"The whole agitation has a nasty taste" - Nye Bevan on so-called 'health tourism'

As the government announces that NHS staff are to be issued with card readers to take payment at hospital bedsides, from anyone who can't prove their eligibility, it's worth re-reading NHS founder Nye Bevan's discussion of the 'health tourism' issue.

6 February 2017

"One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes.

No doubt a little of this objection is still based on the confusion about contributions... The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain.

How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody.

Happily, this is one of those occasions when generosity and convenience march together. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to arrive at an approximate estimate. All we have to do is look up the number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year. Obviously this is an overestimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is. for what it is worth and you will see it does not justify the fuss that has been made about it.

The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine."

OurNHS editor Caroline Molloy writes:

The quote above is from Nye Bevan's chapter on the NHS in his classic book, In Place of Fear.

Clearly both NHS costs and the number of foreign visitors have increased since - but interestingly the ratio between the total cost of the NHS (£110bn) and the actual cost of visitor treatment that isn't recouped but could be (£40m), is roughly similar to the ratio set out by Bevan above. 

Today's proposal to charge foreign visitors upfront, with card-machines by bedsides, before they receive healthcare, is just the latest in a long line of policies to restrict migrant access to healthcare. 

There’s at least five reasons these plans are a bad idea:

1. Migrants (who are largely young, active and healthy) contribute far more to the NHS as employees and as people who pay taxes than they take out of it in care. Already the migrant staff the NHS depends on on a daily basis are beginning to leave, fed up with a government set on migrant-blaming to distract from wider problems with its mismanagement of the NHS.

2. Not treating non-emergency patients because of where they come from is not just medically unethical – it’s likely to store up public health crises. Germany reversed a policy to charge low level fees for seeing a doctor, when it found that people just became sicker and more expensive to treat as emergencies in the long run.

3. Administering all this increased charging of visitors is likely to cost more than it saves. Northern Ireland have significantly rejected such moves on these grounds. How much will card readers by the bedside and an army of enforcers, cost? We've not been told.

4. Crucially, moves to charge visitors are being used to normalise charging for NHS care, and introduce mechanisms such as card-readers to do so. It’s a well trodden political strategy to start with certain, politically unpopular groups before rolling a policy and enforcement out to other groups and eventually to everyone. Already some have already suggested charging fat people and smokers for NHS care – and both groups are already being blanket refused NHS treatment in Yorkshire and elsewhere, for non-clinical reasons. And already, members of the House of Lords are quietly talking about introducing charging for everyone, in 2015 and now again in a more recent Commission currently underway.

5. The problem of 'health tourism' is totally overstated – a distraction from government mismanagement of the NHS. Rather than fuss about the small amount of money spent on health tourism, why is no-one talking about the huge sums of money politicians are wasting on their ideological fixation on running the NHS as a 'market', adding a multi-billion layer of bureaucracy - that achieves nothing apart from allowing the private sector to nab the bits it wants?


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