After endless questions, consultations and media interviews on the topic, the government has finally given a clear estimate of how much health tourism costs the national health service by publishing five reports totalling over 500 pages. Here, we’ll present you with a digested version of their findings and highlight any potential gaps in their anlaysis.
First off, the £2bn figure being cited on Monday might be a memorable number but it’s also rather higher than the government is claiming. The report says:
“We think that this probably in the range £1.5bn to £1.9bn.” (sic)
That’s also a long way off the rough estimate the health secretary, Jeremy Hunt, gave in July, when the audit was launched. Back then, the lower estimate given was just £12m – 167 times lower than today’s figures.
The reason for that is a leap in the definition of “health tourist”. The £12m figure comes from NHS data on how much it spent on treating foreign nationals in 2011/12 (which was £33m) and the money it was able to claim back from those individuals. The remaining figure of £11.5m was unpaid charges that the NHS had to write off.
But Monday’s report takes a very different approach. It identifies three very different groups who might make use of the NHS. They are:
1. regular visitors and non-permanent residents
2. irregular migrants
3. so-called “health tourists”
Each of those groups poses specific challenges when it comes to estimating their burden on the NHS – and indeed the state more broadly.
The first group, defined as “non-permanent residents”, accounts for £1.4bn of the final c£1.8bn estimate. They are, as the study recognises, “mostly in the country to work or study”. Let’s set aside the possible advantages to the taxpayer of that work. On a daily basis, there are around 2 million of them. A quarter of that group are from the European Economic Area. So let’s also set aside the fact that British nationals are entitled to reduced or free healthcare when they are “regular visitors” or “non-permanent residents” in those countries.
Already, a picture is emerging of how these clear calculations might obscure some more complex ones. But let’s look at those other two groups.
“Irregular” is a slightly confusing term in migration speak – here, it includes failed asylum seekers (FASs), over-stayers and illegal migrants. Automatically, one might assume that is a group that might be reluctant to present themselves at a doctor’s surgery. But in any case, as Monday’s report admits, estimating the number of these individuals is “very uncertain and based on historical population estimates, constrained by the lack of detailed up-to-date statistics from the Home Office” (emphasis not added).
Nevertheless, the report estimates that there are 580,000 of those individuals, each of whom costs the NHS £570 a year, meaning that as a group they cost the system £0.3bn.
Finally, there are the “health tourists” – an ambiguous term we attempted to unpick back in July. Monday’s report identifies two groups that make up health tourists: people who have travelled with a deliberate intention to obtain free healthcare to which they are not entitled; and frequent visitors registered with GPs who “take advantage” of routine treatment.
The report estimates that together, those two groups of “health tourists” cost the NHS between £70m and £300m. That’s the real headline figure that we’ll be looking at today. And perhaps unsurprisingly, it’s considerably closer to £12m than it is £2bn.
We’ve only just begun to look at the real figures here. There’s a multitude of other factors – from the public health consequences of not treating some individuals in the UK to how much it would cost to overhaul the system to charge some individuals – which we will be looking at throughout the day. In the meantime, tell us what you think about “health tourism” below, and point us in the direction of any other useful data.
UPDATE 12.47pm: Copious caveats
Many journalists might miss them, so it’s highly unlikely that members of the public who are concerned about the NHS will get through the 99 footnotes that litter today’s main report. But they’re well worth a read. Here are some of them:
6 § – Unable to estimate
That refers to the number of health tourists who take advantage of the NHS. It might seem strange that the report’s authors were able to quantify the cost of these individuals without knowing how many of them there are. But that’s something they acknowledge when they say “empirical knowledge on the magnitude and effect of health tourism is lacking”.
Here’s another footnote worth reading:
28 George et al
Because George et al are the authors of one of the most comprehensive reports so far on the consumption habits of migrants in health and education. It found that migrants aren’t quite the drain on the system that the term “health tourism” might lead some to assume. It’s worth sharing a few sentences of their findings:
Starting with all migrants, whatever their date of arrival (and therefore including those who arrived from Europe around World War II and from the Commonwealth during the 1950s and 1960s and their dependent children), total healthcare expenditure in 2009/10 was £12.6bn. This was 10.8% of total healthcare spending, whereas this group accounts for 13% of the population…
Around a third of expenditure on healthcare for migrants and their families (£4.2 billion) is accounted for by those who have migrated in the last ten years. This group accounts for 3.6 per cent of expenditure and 5.3 per cent of the population.
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