With Labour once again in power and the election campaign behind them, there's a distinct possibility that the issue of a state and private healthcare partnership could once again go on the back-burner.

Among the plans highlighted in the concordat signed last year with the Independent Health Care Association were that elective care, critical care and intermediate care could all be provided for the NHS by the private sector. In addition, the private sector could provide services such as pathology or dialysis. It would also be involved in clinical trials with the NHS and other research.

But will this be enough? Insurers have long called for a debate with the government on the options available and time will tell whether this Labour leadership will deliver this. In the interim, health insurers have other issues to contend with, such as recent claims that they are exploiting the crisis in the NHS and criticism from the Association of Medical Insurance Intermediaries of poor service standards.

Added to this are problems with indistinct legislation in the long-term care market and the possibility that new health legislation in France could outlaw international private medical insurance (PMI) in the country.

But it's not all doom and gloom. A recent report by health analysts Laing & Buisson shows that PMI sales were up by 5.5% in 2000. Income protection sales have also reached an all-time high, with almost 180,000 new policies sold in 2000, according to a report by GE Frankona Re.

Whatever the future holds, one thing is for certain - the health insurance market cannot stand still if it wants to play a major role in NHS reform and the health needs of the nation.

Alison Boyle