Health Tourism – Key Points


Health, Migration Trends, Policy, Population

  • Health tourism drains the NHS of at least £300-400 million each year because hospitals fail to identify overseas patients or never send them bills. 
  • The government has estimated that £388 million is spent each year on EEA and non-EEA patients who should be paying for their care but are not identified or charged. This does not include the cost of what the government calls ‘abnormal’ health tourism, nor the costs of illegal migrants.
  • Health tourists are non-UK nationals who target the NHS because they will often get better treatment than at home — and for free, either by ‘flying in and flying out’ or through existing registration. By their very nature they are difficult to identify and quantify because they are likely to make efforts to conceal their true eligibility status or are not flagged up in the system.
  • Britain is among the worst countries in Europe at extracting payments from foreign patients and four in five hospitals do not expect to start recouping more money (see House of Commons Public Accounts Committee report).
  • Use of the NHS—by foreign visitors who’ve ended up being treated while in England, for non-permanent residents and illegal migrants —is estimated to cost just under £1.74 billion a year. See Department of Health assessment, which broke down the costs as follows:
    • £340m for EEA visitors and non-permanent residents to the UK (excluding expats). While the UK was a member of the EU, the government estimated that approximately £180m of this was recoverable through the European Health Insurance Card (EHIC), with the remainder potentially recoverable through S1 (£60m) and other arrangements. It was estimated that the NHS recovered around £50m in one year, less than 20% of the total potentially recoverable amount.
    • £1,070m for non-EEA visitors and temporary migrants to England. Of this approximately 14% (around £156m) was thought to be potentially, currently chargeable because the total gross expenditure includes both the costs of non-chargeable services A&E and primary care and those individuals who are currently not chargeable due to being ordinarily resident or otherwise exempt.
    • £330m for illegal migrants
      • Total = £1.74 billion
  • In contrast, the cost of those who had traveled to England purely to receive urgent treatment and regular visitors who were described as “taking advantage” of the system by registering for GP services and other NHS services to which they were not entitled was estimated at up to £300 million per year. See Department of Health assessment
  • Figures for 2015/16 show hospitals only managed to invoice patients for £289 million and much of this was never repaid (Public Accounts Committee report, 2017). Government studies also suggest that the NHS is also simply failing to charge when it is supposed to—recouping only a fraction of what should be around £340m from other countries.
  • GPs were also found to be doing too little to flag up those who should be charged. Britain is among the worst countries in Europe at extracting payments from foreign patients and four in five hospitals do not expect to start recouping more money.
  • Surgeon Dr J Meirion Thomas has described health tourism as a ‘gaping wound’ in the NHS. He says abuse is particularly bad in maternity and cancer wards.
  • A relevant question is: Do those saying that this is not a problem believe that it should be the UK’s responsibility to extend free health care to the whole world? 

Contextual points:

  • Unsurprisingly, ‘health’ is currently the public’s top concern (YouGov issue tracking poll), with immigration behind the economy in third place (on par with the environment).
  • A UK-wide poll of just over 1,000 adults by Ipsos Mori for the BBC showed that 74% of respondents supported increasing charges for overseas visitors
  • From April 2017, NHS hospitals in England were made subject to a legal duty to charge overseas patients upfront for non-urgent care if they are not eligible for free treatment (see report).
  • From December 2018, the immigration health surcharge was increased from £200 to £400 per year for non-EU nationals, with students and those on the Youth Mobility Scheme on the discounted rate of £300 per year (see announcement).
  • In mid-2019 the delegates at the British Medical Association voted overwhelmingly to stop charging overseas patients for their treatment at NHS hospitals.
  • Those illegally crossing the Channel in order to claim asylum, as well as 40,000 failed asylum seekers, are able to get immediate and full access to the NHS. Illegal immigrants are able to access GP services (see written Parliamentary Answer, September 2021) despite the huge pressure and crisis which GP practices are facing due to skyrocketing demand. This is surely unfair to the millions of people who pay into the system and expect to get good NHS care when they need it.
  • Between 2010 and 2020, there were just under seven million new GP registrations by migrants in England, Northern Ireland and Wales (ONS local area migration indicators). That is more than one every minute.
  • The total additional cost of net migration for the NHS in 2014 was £360 million (£160 million for EU immigration and £200 million for non-EU immigration) – (See source: NHS Five Year Forward View, Nuffield Trust calculations, May 2016).
  • Total NHS expenditure for the migrant population in 2014/15 was £18.6 billion (see Table 2 of our fiscal analysis).
  • Research suggests that immigration has been a huge overall annual fiscal cost (between £4.3 billion and £13 billion per year for 2014/15 and 2016/17 depending upon assumptions – see e.g. our fiscal analysis).

21st October 2021

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