Xenophobia and health policy

Today the government have announced that they are thinking of charging non-EU visitors to the UK £200 a year to access the NHS, or tell them to take out private health insurance. We are told that this is to address ‘health tourism’ and Jeremy Hunt says he is ‘determined to wipe out abuse in the system’. The Department of Health doesn’t really know how much of a cost issue this is, but seem to be giving what is a guestimate at about £30M a year.

So, let’s ask two questions. First, why is this a problem now? Second, what is the government planning to do about it and does it make any sense?

Why is health tourism a problem now? Let’s be honest, it isn’t really. £30M is a lot of money, but is less than 0.3% of the NHS budget, and actually, we have no idea whether the problem is this big because we really don’t know. So if you are going to change government policy, wouldn’t you want to know how big the problem is first? It’s a pretty difficult research issue (I’m supposed to be good at designing research and doing any kind of good research in this area seems pretty fraught to me), but surely some attempt needs to be made to whether this is actually a problem before you spend time and money trying to fix it.

And so this isn’t really about health tourism (or whatever we want to call it) being a problem now, it’s about the government playing to supporters who are keen to show that it is being tougher on foreigners, or perhaps, if we are being cynical, about them trying to distract from the latest NHS reorganization fiasco (take your pick, but the news that there continue to be major problems with the ‘111’ telephone service is the most recent).

Given this isn’t really the most pressing problem (or perhaps even a problem at all – we don’t know), asking what the government plans to do about it, I’m afraid, makes things even sillier. Now in immigration I can see how we can charge people who plan to stay longer than six months, and don’t come from the EU. It won’t be terribly popular, and we already have a pretty awful reputation with many overseas visitors (many of whom, like students, bring in lots of money), but this is just about viable provided that immigration services ever get the resources they need and raise their competence levels (too big ‘ifs’ there).

But then, how are we going to check whether people should be receiving NHS services or not, and then, how are we going to charge people who aren’t. Checking people will fall to health professionals, and frankly they don’t have the time. GP consultations (where most health appointments occur) are already short, and most surgeries don’t have the facilities to be checking people for their immigration status on the way in or out. So we are going to have to invest in new systems and possibly new staff – and they won’t come cheap. And are we really going to refuse people who don’t have the right coverage or can’t pay?

Then we will have to charge people. That’s going to involve investment in new systems, and possibly credit control and debt collection. Again, that’s going to cost money.

Now really, are all these new systems we are going to need to check people and charge them, when applied across the whole country, going to cost less than the guestimate abuse of £30M? Doesn’t seem likely to be me. I used to work in credit control (no, really), and it takes a great deal of time and effort. Don’t the government realise this?

So in all, we have the government making a lot of noise about a problem we don’t know is a problem (on cost grounds), and which will probably cost more to implement than the funds it can raise. This isn’t about saving money – it’s about playing to xenophobia.


One Response to “Xenophobia and health policy”

  1. No borders, no nations, no user charges | The Academic Health Economists' Blog Says:

    […] can’t fathom a moral objection. Xenophobia might be to blame for the recent policy proposal, but I’ll leave it to others to try and […]

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