Department of Health and Social Care
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New report shows the NHS could raise up to £500 million from better charging of overseas visitors

Government appoints NHS expert to advise on cost recovery.

Up to £500 million could be recovered from overseas visitors’ and migrants’ use of the NHS every year – making clear the need for changes to the current system, Health Secretary Jeremy Hunt revealed today.

The Department of Health is publishing the first comprehensive study of how widely migrants use the NHS. These independent findings show the major financial costs and disruption for staff which result from a system which will be substantially reformed in the interests of British taxpayers.

The study estimates that £388 million is spent each year on patients who find themselves in need of health care while in England and who should already be paying for their care, but who are often not processed and charged by the NHS. Only around 16 per cent is currently recovered by the NHS.

In addition, there is a cost of between £70 million and £300 million from people who deliberately travel to England to get free NHS treatment – so-called ‘health tourists’ – which could be significantly reduced through a better cost recovery system and deterring abuse.

To tackle this issue and deter abuse of the system, the Government is:

  • introducing a new health surcharge in the Immigration Bill – which will generate an estimated £200 million

  • appointing Sir Keith Pearson as an independent adviser on visitor and migrant cost recovery

  • identifying a more efficient system of claiming back costs by establishing a cost recovery unit, headed by a Director of Cost Recovery

  • looking at new incentives so that hospitals report that they have treated someone from the EEA to enable the Government to recover the costs of care from their home country

  • introducing a simpler registration process to help identify earlier those patients who should be charged

In total, the £388 million from patients in England, the £200 million generated through the surcharge, and the deterrent effect on the £70-£300 million from health tourists will together raise or save well over half a billion pounds.

Alongside the quantitative costs report, a separate qualitative study shows clear and widespread evidence of ‘health tourism’, including repeated examples of:

  • family members of residents coming to the country from abroad, registering with a GP and then receiving NHS drugs and hospital care

  • new arrivals on visitor visas seeking immediate or major treatment including maternity services

  • visitors requiring emergency treatment but being unable or unwilling to pay subsequent costs

Previous estimates of the cost to the NHS have varied, but this latest authoritative research reveals the cost is significantly higher than all earlier figures.

Even if only 75 per cent of this £500 million was recovered, it would be the equivalent of almost 4,000 doctors’ or over 8,500 nurses’ salaries.

The study estimates the total cost of visitors and temporary migrants accessing NHS services to be between £1.9 billion and £2 billion. However, this includes some money that is already recovered, a number of vulnerable patient groups and services that it would be impractical or inappropriate to charge for in full, such as treatment for infectious diseases, and the full cost of international students’ healthcare.

Health Secretary Jeremy Hunt said:

Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it. We have one of the most generous systems in the world when it comes to health care for foreign visitors, but it’s time for action to ensure the NHS is a national health service – not an international one.

With the NHS already under pressure from an ageing population, it cannot be right that large amounts of taxpayers’ money is being lost through treating people who should be paying from foreign countries.

These independent reports prove this is a serious problem that the Government was right to address. We are confident our new measures will make the NHS fairer and more sustainable for the British families and taxpayers it was set up to serve.

The healthcare system in England currently provides free care for temporary visitors and students. This is not the case in other countries such as Spain (where students pay £50 a month towards their healthcare costs), or Australia (which charges £260 a year for restricted private health insurance for students).

The recent Home Office Immigration Bill creates powers to increase the number of migrants who will have to pay to access healthcare. This surcharge for temporary migrants will help ensure that those who are using the NHS are making the right financial contribution to it.

The surcharge will be set at around £150 for students and at around £200 for other temporary migrants – raising up to £1.9 billion over a ten year period based on approximately 490,000 applicants who would be required to pay.

Immigration Minister Mark Harper said:

The government is building a fairer immigration system which addresses the concerns of hardworking people. The Immigration Bill will tighten immigration law, strengthen our enforcement powers and clamp down on those from overseas who try to abuse our public services.

The British public expects and deserves an immigration system that is fair and stops migrants using public services that they are not entitled to. These proposals will ensure that migrants here temporarily make a fair contribution to the cost of health services in the UK.

A recent report from the EU Commission speculated that the costs of foreign access to the NHS could be up to £1.5 billion. That research is not comparable with the figures published today, because it gives a different estimate based on treatment costs per head that are much higher than NHS costs and addresses a different population that includes long term residents as well as pensioners and students.

While the results of the consultation on measures to change the system are being carefully considered, the Department of Health has appointed Sir Keith Pearson as the independent NHS adviser to the visitor and migrant NHS cost recovery programme. He will take forward proposals for changes in the system.

Sir Keith said:

I welcome this research as a helpful piece of analysis of the problem. I am confident that we will be able to recover a good proportion of this money.

Having introduced measures to recover at least £500 million, the Government will look to take further steps to recover a larger proportion of the total cost in future.

Notes to Editors

  1. £388 million is spent each year on patients who find themselves in need of health care while in England and who should already be paying for their care – this figure is made up of a cost of £156 million for treatment of non-EEA patients (see p13 of the study) and £305 million for treatment of EEA patients (p12 of the study). The NHS currently recovers £73 million (around 16 per cent), meaning that £388 million is lost each year.

  2. For media enquiries only, contact the Department of Health Press Office on 020 7210 4990.

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