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| Health tourism: how much does it cost the NHS? | Health tourism: how much does it cost the NHS? |
| (3 months later) | |
| "What we have is a free national health service" said David Cameron in March this year, "not a free international health service". The statement by the Prime Minister was part of a speech about controlling immigration. Since then, the government has decided to conduct an audit to assess just how bad "health tourism" is. | "What we have is a free national health service" said David Cameron in March this year, "not a free international health service". The statement by the Prime Minister was part of a speech about controlling immigration. Since then, the government has decided to conduct an audit to assess just how bad "health tourism" is. |
| But the problem is apparently so severe that the Secretary of State for Health is announcing measures to tackle it before the audit has assessed the scale of the problem. The potential policies that are being discussed include: | But the problem is apparently so severe that the Secretary of State for Health is announcing measures to tackle it before the audit has assessed the scale of the problem. The potential policies that are being discussed include: |
| • GP visit charges for those who are in the country less than six months • Improving the way that the NHS claims costs back from other EU countries • A tracking system to make sure that visitors are charged for hospital visits | • GP visit charges for those who are in the country less than six months • Improving the way that the NHS claims costs back from other EU countries • A tracking system to make sure that visitors are charged for hospital visits |
| We want to try to add some numbers to what is quickly becoming a buzzword battle: how much does 'health tourism' cost the NHS and how much will it cost to curb it? | We want to try to add some numbers to what is quickly becoming a buzzword battle: how much does 'health tourism' cost the NHS and how much will it cost to curb it? |
| Who are health tourists? | Who are health tourists? |
| Thought the term might inspire images of hospital sightseeing and holiday snaps in waiting rooms, the debate on health tourism is closely associated with the government's efforts to control immigration. Today's announcements come under the slightly more sober heading "proposals to reform migrant access to health and housing". | Thought the term might inspire images of hospital sightseeing and holiday snaps in waiting rooms, the debate on health tourism is closely associated with the government's efforts to control immigration. Today's announcements come under the slightly more sober heading "proposals to reform migrant access to health and housing". |
| Assuming that GP visits are one of the less urgent issues facing the government when it comes to illegal immigration, it's likely that the government's audit will focus on the "short term migrants coming to study or work with more than six months on their visas" mentioned in today's press release. And according to the NHS advice service, that's exactly the group of non-UK citizens that are eligible for free treatment. | Assuming that GP visits are one of the less urgent issues facing the government when it comes to illegal immigration, it's likely that the government's audit will focus on the "short term migrants coming to study or work with more than six months on their visas" mentioned in today's press release. And according to the NHS advice service, that's exactly the group of non-UK citizens that are eligible for free treatment. |
| So the individuals concerned are coming here for other reasons. Free healthcare may influence their choice of destination but it is not the objective of their visit to the UK. The term 'health tourism' doesn't quite capture that. | So the individuals concerned are coming here for other reasons. Free healthcare may influence their choice of destination but it is not the objective of their visit to the UK. The term 'health tourism' doesn't quite capture that. |
| £12m or billions? | £12m or billions? |
| Despite the wide-ranging figures that are being circulated, the government has admitted that the cost of health tourism remains a mystery. As Jeremy Hunt pointed out on the Today Programme "the truth is we don't know the number and that's why we're doing the audit". | Despite the wide-ranging figures that are being circulated, the government has admitted that the cost of health tourism remains a mystery. As Jeremy Hunt pointed out on the Today Programme "the truth is we don't know the number and that's why we're doing the audit". |
| Despite that, in his interview this morning Hunt did use the lowest estimate - that health tourism is costing the NHS £12m - to give listeners a sense of the scale of the problem by equating this to 2,000 hip operations on the NHS. | Despite that, in his interview this morning Hunt did use the lowest estimate - that health tourism is costing the NHS £12m - to give listeners a sense of the scale of the problem by equating this to 2,000 hip operations on the NHS. |
| Perhaps a better indication of the scale of the problem is the fact that the NHS is being asked to find 'efficiency savings' of £20bn of its £109bn budget. Those figures would mean that eliminating 'health tourism' equates to fulfilling 0.06% of the savings that need to be found and reducing the total NHS budget by 0.011%. | Perhaps a better indication of the scale of the problem is the fact that the NHS is being asked to find 'efficiency savings' of £20bn of its £109bn budget. Those figures would mean that eliminating 'health tourism' equates to fulfilling 0.06% of the savings that need to be found and reducing the total NHS budget by 0.011%. |
| But where did the £12m figure come from? That's the amount (generously rounded up from £11.5m) that the NHS has written off in unpaid charges last year of a total £33m it spent treating foreign nationals. | But where did the £12m figure come from? That's the amount (generously rounded up from £11.5m) that the NHS has written off in unpaid charges last year of a total £33m it spent treating foreign nationals. |
| To be clear, that's not an issue about whether or not visitors are allowed access to UK healthcare, but about the ability of the NHS to pursue those claims - either because the patient is dead, unable to pay or unable to trace, or because the service simply does not have the capacity to do so. | To be clear, that's not an issue about whether or not visitors are allowed access to UK healthcare, but about the ability of the NHS to pursue those claims - either because the patient is dead, unable to pay or unable to trace, or because the service simply does not have the capacity to do so. |
| NHS abandoned claims | NHS abandoned claims |
| Fees from overseas visitors | Fees from overseas visitors |
| The abandoned claims can relate to previous years. So even though the total keeps climbing, this might be because the NHS struggles to keep pace with the workload rather than growing numbers of health tourists. | The abandoned claims can relate to previous years. So even though the total keeps climbing, this might be because the NHS struggles to keep pace with the workload rather than growing numbers of health tourists. |
| Dr Thom Brooks, Reader in Law at Durham University (and also a former non-EU, now British citizen) is skeptical that these official numbers capture the issue: | Dr Thom Brooks, Reader in Law at Durham University (and also a former non-EU, now British citizen) is skeptical that these official numbers capture the issue: |
| Non-EU migrants are required to pay national insurance which contributes financial support to the NHS not unlike all British citizens. The claim that non-EU migrants have a free ride lacks evidence and credibility. | Non-EU migrants are required to pay national insurance which contributes financial support to the NHS not unlike all British citizens. The claim that non-EU migrants have a free ride lacks evidence and credibility. |
| But J Meirion Thomas believes £12m is in fact a gross underestimate. The senior surgeon commented this week that the true cost is billions rather than millions because health tourists should be charged private health care prices rather than the lower charges which the NHS system offers. | But J Meirion Thomas believes £12m is in fact a gross underestimate. The senior surgeon commented this week that the true cost is billions rather than millions because health tourists should be charged private health care prices rather than the lower charges which the NHS system offers. |
| Feasibility | Feasibility |
| Whether or not you believe that non-UK residents who are working or studying here should be charged for their NHS treatment, another issue which will face these proposed policies is implementation. | Whether or not you believe that non-UK residents who are working or studying here should be charged for their NHS treatment, another issue which will face these proposed policies is implementation. |
| Health professionals have already begun to express concern that they will have "immigration control" added to their growing list of responsibilities. The chairwoman of the Royal College of GPs Professor Clare Gerada said today "My first duty is to my patient - I don't ask where they're from or whether they've got a credit card or whether they can pay". | Health professionals have already begun to express concern that they will have "immigration control" added to their growing list of responsibilities. The chairwoman of the Royal College of GPs Professor Clare Gerada said today "My first duty is to my patient - I don't ask where they're from or whether they've got a credit card or whether they can pay". |
| Others have raised concerns on public health grounds. If fees make visitors to the UK reluctant to visit their GP or go to hospital, the risk of disease may be higher which would put everyone's health at risk. The costs of remedying that might be far higher than any implementation measures. | Others have raised concerns on public health grounds. If fees make visitors to the UK reluctant to visit their GP or go to hospital, the risk of disease may be higher which would put everyone's health at risk. The costs of remedying that might be far higher than any implementation measures. |
| Do you think 'health tourists' are an urgent issue facing the NHS? Do you think this is a question of principles rather than price? Do you think that the government's proposals are likely to work? Share your views by posting a comment below or by tweeting to @GuardianData or @MonaChalabi. | Do you think 'health tourists' are an urgent issue facing the NHS? Do you think this is a question of principles rather than price? Do you think that the government's proposals are likely to work? Share your views by posting a comment below or by tweeting to @GuardianData or @MonaChalabi. |
| Download the data | Download the data |
| • DATA: download the full spreadsheet | • DATA: download the full spreadsheet |
| Can you do more with this data? | Can you do more with this data? |
| • Contact us at data@guardian.co.uk • Follow us on Twitter | • Contact us at data@guardian.co.uk • Follow us on Twitter |
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