Intended for healthcare professionals


Charging overseas patients upfront could cause “chaos,” BMA warns

BMJ 2017; 356 doi: (Published 06 February 2017) Cite this as: BMJ 2017;356:j655

Re: Charging overseas patients upfront could cause “chaos,” BMA warns

It is notable that the press coverage largely referred to charging "foreigners" up-front. Eligibility is, of course, based on "ordinary residence". UK nationals resident overseas are not eligible for NHS hospital care.[1] It is not entirely clear what “ordinary residence” means.[2]

This is a classic "dead cat" story,[3] designed to distract the public from the gross underfunding of the NHS and social care by blaming the usual scapegoats - "foreigners".

(It goes without saying that immigrants' to the UK net contribution is greater than similar UK citizens.)

The BMA should make an FOI request: what will be the cost of the infrastructure and overheads of the scheme (to "charge patients 'up-front'")?

Given that "health tourism" costs the NHS just 0.3% of its budget, I suspect that this will cost more more money than it will raise.

It will, however, create an infrastructure that can then be used for charging, making it easier to introduce co-payments for those aspects of (currently free at the point of use) NHS care that commissioners decide to ration.


1. Department of Health. 2016 (February). Guidance on implementing the overseas visitor hospital charging regulations 2015: Ways in which people can be lawfully resident in the UK, Department of Health ( ).
2. English PMB. Eligibility for NHS secondary care since 2012. Peter English's random musings. London, 2017(
3. Dr Helen Wollaston MP, cited in: Upfront charges for overseas patients a ‘distraction’ to underfunding. nhs finance 2017; Updated 08 February 2017; Accessed: 2017 (08 February): ( ).

Competing interests: My wife is an EU citizen who came to the UK in 1976 to train (at her parents' expense) as an OT. She worked in Germany for one year, returning to the UK in mid 1980. She has worked in the UK as an OT or academic (training healthcare workers), apart from breaks for childcare. Unless systems are clarified, we may have to abandon family, friends, and colleagues in the UK, resign from my job, and move to Germany.

08 February 2017
Peter M English
Public Health Physician
N/A - this is a personal response
West Ewell, Surrey