Migrants To Be Charged For A&E Services

[DoYouLikeMyBaubles]

www.theguardian.com/society/2013/dec/30/tourists-migrants-to-be-charged-emergency-care-nhs

Your thoughts?

Like many people on this thread I see this as a first step towards charging for everyone. And the model supported will not be a relatively benign one like the one in some European countries, it will be an out and out rip-off one like the US model. Look at who's in power, where the vested interests lie and then tell me how it could be otherwise.

Oh, and as someone who has been part of the disastrous NHS NPfIT system, I can honestly say I've been there, done that, and would not advise anyone to follow in my footsteps.

I'm a bit peed off at the proposed changes if if affects me directly.
but so far all the information on the news is a bit wishywashy.

I'm from another european country, work here, live here, pay taxes, give blood. I'm registered with the nhs, of course, and so far receive treatment if needed. if would be very difficult to find private health insurance that would insure me.

mousmous I suspect if you have lived here for some time and paid taxes I doubt this will apply to you. You're settled here, you are normally resident and so not a migrant. They would not get away with that sort of thing - I've been here almost 18 years, paid taxes that whole time and if they try to charge me to use the NHS I would take it all the way to bloody Strasbourg.

I don't actually have a problem with a qualifying period though, as long as it is waived as soon as the person starts working and paying into the system. And if they then lose their job, they should be treated no differently from a native Brit who loses theirs. It's all about fairness.

However, as I've said, I think this is the first step on the road to a US style health service.

I think the consultation info is here. This makes interesting reading about the apparent failure to recoup anything like the amount of money that could be under current rules, without giving any reasons to explain why this is.

mousmous, it doesn't appear that it would have any bearing on people ordinarily resident in this country. The report does also note that the UK will continue to pay out more than it collects in the EU because of the number of British people using health services abroad, particularly ex-pat pensioners.

Of course mousmous is a migrant. She migrated here!

If this is brought in, I'd imagine something like citizenship might be used as the cut off.

Because it would be even more insanely too complicated to get into how many years, under which status for how long, and how much tax someone has paid. (Eg someone arrives as student, marries a citizen, becomes a SAHP, gets a part time job: no easy way to "score" that.)

One of my parents is an immigrant - kept their original citizenship as birth country didn't allow dual nationality and there was a possibility of family moving there. Then other parent divorced them. It could have been very nasty, but by luck the country wasn't on a UK shit list at the time; immigration and reciprocal rules vary per country.

X-posted. Ta, tribpot, will go read document.

There are going to have to be administrative changes, the NHS cannot carry on as it is.

If they were to save 80 million on missed charges from ex-pats and overseas people turning up for treatment then it would pay for itself each year.

I don't see how it would lead to UK entitled people being charged. It's nanny state panic thinking related to healthcare. You simply can't have your cake and eat it.

Either you open up to an administration free system where everyone and anyone walks in and gets treated and you pay more tax to benefit from the freedom, or you have some kind of billing and identification system for those not entitled to free healthcare, and the costs of having to run that administration would be billed to those who have to pay for it.

There really isn't another choice is there?

There are plenty if ways to score immigrants believe me. I live in a country where 30% of the population are immigrants. It's no less complicated a life here than any other and yet it seems to be managed efficiently.

It's not the governments duty to chase individuals to update their status in life. It's up to the individual and there should be consequences for not doing so.

Infact there are - try committing a motor offence with an old address on your licence. It's not the governments responsibility to change your licence each time you change name, move house etc.

If you commit a motor offence with an old address on your licence what is the usual penalty?

It's not as bad as the potential consequences of this, surely?

I hate to think of a situation where eg a pregnant woman gets married and there is some kind of urgent pregnancy related problem and she hasn't updated the the records with her married name and so can't get any help.

I think that is a really dire potential consequence and much worse surely than having the wrong address on your driving licence.

It would also negatively impact people with less ordered lives who often need the help from the NHS and other care services most. If a person is suffering from crippling depression should their care be withdrawn as they can't keep their paperwork up to date? I would say not.

I think there are quite polarised views on this thread though.

I don't think you'd be turned away from care and that's not what I'm imagining at all. In every case there's usually a warning and an increased fine with time lapsed.

There's never a simple answer to everything but it would work for the majority. At least if you had a robust administrative system that supported, rather than held back the system people who fell through the net could be contacted.

At the moment any kind of admin change is looked on as an additional job, or effect. To me I think the whole administrative function needs to be revisited.

It says in the second paragraph, and I've posted it, that no-one will be turned away they'll be invoiced after treatment. Which begs the question who's going to chase these invoices

But that's effectively what happens now

Yes that is what happens now. And I also have no idea how they plan to chase people who are illegal migrants and have vanished, or who have gone to a different country!

Others on this thread thought are suggesting alternative approaches, and I think that they warrant examination.

JollySanters the difficulty with healthcare (unlike car ownership) is that it is often the most vulnerable people who need it most. So the rules would work for the majority, sure. With the car ownership thing, you talk about a person committing a crime and then their docs aren't up to date. So the person has done something criminal, in addition they have not done their admin, possibly on purpose to avoid detection for said criminal acts. Whereas a person who is ill has committed no crime, so the minority for whom it will not work will be the most vulnerable people out there. Who will then be criminalised because of it, in addition? Due to non payment of care bills?

I don't think it is really a very good analogy, if I'm honest.

The analogy is really rather relating to those people who don't feel they should update their admin, and there would be consequences in place for not doing it. As I mentioned it wouldn't fix all problems, and without a proper review of administrative procedures in the UK with a global long term view you are papering over the cracks in a failing system.

I am on long term sickness at the moment, I forgot to send in my note last month and promptly lost it, and missed a few calls from my healthcare company, and couldn't properly translate the documents I was sent. I was really struggling.

Next week I have a liaison officer coming to my house to sort out all the forms for me and discuss a plan of action for long term treatment and support, in my native language. There are plenty of vulnerable people in Switzerland, Germany etc that don't seem to fall through the cracks.

I pay less in healthcare insurance and social payments for my entire family than I did in the UK as a single person. I'm assuming that the insurance company still makes a decent profit regardless. So with so many people pouring money into the NHS why can't the administrative side work more efficiently?

I also find it really strange that the first thing people assume is that no one will change their address, and no one will pay their bills. If your right to stay in a country depends on it, then you'd do it surely? It's not an accepted thing here not to pay your bills or be responsible for updating your info. As long as the moral majority do it then the focus can be on those who don't.

I have to say the biggest eye opener I had when leaving the UK is how much responsibility people take for their own lives, tax returns and personal administration.

Sorry battery running out now if I don't respond!

Switzerland and Germany have universal healthcare arrangements though and reciprocal arrangements with the UK. On the funding, I don't know the ins and outs of the healthcare systems there. However I suspect that (as in France) there is a large employer contribution - at the moment there is no onus on UK employers to pay anything specific towards healthcare for their employees. In France most of the insurances are non profit and of course healthcare is heavily subsidised by the state and free for people who can't afford to pay anything / are unemployed. The outcome is the same as in the UK, universal healthcare.

I think that the people on this thread who suggest that people be turned away are hardly likely to agree with things like liaison officers and translators! As that will end up being more expensive than just treating them in the first place!

Out of interest how did you know how much of your tax in the UK went to the NHS? I have no idea how the monies I pay in tax are split out amongst the various services.

Oh and on not paying. If a person comes here and has a heart attack and goes to A&E and gets admitted to a high dependency ward and has surgery to correct the problem then you're looking at tens of thousands of pounds. Maybe more. Not many people can afford that - hence healthcare costs being the no1 cause of bankruptcy in the US.

The fact that at the moment 30% of such bills are being settled is pretty good going I reckon.

I think these new rules or system they work on for newcomers will simply just cost more then it will save the NHS.

I've a personal bad experience with the HMRC about getting tax credits. I just posted it in the financial section.

Because of a rule that if you're coming to live here from the EU. You're not working, but have enough money to pay for private health insurance. That they'll give you tax credits. Which is quite a lot of money.

I wonder how many of those idiotic rules are out there?
First they got to change those. That will firstly save a lot of money!!! Secondly it'll be much harder for people to come here and abuse the system.

Just change the stupid, money wasting rules that there are now. Instead of thinking, planning and creating a whole new system. Because what there's now is good. It just needs some more fine tuning.

JollySanta, you've completely missed the point about addresses, etc.

First, you need a huge IT system and many people to administer this (constantly changing) data. You have to pay for this.

Second, it becomes a law against honest people, who spend their lives diligently trying to submit Form X and Signature Y and Document Z (and forgetting or losing stuff, as you did). While those trying to get round the system will lie about address, borrow or steal other people's cards, pretend to have had their handbag stolen, etc.

If you say no treatment without a card, you deny treatment to entitled citizens who really have had their handbag stolen or their house burn down, or have forgotten to post something like yourself.

If staff use their discretion, this makes medics immigration officials. You don't need a crystal ball to see that "discretion" will act differently on white people with an apparently British accent than for, say, brown people with a Pakistani accent.

And so on.

Every single way of trying to police this is difficult, resource-consuming, expensive and prone to error, appeals and legal costs, and to injustice and serious harm.

And for what? To not give healthcare to people who then end up in A&E anyway with preventable complications.

We have not spent the last 60 years "papering over the cracks" by declining to go this route. We made an active decision to spend the money on providing healthcare, not depriving people of it.

Parsing you are misquoting me - I said that without a proper review of a future long term view of dealing with a global world any fix would be papering over the cracks. I did not say that referred to the current system.

I also didn't say that people would be turned away without a card, there are still many ways people can identify themselves via a computer system, NI number etc.

After a spell in hospital this year I had far less admin and waiting around that I had in the UK as systems were far more efficient. My aunt is an NHS ward manager and I am very aware of how often she bangs her head against the wall with unnecessary admin.

And why wouldn't the majority of responsible adults be able to manage changes of address either online or at their local government office. If people realized the importance of it? It almost sounds like you have absolutely no faith in the people of the UK to manage a simple process. 95% of the population pay and register for a TV licence with little issue, so why wouldn't they support a scheme that would bring benefit to them, won't cost them anything, and save the country money in hospital services?

Nice Tabard - Switzerland does not - it has private healthcare.

I know I pay less because my entire healthcare monthly insurance bill for my family, plus my "pillar" of contribution towards supporting disability and unemployment is less than my total NI & tax bill was in the UK, when I was on half my salary. So I am definitely paying less into it here.

Don't get me wrong, I was a staunch NHS supporter when I lived in the UK. But this is a system with a principle set up at a time where current lifestyles couldn't have been foreseen. There are other countries in the world with public and private systems working well, advancing and improving. America is the extreme version of private healthcare gone wrong, the worst case scenario and the one everyone pulls up when they want a list of horror stories.

Just the same as the US pulling UK or Canadian waiting lists to scare their voters, no one ever looks into Norway, or Luxembourg for example?

Not every country works that way, and there could be a lot to learn from other countries. Not about where the money comes from - but how it's spent.

Here, no one can be refused basic health insurance, and the price of it is agreed and set by the government. Any additional extras (private rooms, alternative treatments etc) are up to the individuals discretion and budget. Hospitals are run by local government, not by private healthcare companies. No one is turned away at point of treatment, but they will be billed if they don't have cover.

If the UK government recognizes that migrants, visitors etc are not entitled to free treatment, and need to police this, they are going to have to put in some kind of administration system to police it. There is no other way round it. Everyone can argue about what is right and isn't, what is costly and isn't, but no one else has actually had a guess or suggested other ways of doing it that work on this thread!!

Look on the bright side. At the rate the NHS is deteriorating more and more health tourists will be looking for a safer place to visit with shorter waiting lists, where wards are cleaner than public toilets and where staff don't need remedial training in hand-washing.