This morning, the Department of Health released a report which led to a rash of headlines on the massive costs of “health tourism”.
Creative Research, a research firm, was commissioned by the Department of Health to examine how much is spent on health for visitors to the UK and migrants.
They came up with a figure of £2bn.
Shortly afterwards, the government said it wanted to collect an extra £500m a year from overseas visitors and migrants. Jeremy Hunt, the health secretary, proposed a £200 health levy on foreigners coming to the UK.
But the figure of £2bn seemed quite a jump from previous estimates. In July, in the House of Commons, Steve McCabe MP said that David Cameron had suggested “health tourism” cost £10m. Jeremy Hunt, the health secretary, had claimed it was £200m and the then health minister, Anna Soubry, had suggested it was £33m.
Does it stand up? We put it to the FactCheck test.
According to the government’s own report, “health tourists” cost us nothing like £2bn a year. The £2bn figure refers to total numbers of visitors and migrants using the NHS.
The Department of Health said that “health tourists” – defined as people who have travelled here to get free healthcare they’re not entitled to – cost £70m to £300m a year.
But it goes on to point out that “these estimates for the costs of health tourists are very rough and far from certain”.
The report says that migrants or visitors from the European economic area (EEA) cost us £261m last year, and those from outside this area cost us £1,075m, or around £1.1bn in 2012-13. It lists another category – “irregular migrants”. This group includes failed asylum seekers, overstayers and illegal migrants. They cost £330m last year.
While the figures are large, they’re not surprising, and actually consume a tiny proportion of overall NHS spending. In their report, they say that NHS expenditure on services was £91.5bn – about 2 per cent.
What did come as a surprise, however, was another group of NHS users who should be paying for treatment, and that’s British expats.
While small in number – the figures the Department of Health uses assumes there may be 65,000 present in England on an average day – they cost health services more per head than anyone else.
Expats, this report suggests, cost £1,449 per head. Visitors here from outside the EEA who’ve been here for less than three months cost £1,000 less, at £449 per head.
Students from outside the EEA cost £713 per head, and migrants who’ve been here more than a year who have come from outside Europe cost £822 per head.
The expat cost is highest because their age tends to be greatest, and they therefore tend to require more complicated and lengthy healthcare.
So do they all owe us £2bn?
No. All of this only looks at how much they actually cost – many of these people are entitled to use the NHS because they’ve been here for long enough, because of European regulations, or because of exemptions.
It’s also the case that A&E and primary care are supposed to be free at the point of delivery – regardless of where you’re from.
The more telling figure is how much the above users could potentially owe the NHS – and that’s far, far lower than £2bn.
The report suggests that for healthcare used by such users, the NHS could charge for just £190m of it.
How much does the NHS get back?
In terms of how much of that the department has managed to collect – they don’t say. What they do say is that a previous Department of Health study has “shown that only about £23m is collected of the £57m that is invoiced” – about 40 per cent.
In terms of what the NHS has lost, that wasn’t in this report either. But a parliamentary question in November 2011 did go some way towards answering that. It said there was £6.8m of bad debts and abandoned claims for overseas patients in 2010-11. In other words, foreign patients (and British expats) who came and used the NHS and should have paid for it but didn’t accounted for just under £7m.
Is this the final word?
However, there are some serious caveats to all of this, and that’s not from us, it’s from the Department of Health.
Here is a “note of caution” contained in the report: “All of the estimates presented are subject to varying degrees of uncertainty… the estimates for the number of irregular migrants are very uncertain and based on out of date population estimates.
“The estimates for health tourism, as for any unlawful activity, are impossible to estimate with confidence and are a structured judgement… The estimates are presented as the best that can be made at present, recognising that they are based on incomplete data, sometimes of varying quality, and a large number of assumptions.”
The report was also based on 30 out of 161 acute NHS trusts. An earlier edition of the report, which looked at qualitative data, suggested that staff were not collecting data in a systematic way. So for all we know, patients who are visitors could cost more.
While much of the rhetoric around ‘health tourism’ uses this single phrase, it’s clear the group themselves don’t cost the NHS £2bn.
Even if we accept the heavily caveated report, they cost £300m at most. Mr Hunt’s proposed levy to raise £500m wouldn’t even come close to addressing the simple category of “health tourism”.
It’s also worth pointing out that some of the people included in the report are British themselves.
In terms of how much visitors, foreign, British, legal or illegal, cost the NHS – this report’s headline figure is on expenditure, not on losses. Based on the free care that many visitors are entitled to, it’s only about £190m they owe, under current guidelines. It doesn’t say how much has been lost, but previous figures from the Department of Health suggest it was about £7m in 2010-11.
There is also the problem of how reliable these figures actually are – the Department of Health concedes their uncertainty.
Nevertheless, it is seen as being one of the most comprehensive estimates to date. There haven’t been many detailed analyses of how much migrants and visitors cost the NHS.
Perhaps now the health secretary has made it his mission to claw back money from visitors and migrants using the NHS, there will be more.