of insurers exclude private medical treatment from cover although in some cases there is, in our opinion, a lack of clarity for policyholders. Our own policies clearly exclude the cost of private treatment unless our 24 hour emergency assistance service has agreed and adequate public hospitals are not available. This is included in our Summary of Cover letter and we also give customers further advice on what to do in a medical emergency.

In some cases, our customers find themselves in the position where they have been referred or taken to a private facility and have been told by clinicians in the facility that it is unsafe for them to move. Given that customer safety is our overriding concern, we will only suggest that the customer be transferred if the risks of being treated in a sub-optimal facility significantly outweigh the risks of transfer to the optimal facility. In a very small number of cases our customer is not in a position to give his opinion, being unconscious or otherwise incapable of choosing where to receive treatment. We never compromise on customer safety.

For these cases, where we accept that it is safer for a customer to receive treatment in a private facility, we assess requests for payment of the treatment costs from the facility on a case-by-case basis. We look at all the circumstances surrounding the customer’s admission to that particular facility before taking a decision on whether to pay the bill.

Generally, in cases where there is no evidence of patient trafficking and genuinely no adequate public facility available, the emergency assistance division will authorise the customer’s emergency treatment in a private facility and, of course, we pay the facility’s reasonable costs.

All high volume tourist resorts in Spain have adequate public facilities which are optimal either for managing any emergency or stabilising any emergency prior to transfer to a higher level facility. As a result, our emergency assistance division hardly ever authorises private treatment for emergency care in these resorts and advises our customers to seek treatment in the more appropriate public facility.

We receive many reports from our customers on the pressure that private clinics put on people to pay medical bills, both at the time of their stay in hospital and then on their return to the UK. One customer reported private clinic staff being rude and intimidating when they said they wished to leave. Clinic staff attempted to force them to pay the bill, then once they were back in the UK they started to receive letters from a debt collection agency in the UK which appears to specialise in recovering money for private facilities in high volume tourist resorts. Needless to say we supported and reassured the customer throughout.

In such cases and for all the reasons above, when the private facility sends its invoices to us we decline to pay them. We continue to act for and defend our customers from any attempt by private facilities to recover the cost of treatment directly from them. Our customers never pay the costs in these circumstances and we always pay any debt established to be due.

Less than one percent of all complaints the assistance division receives relates to the policy not covering emergency private treatment, conversely we find that customers are generally very happy with the quality of care available in the public sector in Spain. We also find that, once customers are made aware of the circumstances surrounding their admission to private clinics, many support the principled stand we take on the issue.

At the heart of everything we do at tifgroup is the desire to make a positive difference to our customers’ lives, particularly in an emergency. Central to our aim of putting the customer first is ensuring as far as we can that our customers get the best available care to give them the best chance of a successful outcome. This conflicts with a well-established infrastructure in high volume tourist resorts in Spain which is geared to steering tourists away from public hospitals and into private facilities. The vast majority of our customers just want the best treatment and we always do everything we can to ensure they get it while providing them with complete support and protection.

Read more about Optimal Care here.