Unwell and over here: what's the "true" cost of health tourism?

22 October 2013

Another week, another claim about the cost of 'health tourists' to the UK taxpayer. The front page of today's Daily Mail claimed that "foreigners using [the] NHS" are running up costs of £2 billion a year.

The headline is a response to the government publishing new research on the use of the NHS by migrants and overseas visitors - in other words, those who aren't "ordinarily resident" in the UK and therefore aren't entitled to free healthcare. This group includes temporary migrants, failed asylum seekers and expats (but not immigrants who are settled here).

In response to the £2 billion figure, the Labour party immediately accused the government of spinning the facts, arguing that the authors of the report have described their numbers as "subject to various degrees of uncertainty".

£2 billion - a breakdown of the bill

Firstly, it's important to note that the £2 billion is the total cost of the use of the NHS by migrants - those who are temporarily resident here, those who are here illegally, and those who have travelled to the UK with the purpose of obtaining some kind of treatment. This means that we're not only talking about "health tourists", which the report specifically defines as those who come to the UK with "deliberate intent" to use the NHS and those "taking advantage" of its services. 

The report suggests that - excluding this particular group - migrants and overseas visitors cost the NHS just under £1.8 billion. Temporary residents (including migrants who don't have permanent residency and UK expats) are responsible for £1.43 billion of this. In addition, irregular migrants (failed asylum seekers and those here illegally) run up £330 million of the £1.8 billion bill.

Then, on top of this £1.8 billion (the so-called "normal use" of the NHS), "there is a plausible range of around £100 million to £300 million attributable to health tourism". The government has previously quoted the cost of this abuse at anywhere from £20 million to £200 million.

Estimates at best

The report has attempted to model the costs of these different groups to produce an overall total. In order to do this, it has relied on certain assumptions - for example, that migrants and overseas visitors are as likely to use the NHS as UK residents.

The report has taken into account the tariffs for different NHS services - from prescription costs to the price of a visit to A&E. However, the £2 billion total doesn't allow for the fact that the NHS provides emergency care to anyone free of charge.

The £2 billion figure also includes £260 million incurred by citizens from the European Economic Area (EEA). In theory, the NHS is able to recoup their costs under EU regulations. For other countries outside of the EEA (for example, Australia), there are reciprocal agreements in place that mean the NHS provides free treatment for their citizens. In addition, UK expats (who arguably aren't "foreigners") account for £94 million of the £2 billion sum.

Overall, the report makes clear that there is very little data on how migrants and overseas visitors use the NHS. Among other caveats, we find the following:

"The estimates for the irregular migrants are very uncertain and based on on out of date population estimates. The estimates for health tourism, as for any unlawful activity, are impossible to estimate with confidence and are a structured judgement."

The Conservatives have insisted that this latest research amounts to "clear and widespread evidence" of health tourism. Yet the report to which they're referring emphasises the paucity of its data and the uncertainty of its estimates. According to this report, the cost of health tourism is not £2 billion but more like a tenth of that.

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