The #NHS is deepening further into crisis with trusts having to drastically cut the costs of running up and down the country. But MPs have recently urged that ‘health tourists’ should be charged up front, rather than the process of chasing the debt from them. Recently a Public Accounts Committee report stated the system used for recouping costs from overseas patients is ‘chaotic’.

The 2015/16 NHS budget was £116.4 billion and after a Spending Review it’ll increase to £133.1 billion by 2020/21, however, the increase will be mostly swallowed up by rising prices.

Health tourism

There are two categories that health tourism can be split into, ‘normal use’ – when foreign visitors have ended up being treated.

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‘Deliberate use’ – Those travelling specifically for free treatment and use of the NHS is more difficult to quantify.

‘Deliberate’ health tourists who travel for expensive surgery that’ll go straight to A&E is estimated to be around £60-80 million. There are those with access to more routine procedures who have been able to register with a GP and visit on a regular basis, estimates suggest £50 – 200 million, including British expats who may be chargeable but have an active GP registration. The report commissioned by the Department of Health (DH) makes it clear “it’s impossible to estimate with confidence”. Overall estimates suggest £110 – £280 million per year.

‘Normal’ use health tourists consist of those who are here for a set period who have been treated by the NHS, costing £1.8 billion, but only hospitals are required to charge overseas visitors, meaning around £500 million is recoverable.

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Much of the costs of non-EEA visitors and migrants are attributed services such as A&E, GPs or others that don’t charge, the same report estimates that around £300 million are related to irregular migrants who have no means to pay.

Worth the costly recovery?

Recent estimates by the DH cost the recovery at £18 million, but these estimates were being compared to what costs were being recovered at the time, £15-25 million. In July 2014, the government introduced new measures to recoup £500 million a year by 2017/18, including better identification of EEA patients and recharging home countries, a ‘health sur-charge’ for non-EEA migrants who have a 6-month plus visa and better identification and recovery from non-EEA patients.

NHS trusts have an estimated £2.45 billion debt, 2015/16, an increase from £894 million in 2014/15, with NHS net deficit at 1.851 billion. The £500 million a year target is not going to offset the increase of costs and interest payments to the private debt owed by the NHS due to some services being sold to private contractors.

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NHS ID scheme

With a group of MPs calling for urgent action to tackle health tourism and the ‘chaotic’ system, the government have been advised to act with caution before they choose to extend the dubbed ‘NHS ID’ scheme, that requires patients to provide two different forms of ID to prove eligibility for free care. The scheme could lead to eligible patients to not visit the hospital because of the hassle to seek treatment as It is difficult to prove ‘eligibility’. The scheme was piloted in a hospital trust in Peterborough, an area with a high number of immigrants.

Patients were asked to provide their passports and a utility bill, but the committee stated “these documents do not demonstrate entitlement to free NHS care”. MPs also pointed out that some UK-based patients would struggle to provide the documents. The report recommends the extension of NHS numbers and electronic patient records use. It stated that it could “help tackle the low levels of cost recovery” and “the problem that some people find it hard to show documents that indicate their entitlement”.

The current government have set the annual budget increase for the NHS at approximately 1% annually but the real increase of costs is around 6% per year, health tourists are a source of blame for failures to properly fund the NHS and its services. #nhs id scheme