BMJ 2013;347:f6883 doi: 10.1136/bmj.f6883 (Published 19 November 2013)

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Letters

LETTERS MIGRANT PATIENTS

Arguments for a healthcare tax on migrants are politically motivated Frank Arnold trustee, On behalf of Medact Medact, Grayston Centre, London N1 6HT, UK

Arie’s summary of the economic consequences of healthcare of migrants to and from Britain fails to capture important aspects.1 To analyse the situation in its totality, we must consider important factors that are difficult to quantify. For example, more than 30% of NHS staff were trained overseas, at substantial cost saving to the NHS and losses to their (largely underdeveloped) countries of origin2; against this we need to set the cost of emigration of (far fewer) British trained clinicians. Department of Health advice is ambiguous regarding the right and duties of GPs to register irregular migrants. This has resulted in recurrent failures to provide timely and effective community care. Consequently, many migrants present as emergencies to secondary care and require expensive hospital stays to repair preventable damage. Restricted access to care may also have helped spread serious communicable diseases, particularly tuberculosis and HIV, putting the population at risk.3

The term “illegal immigrant” perpetuates beliefs that the UK is being swamped by demanding, undeserving (largely mythical) foreigners. Asylum seekers with a valid fear of torture if returned are, and should be, entitled to NHS care while awaiting a decision, as are visitors working and paying tax in this country. The costs of implementing charging mechanisms will be high and must be realistically estimated, as the linked editorial points

out.4 The proposals would also require doctors to act as immigration police, undermining patient trust and potentially putting us in violation of our duties of confidentiality.5

The evidence (and its absence) strongly suggests that arguments for imposing a healthcare tax on migrants are not supported by economic or humane considerations or concern for health, but are driven by a desire for political advantage. Competing interests: I often provide medico-legal reports about asylum seekers who have survived torture and am sometimes paid for doing so. 1 2 3 4 5

Arie S. Are migrant patients really a drain on European health systems? BMJ 2013;347:f6444. (29 October.) Goldacre MJ, Davidson JM, Lambert TW. Country of training and ethnic origin of UK doctors: database and survey studies. BMJ 2004;329:597. Gazzard B, Anderson J, Ainsworth J, Wood C. Treat with respect: HIV, public health and immigration. UK. Coalition of People Living with HIV and AIDS, 2005. www.irr.org.uk/pdf/ HIV_Treat_With_Respect.pdf. Hanefeld J, Lunt N, Smith R. Paying for migrant healthcare. BMJ 2013;347:f6514. General Medical Council. Confidentiality. 2009. www.gmc-uk.org/static/documents/content/ Confidentiality_0910.pdf.

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Arguments for a healthcare tax on migrants are politically motivated.

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