Immigration health surcharge

The Immigration health surcharge was introduced by the Cameron–Clegg coalition under the provisions of the Immigration Act 2014 to deal with the problem of medical tourism involving the NHS in England. A proportion of this medical tourism is fraudulent.

History

Aneurin Bevan dealt with this issue in his essay In Place of Fear (1952):

One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to arrive at an approximate estimate. All we have to do is look up the number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year.Obviously this is an overestimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is. for what it is worth and you will see it does not justify the fuss that has been made about it.

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine.

It is alleged that health tourists in the UK often target the NHS for its free-at-the-point-of-care treatment, allegedly costing the NHS up to £200 million. A study in 2013 concluded that the UK was a net exporter of medical tourists, with 63,000 UK residents travelling abroad for treatment and about 52,000 patients getting treatment in UK. Medical tourists treated as private patients by NHS trusts are more profitable than UK private patients, yielding close to a quarter of the revenue from only 7% of volume of cases. UK dental patients largely go to Hungary and Poland. Fertility tourists mostly travel to Eastern Europe, Cyprus and Spain.

Extent of abuse

In the summer of 2015 immigration officers from the Border Force were stationed in St George's University Hospitals NHS Foundation Trust to train staff to identify "potentially chargeable patients". In October 2016 the trust announced that it planned to require photo identity papers or proof of their right to remain in the UK such as asylum status or a visa for pregnant women. Those not able to provide satisfactory documents would be sent to the trust's overseas patient team "for specialist document screening, in liaison with the UK Border Agency and the Home Office.” It was estimated that £4.6 million a year was spent on care for ineligible patients. A pilot scheme to check whether patients were entitled to free NHS care in 18 NHS trusts, 11 in London, for two months in 2017 asked 8,894 people for two forms of ID prior to non-emergency care. Only 50 were not eligible for free NHS treatment. Campaigners claimed this was “part of the Government’s hostile environment policy”, and that in Newham hospital "you will see huge signs saying you may not be eligible for free NHS treatment".

Ordinarily resident status

Eligibility for free care NHS treatment is based on a person being ordinarily resident in the UK.

Entrance to the United Kingdom

Main article: Visa policy of the United Kingdom

When non-EU migrants enter the UK and England, they have been requested to pay the Health Surcharge, which per family member per year is £200. The Health Surcharge entitles them to 100% free health care on the NHS. Most travel insurance would cost more than this, and would mainly cover emergency care only. The surcharge was introduced in April 2015 and has raised £175m, with 450,000 surcharges issued in the first year. People from the Democratic People’s Republic of Korea have to pay for this surcharge in cash only.

Payment to the NHS

When foreign tourists accessing the NHS were identified and charged, only 16% of these tourists paid the invoices, so the surcharge was introduced. The money for the NHS should be collected by an Overseas Visitor Manager, but many hospitals in England do not have one of these.

Maternity tourism

See also: British nationality law

Many medical tourists to England come for pregnancy care, known as maternity or birth tourism. The cost of a baby on the NHS is around £5,000, and double for a C-section. A special care baby unit or NICU costs much more. Patients are known to come to England, and the UK, for multiple or complicated births. The true figure of how many women come to give birth in England is not known.

See also

• Healthcare in the United Kingdom

External links

• Paying for the NHS as a non-EU migrant