Health tourism - what's the bill?

• A health tourist is someone who isn't entitled to free NHS care but who travels to the UK for the purpose of obtaining treatment.
• Estimates vary considerably, but the latest government report puts the cost of health tourists at up to £300 million (approximately 0.3% of the NHS's budget).
• The government plans to introduce an NHS surcharge that's payable by overseas visitors. This isn't directly targeted at health tourists, but is part of an attempt to ensure everyone pays a "fair contribution".

Who are they?

The NHS was founded on the principle that it's a service "free at the point of use" for people who are 'ordinarily resident' in the UK. However, overseas visitors are usually required to pay for their treatment.

EU regulations ensure that temporary migrants or visitors from the European Economic Area receive NHS care for free. The UK also has bilateral agreements with several other countries (for example, Australia) that allow the NHS to recover its expenses from the country concerned.

According to a recent report commissioned by the government, health tourists are those who come to the UK with "deliberate intent" to use the NHS for the purpose of "taking advantage" of its services.

They're a distinct group and not to be confused with foreign visitors who are either entitled to free NHS care or who pay for it. The definition of 'health tourists' also excludes failed asylum seekers or illegal migrants already here in the UK.

While the NHS must provide urgent treatment to anybody who needs it (regardless of whether or not they're entitled to treatment), the government argues that too few health tourists are being identified and too little money is being recovered.

What's the cost?

The government commissioned report proposed that health tourists cost the NHS "around £100 million to £300 million" each year.

The Department of Health has also produced its own figures, using a slightly different definition of health tourists. A few months ago it estimated that if the NHS identified every overseas visitor who ought to pay, the "best estimate" for income would be £125 million. According to its sample survey of NHS trusts, the NHS is recovering £15-25 million of this sum, while approximately £100 million is lost. However, the Department of Health has told us that this review was based on limited information and that the most recent review uses the best data available.

Meanwhile, the London School of Hygiene and Tropical Medicine has suggested that more overseas visitors travel to the UK to pay for treatment than attempt to obtain it illegally. It argues that these legitimate tourists might be a useful source of income for the NHS.

With relatively little data in this area, any number is reliant on guesswork. The researchers responsible for the most up-to-date £100 million to £300 million figure issued the following caveat:

"The estimates for health tourism, as for any unlawful activity, are impossible to estimate with confidence and are a structured judgement."

A new system?

The government's internal analysis suggests that the current system might be costing more than it saves. At present, NHS trusts have little if any incentive to identify overseas visitors not eligible for free care. Once an overseas visitor is identified, the local Clinical Commissioning Group (CCG) will not pay the NHS trust the usual fee. As well as losing this income, the trust will also run up administration costs in recovering the debt it's owed.

As part of a broader plan to ensure that everyone pays their way, the government intends to impose an NHS surcharge on certain migrants. Those from outside the European Economic Area, who are visiting the UK for more than a year, will be obliged to pay in the region of £200 in case they need to access the NHS. The government estimates that the surcharge will generate almost £2 billion in income over the next decade.