Viewpoint: No convincing evidence health tourism is NHS burden

There is no convincing evidence that health tourism is a significant burden on the NHS, writes BMA deputy chairman Dr Kailash Chand.

Dr Chand: 'Limited evidence migrants or short-term visitors consuming large parts of NHS budget.'
Dr Chand: 'Limited evidence migrants or short-term visitors consuming large parts of NHS budget.'

Health tourism is defined as non-UK citizens travelling to the UK in order to access free NHS treatment. The group is not homogenous; it includes EEA visitors, asylum seekers, illegal immigrants, ex pats, etc.

The DH’s commissioned research puts the cost of health tourism at £2bn. Health secretary Jeremy Hunt believes that up to £500m could be recovered every year from a £200 per immigrant health levy/surcharge.

Such authoritative rhetoric based on uncertain estimates, and large number of assumptions amounts to nothing more than scaremongering. There is limited evidence to suggest that migrants or short-term visitors are consuming large parts of the NHS budget, and if anything it seems that ex pats cost the NHS more than any other group. Economic and social research categorically states that the extent of deliberate health tourism had been ‘hugely overstated’ and was in fact a ‘very small part of NHS expenditure’. 

Further, the implementation and running costs haven’t been factored in at all. Patients are already required to provide proof of their residency in the area when they register with their GP. Anything more would result in another complicated layer of bureaucracy being introduced into general practice that is likely to draw on stretched time and resources that should be spent on treating patients. GPs are already under pressure from soaring patient demand, declining resources, and a proliferation of tick box targets; they do not have the time to act as border guards as well as doctors. This futile exercise will prolong waiting times for patients while the GP expends efforts into recovering the cost of treating his/her migrant population. It is also questionable whether the money recouped would actually cover the set-up costs in the first place.

The proposal of £200 health surcharge/levy per immigrant will be counterproductive, may legitimise use of the NHS and encourage greater use, and it may cost taxpayers more than the £200 recovered. In some groups, accessing treatment based on paying a surcharge might be a deterrent to seeking early medical help. Timely treatment keeps people out of hospital, stops the spread of infectious diseases such as tuberculosis, and ultimately saves money in future treatment costs. Denying healthcare to people who need it—including pregnant women, torture survivors, and people with communicable diseases—is simply inhumane and unacceptable.

The health secretary would be wise to concentrate on the major pressures on the NHS rather than being distracted by imposing an unworkable system of charging for health tourism. There is no scope from within primary care resource to implement this policy, which if it comes to fruition will just simply reduce their role to debt collectors at best or at worst would deter them from registering migrants and asylum seekers with their practice. Tampering with the core principle of the NHS being free at the point of delivery, runs the risk of shoving scarce resource on a minority issue, while the more meaty challenges facing the NHS remain unresolved.

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