Cost of referral treatment for colic in the United Kingdom-What has changed in the last 5 years?

Overview

• This study evaluated how the costs of referral treatment for colic, insurance coverage, and insurance premiums in the UK have changed between 2018 and 2023.
• It found that treatment costs have generally risen with inflation, insurance coverage limits have often not kept pace, premiums have increased above inflation, and insurance documents remain difficult for most people to understand.

Background and Objective

• Colic is a common and serious equine health issue requiring referral treatment, which can include medical management, surgery, or euthanasia.
• Cost of treatment and insurance coverage are important factors influencing treatment decisions for horses with colic.
• The study aimed to compare referral treatment costs and insurance-related factors in the UK between 2018 and 2023 to identify any changes over the five-year period.

Methods

• A cross-sectional study design was used.
• In January 2024, researchers contacted 30 UK equine referral hospitals to obtain data on their recent colic cases.
• Hospitals provided costs for the last three cases in six different categories:
  • Surgical cases with or without bowel resection
  • Euthanasia before surgery
  • Euthanasia during surgery
  • Euthanasia after surgery
  • Medical treatment cases
• The methodology matched a prior 2018 study to allow comparison.
• Data were collected on veterinary fees, insurance coverage limits, and monthly premiums from five insurance companies, using a standardized reference case.
• The study analyzed readability of insurance policy documents using two standard tests:
  • Flesch Kincaid Reading Ease (FKRE): scores 0–100 where below 65 is considered difficult.
  • Gunning Fog Score (GFS): estimates education years needed to understand the text; scores above 12 are too complex for most readers.
• Findings were compared to both raw and inflation-adjusted 2018 data.

Findings – Treatment Costs

• 18 hospitals responded, providing cost data for a total of 248 cases.
• Average and median costs (with ranges) in 2023 were:
  • Euthanasia without surgery (41 cases): £1200 (£500 to £4389)
  • Medical treatment (44 cases): £2379 (£683 to £13,762)
  • Surgical cases surviving surgery (122 cases): £7905 (£3023 to £20,343)
• Compared to inflation-adjusted 2018 data:
  • Costs of medical treatments and euthanasia without surgery have increased.
  • Surgery costs have decreased slightly.

Findings – Insurance Coverage and Premiums

• Maximum insurance coverage amounts ranged from £5000 to £7500.
• For three out of five insurance companies, the actual insurance coverage limits had not changed since 2018.
• After adjusting for inflation, four out of five insurers had effectively reduced coverage amounts.
• Monthly insurance premiums ranged from £42.76 to £97.23 in 2023, all of which increased compared to inflation-adjusted premiums from 2018 (£34.01 to £59.39).

Findings – Insurance Document Readability

• The FKRE scores of insurance documents ranged from 31.2 to 54.8, all below the recommended minimum of 65, indicating difficult readability.
• GFS scores ranged from 13.6 to 20.6, exceeding the threshold of 12, indicating that the documents require more than 12 years of formal education to fully understand.
• Overall, insurance policies remain complex and challenging for most people to read and comprehend.

Conclusions

• Over the past five years, costs of referral treatment for colic in the UK have generally increased in line with inflation, except for surgery costs which decreased slightly.
• Insurance coverage limits have mostly remained the same or effectively decreased after accounting for inflation, meaning treatment costs frequently exceed maximum coverage.
• Insurance premiums have increased beyond inflation rates, making insurance potentially more costly for horse owners.
• Insurance policy documents are still written at a complexity level that is too high for the average reader, potentially limiting owner understanding of coverage details.
• The study was limited by a relatively small sample size and focused solely on UK equine hospitals, so results may not be generalizable internationally.