The human cost of the ‘health tourism’ crackdown

Yet again, we are talking about the costs to the NHS of ‘health tourists’. It’s pretty clear to me that this argument is distracting from the larger debate about central funding.

People who deliberately come to the UK to benefit from NHS care cost £100-300 million per year, 0.3 per cent of the annual health spend.

Compare this to the estimated funding gap of £30 billion by 2020/21, and you have to ask why we are being encouraged to focus our attention on overseas visitors. But this is the debate we are having, so let’s duke it out.

I believe – like the UN – that healthcare is a fundamental human right. I worry about the ethical and practical implications of frontline staff being involved in determining eligibility for care.

What effects will this have on the trust underlying the doctor-patient relationship? What will we ask our patients, or stop ourselves from asking? What won’t they tell us? What will we write in the notes? What is our duty of care?

But that’s not what I will focus on in this blog. I’m going to talk money.

I get it. We work in a service with finite resources, and we ought to put systems in place to recover funds where they are due. However, we must look at what effects placing restrictions on NHS care has.

Systems to charge patients deter many people from presenting in the first place, including documented and undocumented migrants. They may not present at all, but more often, it means that they present later, when their condition has advanced further.

As a result, opportunities to apply preventive care are missed. To put this another way, opportunities to save money are lost. When patients with infectious illness present later, this increases the risk not just for them, but also for the wider population.

And to top it off, the patients who are put off seeking care include people who are eligible for free NHS care, as Dr Rebecca Farrington explained to me: “I know of patients who have been put off accessing care they were entitled to because they were afraid they would be billed.

“I know another who was pursued relentlessly by a debt collection agency for an erroneous bill for something he was entitled to for free. He had two extra consultations with me in primary care to manage the anxiety it created – this would have cost the NHS more than the £60 for which they were hounding him.”

As Dr Farrington’s experience illustrates, systems to recover costs of healthcare rely on humans, and humans make mistakes. These errors have a negative impact on patients’ health, which increases costs to the healthcare system further down the line.

This is on top of the cost of creating, training and maintaining a bureaucracy to do eligibility checks and chase unpaid fees.

I have focused on the financial aspects of the debate to demonstrate this: the seemingly axiomatic point that restricting access to care saves money is actually false.

The argument for “cracking down on health tourism” fails on its own terms. The proposed restrictions would also have a negative impact on the health of vulnerable groups, which could impact on the wider population.

Whichever way you look at it, the government’s plans are indefensible.

Piyush Pushkar is a CT3 trainee in psychiatry

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Original BMA article here…