Money: Pay as you go under

If you need surgical treatment but the NHS makes you wait, you can get private treatment even if you have no medical insurance. Paying a lump sum for a hospital operation is increasingly popular; last year 150,000 people funded treatment from their own pockets - a 25 per cent increase on 1997 - according to Bupa, the health insurer.

It can cost you thousands of pounds but, as dissatisfaction with the NHS continues and the cost of private medical insurance (PMI) soars, it is likely to become more common. A full range of surgical procedures are available under these "self-pay" schemes, some covering operations excluded by PMI policies. Probably the most common self-pay operation is for cosmetic surgery, which insurers usually won't cover. But operations cover anything from varicose veins to major heart surgery. Nuffield Hospitals Direct, a national network of private hospitals, says self-pay treatment is the fastest growing part of its business - particularly now that many over-65s have cancelled their PMI policies since the abolition of tax relief on premiums.

"This is a quiet revolution in private medical care," says Simon Burton, Nuffield spokesman. Many people opt to pay themselves after hearing how long they must wait on the NHS. Young professionals with spare money, but no insurance, are also happy to pay. You can request a fixed, guaranteed price, according to the complexity of your particular operation, after a consultant confirms the diagnosis. This includes accommodation, nursing care, operating theatre fees, drugs, dressings, X-rays, tests and consultant fees. Work is guaranteed for 30 days after leaving hospital.

Or, you can choose a lower "pay-as-you-go" fee, with extra costs if there are complications or further treatment is needed. With Nuffield, varicose veins cost pounds 1,300-1,420 a leg; a hernia pounds 1,350-1,700; a cataract pounds 2,100-2,550, and a hip replacement pounds 6,700-7,500. Nuffield can arrange interest-free credit for a year via Mercantile Credit, on a 10 per cent deposit.

A family with parents in their thirties and two young children would pay pounds 45-90 a month for a standard PMI policy; a single person of 30, pounds 20-40; but a couple in their 60s would pay pounds 90-150, as they're far more likely to need treatment.

Whether self-pay or PMI is better for you is impossible to call - except in hindsight - as it depends on your future state of health. The disadvantage of regular premiums is that you may never claim, or see any return on your money - but if you fall ill and make a claim, all those monthly payments may suddenly seem worthwhile. George Connelly, of Healthcare Matters, sees nothing wrong with paying for care as needed, but argues that private insurance cover has advantages.

"With premiums accelerating it is no surprise that more people are looking at self-funding. I have no problem with that. But when it comes to the crunch you should ask yourself whether you will be willing to pay. If it is a matter of life and death you may be willing to fork out pounds 12,000 for a heart by-pass, but with a hip replacement costing pounds 6,000 or more, you might decide to live with the discomfort. With insurance you don't have to make that choice."

"Self-pay is quite attractive for younger people who don't expect to have too much go wrong, but can pay if necessary - also for conditions not covered by PMI, of which cosmetic surgery is the most common." Since premiums rise sharply the older you get, he says people in their late fifties and over are often attracted by this route. The cost of operations are sometimes borne by their children.

"However, I would advise against cancelling your medical insurance policy as you get older, as you are more likely to need it. If you are retired your income may be fixed or lower and paying thousands for an op would be out of the question," Mr Connelly says. There is another problem with putting money aside. "You've got to be sure you are putting it away: if you do need an op, your coffers will then be empty. With insurance you know you're covered: you're buying peace of mind."

Bupa hospitals sales and marketing director, Howard Beveridge, says most people don't realise they can go into a private hospital without having insurance. "Yet you can go into 90 per cent of Bupa hospitals and pay. The wait for NHS hip replacement is anything from six months to two years, so many people find this tempting."

Bupa has a central service directing prospective patients to its 36 hospitals that offer self-pay treatment. Loans can also be arranged. Mr Beveridge says self-pay may also appeal to people with PMI that excludes cover for a pre-existing medical condition when they took out the policies. "There are more wealthy people out there who can afford to do this, and prefer to do so, rather than endure discomfort."

Surgicare, with centres in London, Birmingham and Manchester, offers cataract, varicose veins and hernia operations, as well as cosmetic surgery.

n Contacts: Bupa, 0345 520 520; Nuffield Hospitals Direct, 0800 688 699; Surgicare 0800 622 222.

SELF-PAY OPERATION COSTS

Through Bupa

Operation Typical cost

Cataract - per eye pounds 1,800-pounds 2,000

Coronary heart bypass pounds 9,600-pounds 12,300

Hernia pounds 1,250-pounds 1,450

Hip replacement pounds 5,500-pounds 6,200

Hysteroscopy pounds 950-pounds 1,100

Knee replacement pounds 6,500-pounds 7,500

Prostate pounds 2,650-pounds 3,100

Varicose vein - per leg pounds 1,250-pounds 1,450

Vasectomy pounds 325-pounds 375

Costs may vary according to the hospital. Prices are inclusive, covering anaesthetist fees, follow-ups and complications.