It seems that hardly a week goes by without reports appearing in the press on how so-called “health tourism” is rampant in the UK. In response, the UK Government is now consulting on proposals to remove access to NHS services for visitors and migrants, while seeking to ensure ineligible patients are charged systematically for the care they receive.
But what is “health tourism” exactly and should we be concerned? The answers are nowhere near as alarming as the panic-mongers suggest…
What is health tourism?
‘Health tourism’ is the idea that people from other countries come to the UK for free NHS care and leave shortly after receiving it. But there's absolutely no evidence it's happening on a significant scale. At the clinic we run in East London, we’ve interviewed migrant patients for the past seven years and found only 1.6% left their country for health reasons. Most migrated to the UK find work or education or escape persecution.
It’s also important to remember that medical tourism doesn’t just go one way. A January 2013 study in the British Medical Journal found that there are in fact more UK residents who travel abroad for medical treatment than there are international patients who travel to the UK to access treatment (in the NHS and privately).
But isn’t health tourism costing the UK billions?
Not at all. Estimates vary, but NHS figures suggest the amount lost providing care for foreign nationals in 2012/2013 was £12 million, just 0.01% of the total £108.9 billion NHS budget for the same period. This should also be seen in the context of the £18 billion overseas visitors spend in the UK each year and £3 billion they pay in taxes. Additionally, migrants to the UK contribute £16.3 billion to the UK economy (1.02% of GDP), according to the OECD. And don't forget that all migrants, working or not, contribute to the health service by paying VAT.
Okay, but isn’t the NHS over-generous compared to other European countries?
No. The UK is far from unique in offering healthcare to undocumented migrants with many countries in Europe offering comparable or better care. In France and Belgium, for example, migrants have free access to essential primary and secondary healthcare with medical providers getting reimbursed for treatment. In Portugal, undocumented migrants have full access to healthcare once they have stayed over 90 days.
That’s all well and good, but what harm is there in charging migrants for the NHS?
Frustratingly, the NHS proposed changes would be costly to put in place and would endanger people’s health needlessly.
Early detection of illness by GPs is the cheapest way of minimizing costs as well as ensuring health conditions can be managed and maintained. If not treated early, patients have a higher chance of presenting at A&E, which costs the NHS three times as much as GP visits. The current system in which visiting a GP is free for anyone who is ‘ordinarily resident’ regardless of their status or ability to pay makes the most sense, in terms of both economics and individual and community well-being.
Why should we provide healthcare regardless of immigration status or ability to pay?
Offering care regardless of immigration status or ability to pay is part of the NHS constitution. As Aneurin Bevan, the Minister for Health when the NHS was introduced, wrote in 1952:
One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous … However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors?
Healthcare professionals should not have to act as immigration officials and should be allowed to focus on delivering medical care.
Even if health tourism is not happening on a large scale, doesn’t that open the door for the system to be exploited by some people?
There are already mechanisms in place to deal with individuals who exploit the system. For instance, if debts are run up and the person has left the country, the UKBA will not let them re-enter the UK without paying up.
In short, the claims being made about health tourism are often wildly exaggerated. Correcting these misconceptions is now incredibly important in order to prevent the UK Government’s proposal to introduce costly changes to the NHS that will mean thousands of people will not receive care they’re entitled to. These changes will be bad for individuals’ health, public health, and simply make bad economic sense.
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