BMA vote not to charge "health tourists"

[IrmaFayLear]

Quite cross about this.

Different of course if someone has a heart attack/car accident, but to turn up specifically to access expensive maternity/cancer etc treatment is not only unacceptable but unsustainable.

Particularly annoyed because the pil's dementia care which they had to self-fund ran into many hundreds of thousands (at a humdrum establishment, too).

It sticks in one's craw to be told constantly that the NHS is crumbling but that an extra couple of billion per year is ok for health tourists.

0.3 % is quoted as an estimate at the upper end for "deliberate" health tourism. That would not include failure to collect from tourists with insurance or via EU system for reimbursement.

Anyway I may not be amongst the super bright but surely 0.3 % of a huge budget like the UK's national health service is pretty damned big.

Anyway I may not be amongst the super bright but surely 0.3 % of a huge budget like the UK's national health service is pretty damned big.

In some cases it's actually a margin of error ...

Under membership conditions of the EU we are able to claim back a set amount (and we set this amount - which is actually higher than the amount other countries set for the same purpose) per citizen from other countries. So, we do not need to deny care; we just have to claim back. In all reality we are pretty bad in claiming back (our fault - we are not filling in the papers) but also we have to pay other countries a lot more than we get as we have the highest number of retirees living abroad (actually we have the highest number of citizens living in other countries - and many of them are of retirement age and thus need healthcare in those countries (which they are granted under the EU health insurance directive).

It's not about what it costs in real terms

It really is actually.

Which other countries offer free health care like we do?

UK does not offer free health care. It offers health care which is free at the point of delivery - as do many other European Health Insurance schemes. UK residents ( and many non residents) pay for it through direct taxation and NI contributions.

The difference between UK and Germany is that the German system issues people with a card which demonstrates that they are entitled to use the system. This prevents people travelling to Germany without health insurance to use a system to which they have not contributed. Seems sensible to me.

The UK residence based model was fine 50 years ago when populations were largely static. It is no longer fit for purpose and acts as a pull factor for migrants moving from low welfare systems. The fact that significant numbers of people who have not contributed are accessing the system without paying means that UK residents who are entitled to use the system get worse treatment. This is not fair.

MPs know this. They know the NHS is cracking at the seams. But it is such a sacred cow that no political party dares to change it. Anyone who has lived in Germany, France or Belgium will tell you that their systems are miles better.

actually we have the highest number of citizens living in other countries -
Is that correct? I remember hearing many times that there are around 3.5 million EU citizens living in the UK and 1.5 million UK citizens in the whole of the rest of the 26 EU countries. Yes, I'll look for a source but I've definitely read and heard that many times

It isnt a matter for the BMA. Its members are there to trieat the sick. It is for hospital managers and administrators to deal with admin and charging. Id be happy to go the american way when it came to tourists and sadly, if people die well they die. Also surcharge airlines who fly overly pregnant and obviously sick people into the country. Export them back where they came from immediately if possible.

I work for the Overseas Visitors team in an NHS Trust and regularly charge patients for treatment. We try our best to identify chargeable patients before they come into hospital and inform them we require payment up front, the majority of them then cancel their appointments, obviously we can't do that with emergency admissions.
The only time we ask for any involvement from a Doctor is if we inform a patient that they are chargeable and the patient says they can't pay, we then ask the Doctor for their opinion on whether or not the treatment is 'urgent or immediately necessary' if it is, then the patient receives treatment and is invoiced afterwards if it isn't then the patient is told to seek treatment on their return home and the appointment is cancelled.
I personally have no problem charging people who are in the UK visiting, but I hate charging failed asylum seekers as these people are often left for years with no legal status and so entitlement no to 'free' NHS treatment. They often rack up huge debts and have no way of paying, but the guidelines say they have to be charged.

• sorry, that should say no entitlement to 'free' NHS treatment.

Maybe there should be a closer multi agency approach? Failed asylum seeker? Border agency rounds them up and exports them as soon as possible,then they dont turn up at hospital. Maybe hospitals should get outside agency doctors to make decisions as to whether treatment is urgent so that direct employed staff dont feel pressured.

We were health tourists, we came to the UK as I have type one diabetes and my parents could not afford adequate insulin and blood monitoring. It’s likely if they hadn’t moved I would either be dead or have severe complicationa due to poorly managed diabetes.

I pay more tax per year in the UK than the average Brit earns in a year.

I think emergencies, childrens care and the care of pregnant women should remain free where the person is not insured.

What we are seeing a lot of at the moment are people coming into the UK on visit visa's (so they don't pay the health surcharge) and then not going home. They are often shocked when informed they are chargeable for their treatment.

Arnoldthecat export them to where? quite often they have no documents and refuse to say where they have come from.

Whenever this comes up, I always wonder quietly to myself if the doctors would so keen to treat such people if the NHS didn't pay them to do so.

"OK Dr Smith. You spent two days this week on non-eligible patients so we've knocked off two days' pay."

Hmmm

Having been a hospital governor I know they do make people pay, our trust even had a credit card machine they would take to people's beds. They also feed info through to customs etc about people who don't pay so they can be stopped on exit or re-entry. Of course if they don't have the money then not sure what happens then.this was at a small Midlands trust, not that near an airport so not a massive problem but still an issue, it would cost them around £140k a year in terms of what they can't recover which may not be a lot in the scheme of things but is still 2 x senior doctors. I imagine in major cities the cost is a lot more and it depends how pro active they are, don't forget traits are short of money - they want the money!They should pursue it and have plenty of admin people to do so.

There are more EU citizens in toto living in the UK than UK citizens living in the EU - but there are 27 member states. The UK is the single country exporting most citizens (1.5 million) whilst 3.5 million citizens from the other member states (not 3.5 per member state but total of EU citizens) are here.

There is such a thing as an EU health insurance card. If you apply for one you will get free health care in member states( for the first three months of treatment which should cover your general health tourist). Spain also has free public healthcare - as do some other EU countries (in particular Ireland and France). Spain, Ireland and France take over 80% of our expats and most are past retirement age requiring therefore higher health expenditure. Most EU citizens within the UK are below retirement age (actually below 40) as the majority of them prefer not to retire in the UK.

Some of the figures being quoted here are inaccurate. From ec.europa.eu/eurostat/statistics-explained/index.php?title=EU_citizens_living_in_another_Member_State_-_statistical_overview

Who are the most mobile EU citizens?
Romanians and Lithuanians leave their country of origin in the highest proportions, while the contrary is true for Germans and British citizens.

In 2017, Romanian citizens of working age (20-64) residing abroad within the EU accounted for about a fifth (19.7 %) of the population residing in Romania, making them by far the first largest national group among EU mobile citizens. The next five national groups accounted from 12.5 % to 15.0 % of the resident populations of their countries of citizenship: Bulgarians (12.5 %), Latvians (12.9 %), Portuguese (13.9 %), Croats (14.0 %) and Lithuanians (15.0 %). The EU Member States with the smallest share of mobile citizens (out of the resident population of country of citizenship) were Germany (1.0 %) and the United Kingdom (1.1 %). In another eight Member States this share was 2 % or less. Overall, EU mobile citizens accounted in 2017 for 3.8 % of total EU resident population, which was 1.3 pp more than in 2007. On the other hand, when looking at absolute numbers, in 2017 the most numerous national groups of mobile EU citizens aged 20-64 were those from Romania (2 366 000 persons), Poland (1 762 100 persons), Italy (1 099 700 persons), Portugal (847 700 persons) and Bulgaria (533 900 persons) .

The problem is also that many of the statistics are simply not comparable - a mobile citizen is, for example, someone who makes use of the freedom of movement for work (and often remains after enjoying the same rights as citizens. However, that excludes tourists, students and often (depending on the statistic and the reporting country) retirees

@notyetsleepingthrough

UK pensioners in receipt of an exportable UK pension and various other benefits resident in the EU/EEA get their health care in those countries paid for by the NHS on what is known as the S1 scheme. Their health care costs do not fall to the host country. This is to reflect the fact that they have paid tax and NI to the uK system throughout their working lives and would be entitled to treatment in UK. The S1 also entitles them to emergency treatment in UK under the EHIC scheme.

This is why those complaining about them coming back to access NHS treatment are wide of the mark. If they have cancer in eg France the UK picks up the bill anyway. But it is often better for them (and cheaper for the NHS) to return to UK where they are better able to access family support.

www.nhs.uk/using-the-nhs/healthcare-abroad/moving-abroad/planning-your-healthcare/

Too hard to implement charging? Costs insignificant? Then the solution is simple. Doctors pay can be cut across the board to fund it. Won’t make any difference to them will it? After all, the costs are do very small.

"First do no harm"....

I understand why the BMA has voted as such.

I agree OP. The NHS is not a charity. It’s funded by our citizens to pay for healthcare for our citizens.

I think people misunderstand the motion. It was not that people shouldn’t be charged if they are ineligible for NHS treatment but that doctors shouldn’t be made to police that charging. They are doctors not immigration officers.

I wonder how many of the people saying doctors who won’t administer charges are themselves not paying national insurance? I think the figures in the original post are inaccurate. Deliberate' use of the NHS—use by those who come here specifically to receive free treatment or who come for other reasons but take advantage of the system when they're here—is hard to quantify. It's thought to be very roughly between £110 million and £280 million a year. That’s quite different from billions.

Arnoldthecat export them to where? quite often they have no documents and refuse to say where they have come from.
Well of course we are digressing but the bottom line is that they cannot be recognised as asylum seekers as international protocols require them to claim asylum in the first safe country. They refuse to do that as they wish to come to blighty to take the piss. They have heard that the streets are paved with gold.

As they are illegal aliens they must be detained and monitored until such time as they divulge their nationality and/or it is discovered by surveillance and the gathering of other evidence.

Perhaps we could reach an agreement with a country like Mauritania to take them if they wont divulge their nationality?

They must then be removed by force if necessary.
We cannot continue the way we are going.