New law will force hospitals to charge foreign patients for non-urgent care

BMJ 2017; 358 doi: (Published 13 July 2017) Cite this as: BMJ 2017;358:j3371
  1. Gareth Iacobucci
  1. The BMJ

The UK government is to press ahead with plans to make it a legal requirement for NHS hospitals to charge foreign visitors and migrants upfront for any non-urgent care received as part of its crackdown on so called health tourism.

New regulations—to be laid out in parliament “in due course,” a Department of Health spokesperson said—will kick start the government’s bid to recover £500m (€570m; $640m) a year in costs of treatment of patients from countries inside and outside the European Economic Area by the end of 2017-18, a target that the National Audit Office has said ministers will struggle to meet.1

The plans, initially set to be implemented on 1 April 2017,2 seemed to have been shelved in the wake of the Brexit referendum and were not included in the Queen’s speech last month. But the health department has now confirmed that it is pressing ahead.

The government first launched a programme in 2014 to tackle concerns that the NHS was “overly generous” to visitors from overseas.3 This included a new requirement for migrants and foreign visitors from outside the EEA to pay an additional 50% on the cost of treatment they received on the NHS and a policy to pay NHS hospitals 25% extra on the top of the cost of every procedure carried out on visitors from the EEA who have a European health insurance card (EHIC).

But progress has been slow. In a written answer disclosed in the House of Commons last week the government said that the UK had recovered £56m from EEA countries in 2015-16, leaving it some way short of the £200m a year that it had targeted as part of the overall £500m.4

Although the new legislation will not affect migrants and visitors from other EEA countries who currently have their treatment costs covered through the EHIC, this may change in the future, depending on the terms of the UK’s exit from the European Union.

NHS leaders said that they recognised the importance of recovering costs of treatment from foreign visitors where practical but that it was important that the measures did not stop people getting treatment when they needed it or placed undue burden on NHS trusts.

Phillippa Hentsch, head of analysis at NHS Providers, said, “More of these costs are now being collected, and trusts are continuing to make the necessary changes to support this policy, but this initiative needs to be seen in the context of the wider challenges being faced by providers. The NHS will always treat those who need urgent care, so it is important that these measures do not compromise care or unduly burden trusts.”

Hentsch added, “In an urgent care scenario it can be difficult to identify those patients who should be charged, and outside of urban areas it is only a small number of patients who would be affected. Rather than continue setting targets, we should prioritise helping trusts to learn from each other about what works.”

A spokesperson for the health department England said, “The government remains committed to ensuring overseas visitors and migrants not eligible for NHS funded care make a fair contribution.

“In the last three years we have more than trebled the amount we have identified from international visitors and migrants [from inside and outside the EEA], from £89m to £290m, and we will now go further by introducing regulations to make it a legal requirement that hospitals charge patients who are not eligible for free NHS treatment upfront and in full for any non-urgent care.”


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