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?

jollysanters from the wiki here it looks to be a similar system to france with universal coverage paid for via a compulsory system, with insurers unable to differentiate on price due to age, health etc and not able to decline. The true private element looks to be the optional top-up coverage.

However you want to cut it, the "private" systems in countries like switzerland & france are not actually private at all, but a method of administering and paying for a system which delivers the same goal as the NHS ie universal healthcare.

The fact is that the WHO put France (which sounds like a similar system) in at no 1 in the world when they did their study. However the costs for us to switch to that would need to be very carefully considered before changing wholesale in the UK. Is there really a need. Not sure.

I also think that your method of comparing costs is not quite right. You assume that because you paid more in total tax and NI in the UK, that a lot of that contribution was for healthcare, mentioning only unemployment and disability benefits otherwise. The UK and Switzerland are very different countries though. Switzerland has a tiny population compared to the UK, and I would guess a quite different population demographically, on various measures. It has a very different approach to tax in general I would imagine (being the world's most famous tax haven) and also think about something like the armed forces, a quick wiki tells me that UK armed forces cost us 2.5% of our GDP, while Switzerland spends 0.9% of it's GDP. I think that the situation is probably a bit more involved than concluding that due to your relative tax situation, the cost of health for you and your entire family in Switzerland is more than it was to you in the UK as a single person. Most of the money we pay in taxes goes to paying old age pensions, AFAIK, did you factor that in? That sort of thing. Do you see what I mean. I have no doubt that the swiss system is perfectly reasonable, as are the ones in the UK, France, Germany etc based as they all are on an idea of a universal healthcare system.

Overall I think that ideas to improve the NHS should of course be welcome, but many on this thread have said "what do america do, let's do that" when that is the MOST expensive system in the world and the results are terrible. And the idea that people in dire need of help should be "turned away" if they, what, look a bit forrin (people haven't really explained how that should work) is just really distressing.

I mention the disability and unemployment because they are separate "pillars" - so I know exactly where my social payments go here as I pay into separate pillars.

Similarly last year the UK government produced budget breakdowns in the UK for the first time - I would probably earn around 50k there, and last year they said on 50k £2500 of your £14000 tax bill was spent on healthcare.

As a percentage of my expenditure on healthcare here (including social payments for those who can't pay their healthcare + my own private payments) I seem to pay out less and receive a more efficient service, with all the admin IYSWIM?

Completely agree about not going down a US route though, god no. Unbelievable that a country that considers itself to be the most civilized in the world seems to support such a barbaric institution, where doctors become doctors to become millionaires and people are thrown out I hospitals due to coverage.

Switzerland isn't perfect, there is a lot of small print. It's no wonder France came out on top. Infact the French-Swiss have been battling for years for a more similar socialist healthcare system.

People laughing at liaison officers and childcare assistants being paid for though - happens in France through their healthcare too!

Did you look at the WHO rankings from 2000? Teh wiki says the measures they used were contraversial, but it's still interesting to look at:

here

When I took my son to A&E one night (in NW London) the room was covered in posters in reception about obligations to pay, no right to claim if from abroad etc so I assumed we were already doing it. They seemed very hot on the topic at that A&E department. They asked at the counter where you lived too. I think I heard some people being told they may not qualify.

There was that African lady who came here to have her 5 babies I think at once as she could not afford treatment in Nigeria.

We could require as part of the VISA for entry to the UK people to put up a financial bond or produce a credit card against costs of state services whilst here. We could pay nurses or others say 20% of what is recovered to make them happy to take on some extra work in their own time to recover the monies.

Me and my dp were in the UK last week.

Dp unfortunately needed treatment for a broken bone in A+E.

Dp is not British, we don't live or pay tax in the UK.

The hospital had many posters stating that people living outside the UK were not entitled to free nhs care.

We informed the receptionist at arrival that we didn't live in the uk, she said just write down the address where your staying, so we did as dp was in lots of pain.

When dp had been treated we asked how we could pay/fill out forms so the nhs could claim back the money. The Dr looked confused, called the receptionist over who had no idea what to do, they then said to us to just leave and we didn't have to pay.

They have my dp's name and the address of where we were staying, that is all, they didn't even ask which country we live in or ask to see any ID.

I think the nhs need to work on a system to actually take payment from those people willing and ready to pay for treatment before they do a daft poster campaign and make empty threats.

when my relative was in a hospital with a broken bone, the foreing office was very quick (=same day) with the ehic forms.
but they were inpatient, requiring an operation and staying in 2 weeks in total until the travel insurance was able to sort out transportation.

I can't understand why they have to make things so complicated. We all have an NHS number, we should use it. If we don't have one we should have to pay for healthcare. Same as getting on a bus without your oyster card.

It has always been the case that foreign nationals don't get free healthcare, they just don't get asked or charged. Having a simple rule will make a huge difference. Payment should be made by credit card and if they haven't got that then they should be turned away unless it is a matter of life or death.

The difficulty lies in accurate charging - but if other hospitals around the world can do it why can't ours?

Frontline services have a severe aversion to form filling and accounting for the work they do. This is understandable as they are not accountants or business people in fact it is anathema to the skills that they have.

So the NHS bosses need to get their thinking caps on and find a way of making this work well for the staff that they have. They have trained receptionists that can fill in forms and look up your name and address, no reason why they can't do this task.

A&E should always be an exception, you can't quibble when someone's life is in danger but if you're not stretchered in you should be registered.

Sorry OP, but did you mean migrants or visitors?

Because honestly I wouldn't like to be stripped of free NHS healthcare after years I'm here only because I've no British citizenship yet, I pay the same taxes as every Brit does.

And by the way, with the EHIC card you can have emergency services for free in the countries that have agreements with the United Kingdom.

I don't know what the answer to this is, but I can tell you what happened to me when I was pregnant with twins a few years ago. We live close to a major airport, which is relevant. I had contractions very early, at a time when the babies would have struggled to survive. I went to the local hospital and was told that there was only one incubator available, and that if the babies were born, one would have to be taken by ambulance to the nearest hospital with an available incubator, which was an hour or two drive away. Obviously, this would have greatly reduced their chances of survival.

Luckily, it was a false alarm, and when I did give birth a few weeks later there were two incubators available and my children were fine.

They were in the special baby care unit for a few weeks and, during that time, I chatted to the nurses about the shortage of incubators etc. and was told that a significant problem was caused by women coming from abroad to have their babies here. It seems that some women who know they are likely to have a problem with the birth, or who are aware that there are issues with the health of the baby, come here looking for the best outcomes at no financial cost to themselves other than the airfare. They were arriving at the airport and going to the nearest hospital.

I can't say that I blame them, but I'm not sure I would feel so generous if I had lost one of my babies because a health tourist was using an incubator I help pay for through my taxes.

I think people coming here who are not entitled to free medical treatment need to show proof of medical insurance before they come in, especially if they are obviously pregnant.

themuse - so are you suggesting that women who don't have proof of medical insurance should end up giving birth unassisted in some room in the airport and the children born by such women not receive any medical assistance and potentially left to die? Really?

I'd be interested to see the hard figures, how many babies are prematurely born to just arrived immigrants - and not what's allegedly claimed by a xenophobic nurse.

This country has to fall in line with other countries. If they don't offer free healthcare to everyone I don't see how this country can possibly offer it free either. Presumably in most countries medical emergencies are dealt with but a bill is payable afterwards.

VivienneMary - people who do not fulfill the criteria for entitlement, namely residency, can get charged.

I'm uncomfortable with the rhetoric of healthcare paid for by tax payers should not be given to those who don't pay tax - it insinuates wrongly that immigrants don't pay tax, and also that UK citizens who don't pay tax should have less entitlement.

If you begin to install tills at GP and hospital reception desks it won't be long until everyone is charged.

And the willful confusion between immigrants and tourists really pisses me off.

Widowwadam - no I'm not suggesting that. Of course not. But I am suggesting that we cannot provide health care for everyone who wants it, and we should take steps to ensure that people who come here take out medical insurance before they arrive.

I wasn't suggesting that the people who the nurses were talking about were immigrants. My understanding was that they were "tourists" and that it was not an uncommon situation. I also was left with the impression that the people who were doing this were not those at the bottom of the social pile, but rather those who knew their way around the system.

And it really hacks me off that we are unable to have any sort of sensible discussion about this without insults being thrown around. As a society, we have a problem with funding the NHS. As a society, we demand more and more from increasingly stretched services. We need to be having sensible discussions about how to tackle this.

You were left with that impression by the claims of a xenophobic nurse, not by any hard facts. If the incubator-stealing tourists indeed were not residents of the UK the trust indeed could and should charge them.

The whole idea that well off people jump into airplanes to receive free healthcare and "play the system" because that's allegedly easier is a hate-stirring myth.

Well, of course I don't know the truth of it - just what I was told. But it wasn't just one nurse who mentioned this. I also talked to a someone I knew who was a nurse at that hospital, and she said it was happening. They also talked about trying to get the money back from these people and how futile it was.

Do YOU know the truth of it, or are you just hoping it isn't true?

Oh, a nurse, and another ex-nurse. Must be true then

How about

"Within a day, however, evidence from the London School of Hygiene and Tropical Medicine and the University of York, quoting research commissioned by the government itself, showed that, contrary to the health secretary's assertions, twice as may foreign visitors pay to use the NHS as exploit free health care, while the UK is a net exporter of patients seeking treatment. Again, the government's own research indicates that far from costing the sum suggested by Hunt, only between 5,000 and 20,000 people could be reasonably labelled as health tourists at a more modest cost of £60m to £80m." source

or

"To put these numbers in context, whether we are referring to £200 million (CCI's estimate), £20 million (the Government's official estimate) or £45 million (a figure calculated on the basis of the Government's internal analysis), we're talking about no more than 0.15% of the NHS's overall budget of £104 billion."

source

or

"Data from the UK Office of National Statistics International Passenger Survey (IPS) suggest that more people leave the UK than visit for medical treatment. IPS data indicate that a large proportion of those entering the UK for medical treatment are from within the EEA, British expatriates, or those intending to access treatment privately either in the NHS or in private hospitals, contributing resources to UK health services and the economy more generally."

source

WidowMadman

Good posts! And yes I don't like the confusion of the OP between visitors and migrants either.
It makes people assume migrants don't pay taxes! People consider you as a migrant even after years, yet we pay taxes as soon as you start work.

Okay, I wasn't going to come back on this, but I did look at your links and found them interesting, but not in the way you might imagine.

Before I go onto that, I would like to say that by the time I had read through the thread & was about to post for the first time, I had forgotten that the title referred to migrants. I know the difference between migrants and tourists and I absolutely understand your indignation if this debate was only about migrants. However, I was taking about medical "tourists".

The reason I found the Guardian article interesting is that it was a reminder for me to disbelieve anything I read in any newspaper, no-matter how worthy they appear to be. The research you refer to and mentioned in the article is not about those coming here or going elsewhere for free health treatment at all, but relates to those travelling for treatment which they will pay for. There is a big difference, don't you think?

The statistics were gathered from the following sources:-

1. an analysis of the International Passenger Survey (IPS). Passengers entering the UK are randomly selected as they travel through passport control and are asked a number of questions, one of which is to define their primary purpose for travel. One of the answers is "medical treatment". So the figures are based on passengers self-declaring that they are travelling for medical treatment. Surely, it is obvious that not many of those seeking free treatment are likely to make such a declaration.

1. information from 28 Foundation Trusts about the volume and income from international private patients. So not about those seeking free treatment at all.

1. 77 UK residents who travelled abroad for treatment & 63 other UK stakeholders between March 2011 & August 2012, who presumably provided the statistics for those travelling from the UK to seek private medical treatment elsewhere.

The report is here.

At the end of the day, I have no idea how big the problem is, but I do think a sensible discussion needs to be had about it. The nurses I spoke to were concerned about the impact of health tourism on available facilities, not about the racial origin of those seeking treatment. If health tourists were either dissuaded from coming here in order to access free treatment or alternatively were obliged to pay for such treatment then more money would be available to pay for equipment /staff etc and there need never be a shortage of incubators. Shouldn't we all be concerned about that - all of us who live here?

TheMuse for the nth time: tourists (including British nationals who have settled in another country) aren't entitled to free treatment and can/should be charged.
There's no change in the rules necessary to charge tourists, the rules already allow it.

Yes, Widow, I know they can be charged. The point is that once they have returned home, it is not always possible to recover the money. If you read the thread, you will find at least one example of someone who offered to pay and the staff didn't know how to deal with it.

The law might be in place, but the necessary structures/administrative support is not. I am suggesting that we need tighter control.

No comment on the rest of my last post then?