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A confidential internal report on health tourism estimates that the bill for treating foreign patients amounts to at least £62 million a year, The Times has learnt.
The figure is “bound to be an underestimate” since new rules intended to prevent the abuse of the NHS by foreign patients are being ignored, according to the report.
A survey has found that NHS managers are failing to ensure patients are asked to prove their eligibility and are chasing only around half of the debts owed. The findings suggest that taxpayers are picking up hospital bills for foreign patients that come to more than £30 million a year. Some of the £62 million is paid back by the patients.
The Government promised a crack-down three years ago. Hospitals were told to charge patients who were found not to be resident in Britain or from countries with reciprocal arrangements. John Hutton, when he was a health minister, said in April 2004: “I expect trusts to make enforcement of the regulations part of their core business.”
Ministers have repeatedly refused to answer questions on how much health tourism costs the NHS, claiming that statistics are not collected on the number of patients treated who are not entitled to free care.
The scale of abuse was estimated internally following the introduction of the new regulations. The Department of Health last week lost an 18-month battle to suppress findings of an internal report when they were released to the Conservative MP Ben Wallace under the Freedom of Information Act.
In addition to the first official estimates the documentbears out previously anecdotal suggestions that maternity and HIV services are being targeted.
“Maternity . . . was frequently mentioned as an issue,” the report states. The problem uncovered by the survey, carried out in late 2004 to early 2005, was so acute that officials suggested that the Government contacted air-lines to ask them to prevent heavily pregnant women from flying to the UK from Nigeria, India or Pakistan.
Treatment for HIV was “widely recognised to be a problem area” with cli-nicians “hostile” to the idea of charging foreign patients. Department of Health officials found that the manager responsible for checking eligibility “was not welcome” in one hospital’s HIV ward. “We are currently being criticised by the the Terrence Higgins Trust without actually charging many people or collecting the money,” the official notes.
Last night a spokeswoman for the Department of Health said that it refused to accept the findings of its own report, insisting that it was based on a sample of only 12 trusts. She claimed that the “situation is much better than it was three years ago” but conceded that the department could not produce figures to prove it.
She added: “We are in the middle of a review with the Home Office, which is looking at tightening up enforcement of the regulations.”
Mr Wallace, who uncovered the report, said: “This Government is conniving at a ‘Don’t ask, don’t charge and don’t chase’ policy that is leaving the NHS wide open to abuse.”
Foreign bodies
36% of money received from overseas patients is for maternity care
50% or more of the £62 million worth of treatment on overseas visitors is not recovered
75% of foreign patients are not charged in most hospital trusts
25% are from Africa
20% are from the Indian subcontinent
18% are from North America
Source: Overseas Visitors report
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Unlike about anyother health system in the world , the NHS functions on a "no charge at point of treatment" basis. This means the it is assumed that there will be no bills. In all other countries that I know of ,no treatment is given unless the method of payment is clearly established. Any available refunds can be worked out later. We have no system to charge people and nobody actually working in the NHS actually suffers if a bill isn't paid. Rather we all suffer as the NHS is so expensive.I have never managed to get free health care in any country overseas and most people arriving here expect to be given a bill for medical care, except the ones who have worked the system to their advantage. The recipricol arrangement is a joke on the whole and many people are "resident" in more than one country, having resident status doesn't mean that you pay taxes or national insurance. We need to establish a system in this country whereby people, all people need to prove entilement to treatment.
Alison Lennox, Newport, Shropshire
So if I buy alcohol and pay taxes Mr Cameron suggests I shouldn't be treated as I drink booze. However I fly into Heathrow and go straight to the nearest hospital and will be given expensive drugs and treatment immediately without any checks! wow the workers in the uk really are the lowest class of citizen these days aren't they
Anne Murphy, London,
This statistic is meaningless unless the value of care for British nationals overseas is given: I don't imagine that a friend of mine who went to France for the higher standards of cancer care can be the only one.
Anneka, Cambridge,
Earlier this year Prody of Italy sanctioned by the EU set up an agreement with muslim countries that has enabled this to happen more and more,
For the government to say that they will tighten up the rules is just another downright lie!
They at Westminster are fully aware of this agreement.
Paul perhaps their own countries should spend less on arms!
Taxes paid here should be used for the people that reside in the UK.
Veronica, Doncaster, England
I left England two years ago and earlier this year I fell ill when visiting family. I called the doctor to see if they were able to see me as a private patient. I no longer pay tax in the UK so I should not be able to receive free healthcare. I got an appointment and attended. Upon leaving I had a script and tried to pay for the appointment. I was told I was entitled to free healthcare because I had a British passport. I again refused and asked for an invoice. I then went to the pharmacy to fill the script and told them that I no longer live in the UK. They told me that is was no problem and I should pay the NHS rate. Again I refused and I paid private because I have a conscience.
We already have the NHS card system. To register with a Doctor you have to produce it. If someone is not registerd with a Doctor they should have to provide this card to recieve care under the NHS. If no card the patient has to pay before treatment or show they have travel insurance to cover their bill.
Britchick, NYC, USA
Before foreigners are even looked at by NHS etc their "right of abode" should be scrutinised. If they are not residents don't give them even an elastoplast but send them on their way to their own countries. This country is so gullible and never query outsiders believing that they wont "try and pull the wool " over our officials but are hard on their own citizens. Every citizen should have a chip inserted within our bodies which states who we are and gives information on our status etc. This will cut out the chancers who are arriving daily to bleed our legitimate citizens of their own benefits. No one gets help in Pakistan, India or South Africa if you are a tourist so why should we start here. Deposits have to be "put up front" before these countries will even look at you.
bugsy, Burley-in-Wharfedale, West Yorkshire
I am really pleased and comforted that the British taxpayer is supporting the welfare of immigrants, both legal and illegal and citizens of EU countries where the benefits are less than in Britain. Maybe though the situation would be different if the decisions were not made by those both financially and socially very comfortable, because of course it is always those without who have to go without more. Another comforting thought is that Bob Geldorf and his kind only see poverty outside the British Isles, although maybe in his case it is a matter of supporting anything not British. It makes be wonder what has changed since Dickens times? Of course the comments of Graham of Leeds were most reassuring.
Jean Elaine Seaman, Vienna, Austria
Don't forget all the UK nationals who retire and go to live abroad; but come back for NHS treatment that they are not entitled to any more.
C Ferguson, Glasgow,
So that would make the "problem" worth about 0.04% of the annual £75bn NHS budget then? I'm sure recovering that would make an enormous difference to the quality of care we all get.
If maternity care is so bad in other countries that women are so desperate to come here, perhaps we should be spending more money as aid to improve health services overseas, instead of buying bullets and missiles for Iraq.
paul, Glasgow, Scotland
Mad Britain. No wonder we can't afford quality doctors anymore. The good ones are off to the USA and potentional students for medicine are not encouraged. We need new and better politicians running this country!
Eric Price, Lichfield, Staffs.,
Who will count how much Britain saves on those Eastern European workers who fly back home when they are ill even though they pay taxes here. I am petrified to go to NHS here.
Lithuanian citizen, London, UK
News like this just confirms my view of politicians selling their soul for the votes of immigrants. One can only hope they end up living in the high tax ghetto they deserve.
NN, Plymouth, UK
The sick joke played on ex pats like me is that at the age of 62 after paying NI contributions for 40 years, I don't get health cover in either Britain or Spain. I have to wait another 3 years before the UK will deign to provide reciprocal health cover with the Spanish authorities whilst giving it to all and sundry that arrive in Britain without paying a penny.
Mike, Alicante, Spain
Perhaps if the system were more stringent then there might be funds in the kitty and staff in the wards so that my father-in-law could have some simple treatment in readiness for the heart surgery he urgently needs. Instead he has been told he will definitely be treated within 20 weeks- if he has got that long, after suffering for months already.
CB, Essex,
As a British citizen,resident in Australia, I was recently visiting England. I was denied any NHS services for a severe infection and had to be treated as a private patient and purchase medicines with private presecriptions. Any questons regarding reciprical arrangements with Australia were ignored. So who are these people getting the free services? Certainly not me!!
Simon Foster, Melbourne, Victoria, Australia
When any of us travel to any part of the world, even within the EU and more especially now in France, we have to take out medical insurance and are warned, even by our Foreign Office, that we must do this to ensure that medical bills will be covered. Why on earth this and previous governments find it hard to insist that health tourists have insurance policies before treating them I have no idea. We must re-enforce the fact that this is the British Health Service and not the World Health Service unless of course a country clearly indicates that there are full reciprocal arrangements in place for British visitors to their country.
Kenneth Armitage, Suffolk, England
Why would the Government care about any of this? Hasn't it been their policy all along, to throw money at the NHS and then shrug their shoulders when people want to know what has happened to their taxes? It's almost as if the Government's involvement in anything is miraculous! All you people who expect efficiency, stop expecting.......it will never happen under this Government.
Judy , Liverpool, england
It's nice to know that If I'm ever in the UK visiting that my medical expenses would be picked up by the kind and generous subjects of Great Britain.
64 million pounds is a pittance. How much is the budget for health care in GB? Does this even amount to 1%? I have insurance here in the US and I have no idea how it would compensate GB for any incurred health care costs. If I'm sick I go to see my doctors in my country. I have no reason to hop a flight across the pond for treatment. You would think that it would cheaper for all these disparate "health tourists" to stay home and receive care at home..
Paul Bahre, Granby, CT
6.6 billion pounds spent in iraq and afghanistan and the cost of keeping the royal family and the corrupt politicians.
this is why nhs is where it is now.it is not 62.5 million.the problems are elsewhere.
ebbi, valencia,
Its always good to know where you can go for Free medical care, thanks NHS UK !
Trevor, Raleigh, USA, NC
In 2002 a Commons report estimated the cost to the NHS of obesity in England alone stood at £500 milion. The cost to the economy was estimated at nearer £2 billion. Considering the main cause of obesity is over-eating and getting too little exercise I'd have thought this should be considered much more of a needless drain to taxpayers money.
Rod Munch, Northampton, UK
A fairly recent incident in Spain showed how they manage to confirm eligeability before treatment it was thorough and all embracing. Confirmation of identity and membership of a reciprocal agreement was carried out at point of entry to the hospital. Presumably failing the check would have meant proving the ability to pay. How come we seem incapable of applying such a system?
mike gee, bournemouth, uk
Who is the spokeswoman for the Dept of Health kidding when she insists that the NHS would be able to cope with demands from tourists. HIV and cancer sufferers come to Britain as they can get free, unquestioned treatment and E. Europeans who emigrate here and have worked here a short time can and will bring their relatives here. This will include their elderly and sick relatives who will definitely overwhelm the NHS. Yet again the indigenous population of this country will be taken for idiots and expected to say nothing when they are at the back of the queues waiting for the treatment that they have paid in for most of their lives only to see non contributors reaping the benefits for which they havent contributed. Its obvious the health tourism and immigration from E. Europe position has not been thought through properly by the politicians and civil servants. Its time the British people were put first in their own country. How much longer are our politicians going to walk all over us?
Ida Letugo, London, uk
Ah, the UK is now experiencing the same crisis as foreigners flock in for medical services. Just as the US is facing a crisis with free medical care for illegal immigrants jeopardize the existence of hospitals who cannot, by law, turn them away, but cannot get any compensation. Who must bear the burden? Every American who has health insurance, for the hospitals must pass the costs on to someone!
Bob Evans, Anaheim, California
It depends on what is classed as overseas and to which country tax is paid. I pay almost all my tax in the UK but do not live there. I am in the British Isles and can see no reason why I should not have NHS teatment. I give my address unlike some who use a UK address and live as far away as America.
Foreigners should not be permitted to have NHS treatment without payment if they do not pay the majority of their tax in the UK. If they do then the situation should be diffierent.
E Trevor, St Helier, Jersey
The tip of the iceberg is revealed. What about the "visitors" who receive organ transplants? Investigate Leed trust. It would be very revealing to publish regional figures of uncollected debt- perhaps showing correlations with Health authorities who are in the "red".
dalesman, leeds,
Only 18% from North America?? I wonder how 'doctored' these figures are. The simple fact is that Americans have been coming her to have their babies for many a long year. I met one back in 1967 when I was having my daughter. She said that they could come here and have a holiday as well as giving birth and it cost no more than their maternity care in the USA .
Joy Gibbs, Fleet, UK
The HIV treatment centres are treating many Portuguese patient's who cannot get the drugs at home.
When I had to have medical treatment in France, I had to pay for it, and claim the money back with the E111 form. [I think that was the number!]
Why can't people from the EEC be made to pay for their treatment, and claim it back from their governments?
There has always been a steady trickle of abortion cases coming over from Ireland to get treatment that was unavailable to them.
While our patients are refused modern medicines because NICE says we can't afford to treat them, people are coming here and costing NHS money which should be spent on people who have paid into the system.
Pity we can't refuse entry to the UK to anyone unable to produce 2 things. 1) a clean bill of health, and 2) Medical Insurance.
Beryl, WINDSOR, England
So what's new?
Our "representatives" in Westminster have resolutely been closing their eyes to these abuses of the welfare state for the last fifty years, and crying down anyone daring to mention such things as (predictably!) "racists" etc.
Brian Clacey, Croydon,
Working as a paramedic in West Yorkshire we often get 999 calls from Leeds-Bradford airport for foreign nationals who have just landed with chronic problems that need treatment.
I personally have been on a 999 call for a man who went see his family doctor in Pakistan, was told he had broken his arm and flew here to get treatment!
Graham, Leeds, England