Feature Data Briefing

Migrants’ healthcare: who pays?

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6483 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6483

This article has a correction. Please see:

  1. John Appleby, chief economist
  1. 1King’s Fund, London, UK
  1. j.appleby{at}kingsfund.org.uk

While there has been much heat generated by the charging suggestions in the government’s new Immigration Bill, there has been less light, finds John Appleby

Despite the National Health Service being designed expressly on the basis of free access, the complications of who, exactly, is entitled to free access and who should be charged for what type of care has a long history.

Since almost the day of its inception the NHS has had the power to charge people not “ordinarily resident.” In practice the charging regulations in the 1949 act were not implemented until the 1980s. And while NHS hospitals have always had a statutory duty to identify, bill, and collect charges from patients not ordinarily resident for the services specified in the 1949 act, in practice this has been somewhat ad hoc. This is partly because of the costs of collection relative to income, misaligned incentives (hospitals now get paid for their work by commissioners regardless of who …

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