Briefing: What is contextualised care and what does it mean for pet insurance?

When a dog or cat becomes unwell, deciding what to do is rarely just about what treatment is clinically available.

It is also about the individual animal, the circumstances and preferences of their owner, veterinary judgement, practical realities and, inevitably, money. This is the principle behind contextualised care – the right care for the individual animal in the circumstances that actually exist.

A paper published in June by Katie Mantell and colleagues at charity RCVS Knowledge, entitled Barriers to the delivery of contextualised care in UK small animal veterinary practice, focused on veterinary care, but it also raised important questions for pet insurers.

The study drew on responses from more than 400 veterinary professionals and 700 dog and cat owners, identifying continuity of care and financial constraints as the two biggest barriers to contextualised care.

But beneath those headline findings sits a more complex picture involving professional confidence, conversations about cost, fear of complaints, expectations around diagnosis and the role insurance may play in clinical decision-making.

A striking finding

One result in particular caught my eye.

Among veterinary surgeons who qualified in the 1980s, 36% said they felt relieved when an animal was insured. Among those who qualified since 2020, the figure was 83% – a remarkable difference.

The research does not explain why this difference exists, so caution is needed. Insurance may simply remove concerns about funding, allowing owners and veterinary teams to consider a wider range of options.

However, another finding makes the comparison particularly interesting. Half of the vets who qualified since 2020 said they relied on tests and diagnostics to reach a clear answer because they worried about complaints or disciplinary action if they made the ’wrong’ decision. Among vets who qualified in the 1980s, the figure was just 9%.

That does not mean insurance causes more testing, nor that additional diagnostics are inappropriate, but it does raise a question – does knowing an animal is insured change the clinical conversation and, if so, how?

Enabling choice, not defining care

At its best, pet insurance helps people manage unexpected veterinary costs and access care that might otherwise be difficult to fund. 

But access to funding and clinical need are not the same thing. An insured animal does not automatically need more treatment, nor should an uninsured animal automatically be offered less appropriate care.

The starting point should remain the same – what is appropriate for the animal? Answering that question appropriately means considering welfare, clinical need, evidence, likely outcomes, veterinary judgement and the owner’s circumstances and preferences.

Insurance sits within that decision. It may make some options possible, but it is one part of the context rather than the factor that determines care.

There is another question too – when the financial constraint is removed, does the conversation shift from whether we can treat to whether we should?

Insurance can create valuable choices, but that does not mean every available intervention is right for the individual animal. Sometimes doing less may be entirely appropriate.

Notably, the research found that most owners wanted to understand the full range of options before discussing costs or insurance cover.

That’s another part of contextualised care – insurance should create choice, not an assumption that every available option should be pursued.

Affordability is more than cost

One of the paper’s most useful ideas is that finances should be viewed not simply as a barrier to care, but as part of the context in which care is delivered.

That distinction matters. Money is part of veterinary care whether anyone wants it to be and avoiding the subject does not make the cost disappear. But how we discuss it is important.

Some owners described feeling guilty when they couldn’t afford every option offered to them. Veterinary professionals, meanwhile, described the difficulty of discussing alternatives without making someone feel they were choosing ’second best’.

This is where language such as ’gold standard’ can become problematic.

There may be more than one clinically and ethically appropriate way to care for an animal. One route might involve advanced diagnostics and intervention, another a more conservative approach. A lower-cost option is not automatically an inferior one.

Importance for insurers

The paper highlights the impact that fear of complaints, disciplinary action or simply getting something wrong can have on veterinary decision-making.

This does not mean additional investigations are unnecessary. Many will be entirely appropriate. But if fear or uncertainty contributes to more defensive decision-making, there is potentially a wider system effect.

More investigation can mean higher veterinary costs. Higher costs can contribute to higher claims. Claims costs influence premiums. Premiums affect affordability and whether people take out or retain insurance.

It illustrates why veterinary care and pet insurance cannot be understood entirely in isolation from one another.

That does not mean insurers should interfere with clinical judgement. Decisions about investigation and treatment belong with veterinary professionals and those responsible for the animal.

But insurers can reasonably ask whether their products and processes make good decision-making easier or harder.

How quickly can owners establish whether treatment is covered? How well do they understand their limits, excesses and exclusions? Can uncertainty around a claim delay a decision? 

These questions take us beyond debates about whether veterinary fees or premiums are too high and towards understanding how the system actually works.

Asking better questions

The research leaves us with questions rather than simple answers – and that is valuable.

Does knowing an animal is insured influence the clinical conversation? Does uncertainty about cover delay decisions? Are insurance products keeping pace with changes in veterinary medicine and chronic care?

And ultimately, how do we ensure insurance continues to support access to appropriate veterinary care while remaining affordable enough for people to keep buying it?

No single part of the sector can answer those questions alone.

At Peia, that is one reason we are mapping the Companion Animal Welfare Journey. Decisions in one area of the system create consequences elsewhere.

Research like this gives us evidence with which to ask better questions before jumping to solutions. And for veterinary professionals, pet owners and insurers alike, that feels like an important place to start