Established practice
Your self-pay growth is real, but without a clear pricing strategy you are leaving up to a fifth of that revenue on the table
Most hospitals now treat a growing self-pay cohort alongside their insured base, yet few have distinct pricing or positioning for each. The result is margin erosion, inconsistent patient experience, and no reliable revenue forecast.
- steps
- 6
- steps
- to start
- 2 weeks
- to start
The short answer
Each payer brings a different margin, volume and risk: insured work is steadier but tariff-bound, self-pay earns more per case but moves with household budgets and NHS waits, and NHS-funded work fills capacity at lower rates. Decide deliberately how much of each session to give each payer, procedure by procedure, and review it quarterly, rather than letting the mix happen by default.
6 steps
Do it yourself: step by step
0 of 6 done
For the last 12 months, show admissions, revenue and margin by payer (each insurer, self-pay, NHS) for each specialty.
- Time
- 2 weeks
- Typical cost
- Staff time only
- Who does it
- Finance lead
Done when: A payer mix table by specialty with margin per case.
This problem is Solvable.
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Payer mix review table
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Payer mix review
Period: [last 12 months] Prepared by: [name]
1. Current mix by specialty
| Specialty | Payer | Admissions | Share of specialty % | Revenue (£) | Margin per case (£) | Trend vs prior year |
|---|---|---|---|---|---|---|
| [Orthopaedics] | Insured (all) | |||||
| [Orthopaedics] | Self-pay | |||||
| [Orthopaedics] | NHS | |||||
| [Ophthalmology] | Insured (all) | |||||
| [Ophthalmology] | Self-pay | |||||
| [Ophthalmology] | NHS |
2. Target mix and session allocation
| Specialty | Role of self-pay | Role of insured | Role of NHS | Sessions a week: self-pay | Insured | NHS | Release rule for unused sessions |
|---|---|---|---|---|---|---|---|
| [Specialty] | [margin, growth, hold] | [volume, hold] | [fill capacity, hold, reduce] | [e.g. released to other payers 14 days ahead] |
3. Risks
- Concentration: any single payer above [x]% of a specialty's revenue: [list]
- Demand risk: self-pay procedures where local NHS waits are shortening: [list]
- Contract risk: insurer or NHS contracts due for renewal in the next 12 months: [list]
4. Decisions this quarter
- [Decision, owner]
- [Decision, owner]
Avoid these
Common mistakes
- Letting the mix happen by default with no session allocation by payer.
- Chasing self-pay with discounts rather than clear packages.
- Growing NHS work at low rates into sessions that could earn more.
- Ignoring concentration risk when one insurer dominates a specialty.
- Comparing payers on revenue per case rather than margin per case.
Free personal check
Done by Paul Robinson, not software
Give me three numbers and I'll show you whether your payer mix is working for you
What I need from you
- Share of revenue from insured, self-pay and NHS-funded work (%)
- Which payer earns you the most per case
- Theatre utilisation (%)
What you get
- How your mix compares with similar hospitals
- Where your margin and risk sit
- The three session or offer changes to consider
Within 2 working days
No sign-in, no sales call. I read every request myself and reply on WhatsApp.
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Check where you stand
Benchmarks
About 670,300 insured and 282,625 self-pay admissions in 2025, a split of about 70:30
Insured work is the larger, steadier channel
Self-pay admissions rose 7.7% in Q1 2026 and funded 31% of private admissions, while insured admissions fell 2.6%
The mix is shifting towards self-pay
The independent sector delivered 7.5% of NHS elective care in February 2026, down from a peak of about 10% in late 2024 and early 2025, after ICBs began capping activity with Activity Management Plans
NHS-funded volume is less certain than it was
Paul Robinson
14 years in UK private healthcare
I solve this one for hospitals
Want a hand? I'll look at your situation and tell you the three things I'd tackle first.
A few quick questions, about two minutes. I read every one myself and usually reply the same day.
No sales call unless you ask for one. Just a straight answer from me.
I reply personally, usually the same day.
Questions
Frequently asked questions
What is the right mix?
There is no single answer. It depends on your local NHS waits, insurer contracts and margins. The point is to decide and review it, not to hit a national average.
Is self-pay always more profitable?
Usually per case, but it is less predictable. Compare margin, not price, and allow for marketing and enquiry handling costs.
Should we take NHS work?
It can fill otherwise empty sessions at predictable volumes. Check margin after all costs and keep it out of sessions that self-pay or insured patients would fill.
How do insurers react to a self-pay push?
They notice if access times for their members lengthen. Protect agreed access times.
How often should we review?
Quarterly, with a fuller annual review before contract renewals.
Last reviewed:
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