Charging for the NHS puts everyone’s health at risk

The Tories are going for increasingly tabloid friendly policies that will sound like a good idea to Daily Mail readers, but ultimately achieve nothing, other than pour more fuel on the fire of xenophobia. Take their recent announcement that foreigners will have to pay for NHS services up front.

Certainly no doubt the NHS is chronically underfunded and over stretched. Nine out of ten UK hospitals is overcrowded at the moment and the country now has the shortest GP appointment times in the world.

So how much could this save the NHS? Well foreigners using the NHS fall into two categories. The first group are what we’d refer to as “health tourism”, where someone enters the UK for the expressed purpose of taking advantage of NHS services. This costs the UK between £110 – £280 million. The second represent more “normal” use of the NHS, where say a Spanish tourist breaks his leg and has to go to A&E. These costs amount to £1.8 billion per year. However it should be noted that probably only about £500 million is actually recoverable or chargeable.

The bulk of those being treated in this 2nd category are from European countries (or Australia) where the UK had reciprocal health care agreements with those nations (e.g. if a British pensioner or tourist needs treatment in Spain they get treated). Individuals nominally resident in the UK (e.g. students or those in employment) are generally exempt from NHS charges. Of course these conditions may not hold post brexit.

Note that the patient in this second group may not have much choice that they get treated in an NHS hospital. An American tourist who collapses in the street, a passenger who is taken ill on a transatlantic flight. So recovering costs from these people “up front” would likely be impossible.

Adding it all together, the NHS can recover (or avoid spending) between £610 – £780 million per year. That sounds like a lot, until you realise that the current NHS budget is about £120 billion, out of the £145 billion the UK spends on healthcare. So at most 0.65% of the NHS budget, or probably more realistically 0.3% of the UK’s total health spending. Even the infamous NHS funding gap of £30 billion, cannot be plugged by such charges, meeting barely 3-4% of this deficit.

The simple fact is that charging foreigners for NHS services will not solve anything. Yes it is unethical for someone to get on a plane and go to the UK intentionally to use NHS services, but its hardly a crippling burden and this represent a tiny fraction of those using the NHS. Trying to recover healthcare costs from them would be a drop in the ocean compared to the money spent treating UK residents.

And one has to consider the consequences to such up front costs. The government is talking about putting sick people in need of treatment out on the curb, or perhaps detaining those who are given emergency treatment and putting them in the equivalent of a debtors prison. We are talking about going against every principle the NHS was founded on, sinking the UK to Dickensian levels. Yes the Tories are going to turn the clock back post-brexit to the 19th century.

 And what’s the bet that the Tories will float off the unit responsible for this treatment and sell it in the private sector? Remember, many in the Tory party want to privatise the NHS (and they’ve been quietly privatising bits of the NHS), so one does have to worry if this is merely the first step on a slippery slope.

And worse, what happens, as I considered in a prior post, if a foreigner comes down with some sort of new virus or infection. Stopping any pandemic requires swift action, you need to get that person to a hospital as early as possible. Outbreaks have been avoided where healthcare could be given swiftly to the patient zero and a cordon put up around those inadvertently exposed to the virus. However, in other cases, where such action wasn’t taken (generally because the patient zero didn’t get treated swiftly enough), the virus has spread around the world with frightening speed. Consider that the bulk of the deaths related to the SARS outbreak of 2002, can be attributed to a single sneeze in a lift lobby.

So this policy will not help plug the NHS funding gap, it will be a drop in the ocean. Refusing treatment is not only morally bankrupt but puts the health of everyone in the country at risk. And it is being done purely to the benefit of the Daily Mail reading UKIP types.

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