BMJ 2013;347:f6408 doi: 10.1136/bmj.f6408 (Published 22 October 2013)
Page 1 of 2
News
NEWS Doctors’ leaders question £2bn estimated cost to NHS of caring for visitors Gareth Iacobucci BMJ
The NHS in England could save up to £500m (€590m; $810m) a year if new measures were implemented to ensure that visitors from overseas and immigrants paid for healthcare in the United Kingdom, says new research published by the government. England’s health secretary, Jeremy Hunt, said that the study conducted for the Department of Health supported his proposed changes to the current system of recovering costs for NHS care, designed to ensure fairness for British taxpayers.1
But the BMA has said that the estimates were based on numerous assumptions. The researchers themselves acknowledged that there was “no robust evidence” to conclusively show how much of the NHS budget was consumed by temporary visitors.2 The research included a quantitative report that analysed data from the 2011 census, the 2012 international passenger survey of people entering and leaving the UK, and government immigration data. This report estimated that £388m is spent each year on patients needing healthcare while in the UK who should be paying for their care but who were often not processed and charged by the NHS. The government said that only around 16% of this sum was currently recovered by the NHS.
The report said that the government could also recover between £70m and £300m each year that is currently spent on treating people who travel to the UK specifically to obtain free NHS treatment. Ministers said that this could be “significantly reduced” through the introduction of a new cost recovery system and through deterring misuse. An additional £200m could be raised through the new health surcharge for students and other temporary migrants being introduced through the Home Office’s Immigration Bill, it added.
The government has also published a separate qualitative study that showed “clear and widespread evidence of ‘health tourism,’” it claimed, including examples of family members of UK residents coming to the UK from abroad, registering with a GP, and then receiving NHS drugs and hospital care.3 But the research warned, “The NHS has no robust evidence on which either to base estimates of the amount of money spent on those who are not entitled to free treatment or to prioritise action to combat abuse.”
To support the plans, ministers are examining new incentives to encourage hospitals to report that they have treated someone from the European Economic Area, to allow costs of care to be recovered from their home country.4 Ministers also want to For personal use only: See rights and reprints http://www.bmj.com/permissions
introduce a simpler registration process to enable earlier identification of patients who should be charged.
The government has also appointed Health Education England’s chairman, Keith Pearson, to advise on its proposals. Its study estimated that the total cost of visitors and temporary migrants accessing NHS services could be as high as £2bn. But this included some money that was already being recovered, services for some vulnerable patient groups that it would be “impractical or inappropriate to charge for in full,” such as treatment for infectious diseases, and the full cost of healthcare for international students. Hunt said, “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 BMA and the Royal College of General Practitioners have previously warned that the plans could see GPs becoming a form of border control.5 6 There were also potential risks to public health if patients were deterred from seeking treatment when they needed it, which could in turn lead to them requiring more expensive emergency treatment if their condition deteriorated, they said.
Commenting on the latest research, Chaand Nagpaul, chairman of the BMA’s General Practitioners Committee, said, “There is limited evidence to suggest that migrants or short term visitors are consuming large parts of the NHS budget. The government’s estimates are based on a number of assumptions that result in a figure significantly higher than previous estimates.” Clare Gerada, chairwoman of the Royal College of General Practitioners, said, “The most important issue continues to be implementation. It is imperative that GPs are not tasked with being a ‘new border agency’ in policing the NHS.” 1
2
3
4
Department of Health. Sustaining services, ensuring fairness: a consultation on migrant access and their financial contribution to NHS provision in England. Jul 2013. www.gov. uk/government/uploads/system/uploads/attachment_data/file/210438/Sustaining_services_ _ensuring_fairness_consultation_document.pdf. Prederi. Quantitative assessment of visitor and migrant use of the NHS in England: exploring the data—main report. 3 Oct 2013. https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/251909/Quantitative_Assessment_of_Visitor_and_ Migrant_Use_of_the_NHS_in_England_-_Exploring_the_Data_-_FULL_REPORT.pdf. Creative Research. Qualitative assessment of visitor and migrant use of the NHS in England: observations from the front line. 7 Oct 2013. https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/251908/Qualitative_Assessment_of_Visitor_ __Migrant_use_of_the_NHS_in_England_-_Observations_from_the_front-line_-_FULL_ REPORT.pdf. Dyer C. Checking GP patients’ citizenship would be “bureaucratic nightmare,” says GP leader. BMJ 2013;347:f6181.
Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f6408 doi: 10.1136/bmj.f6408 (Published 22 October 2013)
Page 2 of 2
NEWS
5 6
Iacobucci G. Proposals to charge migrants for NHS care are unworkable, says BMA. BMJ 2013;347:f5342. Iacobucci G. College raises concern about GPs’ role in government plans to restrict access to NHS. BMJ 2013;346:f3020.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Cite this as: BMJ 2013;347:f6408 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS Doctors’ leaders question £2bn estimated cost to NHS of caring for visitors Gareth Iacobucci BMJ
The NHS in England could save up to £500m (€590m; $810m) a year if new measures were implemented to ensure that visitors from overseas and immigrants paid for healthcare in the United Kingdom, says new research published by the government. England’s health secretary, Jeremy Hunt, said that the study conducted for the Department of Health supported his proposed changes to the current system of recovering costs for NHS care, designed to ensure fairness for British taxpayers.1
But the BMA has said that the estimates were based on numerous assumptions. The researchers themselves acknowledged that there was “no robust evidence” to conclusively show how much of the NHS budget was consumed by temporary visitors.2 The research included a quantitative report that analysed data from the 2011 census, the 2012 international passenger survey of people entering and leaving the UK, and government immigration data. This report estimated that £388m is spent each year on patients needing healthcare while in the UK who should be paying for their care but who were often not processed and charged by the NHS. The government said that only around 16% of this sum was currently recovered by the NHS.
The report said that the government could also recover between £70m and £300m each year that is currently spent on treating people who travel to the UK specifically to obtain free NHS treatment. Ministers said that this could be “significantly reduced” through the introduction of a new cost recovery system and through deterring misuse. An additional £200m could be raised through the new health surcharge for students and other temporary migrants being introduced through the Home Office’s Immigration Bill, it added.
The government has also published a separate qualitative study that showed “clear and widespread evidence of ‘health tourism,’” it claimed, including examples of family members of UK residents coming to the UK from abroad, registering with a GP, and then receiving NHS drugs and hospital care.3 But the research warned, “The NHS has no robust evidence on which either to base estimates of the amount of money spent on those who are not entitled to free treatment or to prioritise action to combat abuse.”
To support the plans, ministers are examining new incentives to encourage hospitals to report that they have treated someone from the European Economic Area, to allow costs of care to be recovered from their home country.4 Ministers also want to For personal use only: See rights and reprints http://www.bmj.com/permissions
introduce a simpler registration process to enable earlier identification of patients who should be charged.
The government has also appointed Health Education England’s chairman, Keith Pearson, to advise on its proposals. Its study estimated that the total cost of visitors and temporary migrants accessing NHS services could be as high as £2bn. But this included some money that was already being recovered, services for some vulnerable patient groups that it would be “impractical or inappropriate to charge for in full,” such as treatment for infectious diseases, and the full cost of healthcare for international students. Hunt said, “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 BMA and the Royal College of General Practitioners have previously warned that the plans could see GPs becoming a form of border control.5 6 There were also potential risks to public health if patients were deterred from seeking treatment when they needed it, which could in turn lead to them requiring more expensive emergency treatment if their condition deteriorated, they said.
Commenting on the latest research, Chaand Nagpaul, chairman of the BMA’s General Practitioners Committee, said, “There is limited evidence to suggest that migrants or short term visitors are consuming large parts of the NHS budget. The government’s estimates are based on a number of assumptions that result in a figure significantly higher than previous estimates.” Clare Gerada, chairwoman of the Royal College of General Practitioners, said, “The most important issue continues to be implementation. It is imperative that GPs are not tasked with being a ‘new border agency’ in policing the NHS.” 1
2
3
4
Department of Health. Sustaining services, ensuring fairness: a consultation on migrant access and their financial contribution to NHS provision in England. Jul 2013. www.gov. uk/government/uploads/system/uploads/attachment_data/file/210438/Sustaining_services_ _ensuring_fairness_consultation_document.pdf. Prederi. Quantitative assessment of visitor and migrant use of the NHS in England: exploring the data—main report. 3 Oct 2013. https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/251909/Quantitative_Assessment_of_Visitor_and_ Migrant_Use_of_the_NHS_in_England_-_Exploring_the_Data_-_FULL_REPORT.pdf. Creative Research. Qualitative assessment of visitor and migrant use of the NHS in England: observations from the front line. 7 Oct 2013. https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/251908/Qualitative_Assessment_of_Visitor_ __Migrant_use_of_the_NHS_in_England_-_Observations_from_the_front-line_-_FULL_ REPORT.pdf. Dyer C. Checking GP patients’ citizenship would be “bureaucratic nightmare,” says GP leader. BMJ 2013;347:f6181.
Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f6408 doi: 10.1136/bmj.f6408 (Published 22 October 2013)
Page 2 of 2
NEWS
5 6
Iacobucci G. Proposals to charge migrants for NHS care are unworkable, says BMA. BMJ 2013;347:f5342. Iacobucci G. College raises concern about GPs’ role in government plans to restrict access to NHS. BMJ 2013;346:f3020.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Cite this as: BMJ 2013;347:f6408 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
