Intended for healthcare professionals

Feature Briefing

Are migrant patients really a drain on European health systems?

BMJ 2013; 347 doi: (Published 29 October 2013) Cite this as: BMJ 2013;347:f6444
  1. Sophie Arie, freelance journalist
  1. 1London, UK
  1. sophiearie{at}

All over Europe access to health services by migrants is being tightened, but does the evidence show this is necessary? Sophie Arie reports

What’s changing?

Britain is proposing to introduce a levy on temporary migrants from outside the European Economic Area (EEA), such as students and people on temporary permits (allowing them to work in the UK for six months to five years), who until now have had free access to the NHS. Students will be charged £150 (€176; $242) a year and others £200. The Immigration Bill also proposes that general practitioners should charge for services to short term migrants (those with permission to live in the country for up to six months), and illegal migrants, who currently have access to free primary care. And a better system is being created for retrieving costs that should be paid by foreign patients or by their countries under EU agreements.1

How does this compare with systems in the rest of Europe?

Many European countries are tightening access to healthcare for visitors and migrants as health budgets are squeezed. Since 2012, Spain has barred illegal migrants from receiving any healthcare except emergency care (including childbirth).2 In Spain, non-EU students pay €59 (£50; $80) a month for access to health services and those over 60 must pay €259 a month for the same access.3 In Greece, although healthcare has been free at the point of access, from January it will introduce e a €25 charge for entry to all hospitals and health centres (people earning less than €11 000/year are exempt) and a €30 charge for any interventions after an initial consultation as part of the country’s efforts to reduce its health budget.3

What does the European Union require?

Since 1971, EU regulations have obliged EU countries to provide the same access to healthcare for visiting EU citizens and non-resident migrants as they do for their own nationals. The …

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