Making “health tourists” pay for care

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j771 (Published 15 February 2017) Cite this as: BMJ 2017;356:j771
  1. Johanna Hanefeld, associate professor of health policy and systems1,
  2. Kate Mandeville, consultant in public health2,
  3. Richard Smith, professor of health systems economics and dean faculty of public health and policy1
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2Ealing Council, London, UK
  1. Correspondence to: J Hanefeld johanna.hanefeld{at}lshtm.ac.uk

A pointless and damaging distraction from bigger problems in NHS

Concern that patients normally resident in one country use a tax based national health system in another without financial contribution is not unique to the NHS. Similar discussions are occurring elsewhere, including in South Africa1 and Thailand.2 The recent announcement by the secretary of state for health that all hospitals will need to charge patients not eligible for free NHS treatment before they receive non-urgent care seeks to address this in England.3 The question is, will it work?

The first barrier to success is the lack of a unique identifier of eligibility to NHS care. Passports or utility bills are not reliable indicators. Research funded by the Department of Health showed that British expatriates, holding British passports but no longer eligible for NHS care, incur the highest average cost of all visitor types.4 Given the chequered history of information technology in the NHS, implementing a reliable system of identification that will cost less to run …

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