Is Jeremy Hunt right to act on health tourism?

http://www.theguardian.com/commentisfree/2013/oct/23/jeremy-hunt-health-tourism-nhs-visitors

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J Meirion Thomas: 'British taxpayers should not be funding an international health service'<br />

I have worked in the NHS for 44 years, 31 as a consultant surgeon specialising in cancer treatment, and I believe health tourists should not be treated in NHS hospitals.

My only motive in campaigning against health tourism is to protect the NHS for future generations. Our health system has finite resources and any capacity taken up by ineligible patients means that other patients remain on the waiting list.

The definition of a health tourist is specific. The term describes somebody who arrives in the UK with a pre-existing illness whose purpose is to access free NHS care. It does not apply to visitors who suffer accidental or incidental illness, nor to asylum seekers or disadvantaged migrants, who are entitled to "good Samaritan" NHS care.

A fundamental principle of the NHS is that it is free at the point of use. Abuse by ineligible patients is the consequence of such altruism. Maternity, renal dialysis, cancer and HIV are the services most commonly targeted.

Health tourists fall into three categories. First, British citizens who have lived abroad who return for treatment of a serious illness. They have an NHS number from birth and are almost impossible to identify. Quantifying their number and treatment cost is impossible. Second, a proportion of migrants from within the European economic area who come either for better quality of care or because of contraction of health services at home. These patients are equally difficult to identify and are rarely charged. The third category is patients who arrive on a visitor's visa, have no NHS number and can be identified at the treating hospital. These patients can be charged, although less than 20% of invoices are paid. The charges for this group form the only reliable record of the cost of health tourism, which explains why the total cost is unknown and is inevitably underestimated.

The NHS is more vulnerable to exploitation than comparable health systems, all of which have a personal identification mechanism in place to prove entitlement to care. This should be based on residency and contribution as happens in France, Germany, Holland, Scandinavia, Canada and Australia, whose systems successfully prevent health tourism.

Essentially, the Department of Health allows open access to our health service. The current rules and regulations are porous, ineffective and difficult to enforce. They can easily be breached. The task for Jeremy Hunt is to close the loopholes. Even if visitors pay, the charge is levied at the reduced NHS tariff, which is about 25% of the tariff charged in the private sector.

The biggest error of all would be to adopt a health levy (said to be £200) on all migrants and students coming to the UK. That would be a disaster. For health tourists, it would amount to the cheapest travel insurance available anywhere and, furthermore, would confirm entitlement.

The time has come to protect our NHS from abuse. British taxpayers should not be funding an international health service.

• J Meirion Thomas is a consultant surgeon in the NHS

Kailash Chand: 'This plan will reduce doctors to debt collectors' <br />

Anyone seeking to access the NHS should be eligible to do so and proposals to improve the current system of recovering treatment costs from other governments must be considered. However, there is little evidence that health tourism is a significant burden on the NHS or that migrants and short-term visitors are consuming a large part of the NHS budget.

We need unambiguous evidence and sound facts. The latest government figures are hundreds of millions of pounds higher than previous estimates, because they are based on a particular set of assumptions. Earlier this year, the health secretary, Jeremy Hunt, suggested that health tourism, at a minimum, cost around £12m, but now his department's new reports suggest that the cost could range anywhere from £70m to £2bn. We need to ensure that new structure for charging short-term visitors is based on concrete figures rather than guesswork.

Most importantly, GPs and other healthcare professionals do not have the capacity or the resources to administer an extended charging system that could require them to extensively vet every single patient when they register with a new practice. At many GP surgeries, patients are already required to provide proof of residence. Anything more would result in another layer of bureaucracy chewing up time and resources that should be spent on treating the most important people in this – the patients.

GPs are already under pressure from soaring patient demand, declining resources and a proliferation of box-ticking targets. We should not be burdened further by having to verify every patient's eligibility. The government has failed to address the cost of the new structure and it is far from clear that the proposed changes would recoup enough money to cover the costs of setting it up in the first place.

There are also wider risks. Timely treatment keeps people out of hospital, stops the spread of infectious disease such as tuberculosis, and ultimately saves money. Denying treatment to people who need it – including pregnant women, torture survivors, and those with communicable diseases – is inhumane, impractical and could result in further costs to the NHS should a patient's condition deteriorate.

The health secretary would be wise to concentrate on the major pressures on the NHS rather than being distracted by imposing an unworkable system of charging for health tourism. If this plan comes to fruition it will at best reduce the role of doctors to debt collectors. At worst it will deter them from registering migrants and asylum seekers. Tampering with the core principle of the NHS , that it is free at the point of delivery, runs the risk of loading scarce resources on a minority issue, while the more meaty challenges remain unresolved.

• Dr Kailash Chand is deputy chairman of the BMA council

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