Tuesday, 3 April 2018

Health tourism and acceptable losses

From fullfact.org:

Who is a “health tourist”?

Qualifying for free NHS care isn’t based on nationality or where someone was born. It’s based on whether you are “ordinarily resident” in the UK and the type of treatment you need... The government has estimated that treating deliberate health tourists and those taking advantage costs around £100 to £300 million a year. Those are incredibly rough figures.

At the moment there are some services which, no matter whether you are “ordinarily resident” or not, you can’t be charged for. The costs estimated by the government also include these services, like going to see a GP or using Accident and Emergency. So even if the NHS charged for all the services it possibly could and received the money, it wouldn’t cover the full amount health tourism is estimated to cost.

From NHS Digital:

Hospital admissions in England rose to record levels last year, with 16.2 million admissions during 2015-16 - up from 12.7 million ten years ago.

OK, so let's assume the NHS starts doing identity checks on every single hospital patient to deter  health tourists. Firstly, it will lead to some unpleasant situations where somebody is a bit old and doddery and simply can't produce a passport or driving licence etc, what are they going to do, turn them away? I doubt it. Leave them in the waiting area while a relative is despatched to try and rustle something up?

I can easily imagine that this will add £20 to the cost of a hospital visit. Some officious person will disappear with your passport and council tax bill for ten minutes just to check they are legit (i.e. have a nice cup of tea while you're waiting).

Cost of weeding out health tourists = 16.2 million x £20 = £324 million

Upper end of estimates of cost of health tourism = £300 million.

So, as unpalatable as this may sound, it's cheaper just to accept it.


mombers said...

A huge saving that the NHS achieves is by not having to sort out billing various insurance companies, chasing bad debt, etc. Any move towards a system with more bureaucracy must be resisted fiercely IMHO. The big elephant in the room is that it is the elderly who consume more than half of the NHS budget (and growing). They get a fantastic deal, being subject to much lower taxes (no NI) on top of a nice negative tax via the state pension. Eventually we're going to have to grasp the nettle and broaden the tax base.

jack ketch said...

A huge saving that the NHS achieves is by not having to sort out billing various insurance companies, chasing bad debt, etc

Strange how the German Health Scheme (subsidised compulsory insurance) manages to cope admirably with the bureaucracy and turn a profit. Perhaps because Germany invented the Welfare state/universal medical insurance half a century at least before we did?

Penseivat said...

Last year, my wife became ill while we were on holiday in the Canary Islands, and was admitted to hospital. While she was being assessed, I had to produce her passport, EHIC card and insurance certificate, plus a €1,000 deposit as a down payment for her treatment pending assurance that our insurance company would cover the cost. After discharge from hospital, each subsequent appointment had to be paid for in advance, as did the final fit to travel certificate, without which the insurance company will not pay out. Talking to one of the administrators, the charges made by the hospital pay for, not only the treatment, but the cost of administrative and finance department. In the event, our insurance company met the bill in full and even repaid the difference in the payment of the deposit from £ to € and back again.
A similar system by the NHS hospitals and medical facilities would therefore cost the NHS nothing. Unfortunately, our PC political masters continue to insist that all medical treatment, including that given to those not entitled, should not be charged.
Way back in the 70's, there was a report of an American woman who travelled to London with appendicitis, admitted to hospital, operated on, and then flew home, it being cheaper to do this than have the operation in the USA. To the best of my knowledge, this bill has never been paid, just like the thousands of other bills sent to patients now residing overseas, such as the Nigerian having heart surgery or the Indian millionaire requiring a kidney transplant.
It is no good NHS authorities whinging about a lack of funds when they still insist on it being an international health service. Physician, heal thyself.

Mark Wadsworth said...

M, land value tax will sort that out. 'Free' NHS or free housing, one or the other not both.

JK, you are looking at this through rose tinted bandages.

The insurance companies are tightly regulated, fulfil a statutory duty and the government says what % they can dock from your salary, 14% of the first €4,425 per month plus or minus a bit, with discounts for the self employed, so highly regressive like National Insurance.

The payments are earmarked to pay for actual treatment, which is provided by competing providers at prices also dictated by the government.

The system is designed to break even, not make a profit. The only people making a profit are the competing providers, who compete on quality not price.

And the old Krankenschein system was a pain in the arse, even if the doctor knew you, you had to get a certificate of coverage from the insurers (via your payroll lady, I think, I can't remember).

So while there is far too much bureaucratic crap in the NHS, I would not assume that there is any less in Germany.

So yes, it costs more than the NHS and the service is better. Whether it's better value for money is a value judgement.

PS, you appear to have missed the point of the post. Of course there is health tourism and some people take the piss. But if it's cheaper just treating them than it is persecuting Brits who want legit treatment with some crap extra admin at huge cost, we might as well accept it.

jack ketch said...

So while there is far too much bureaucratic crap in the NHS, I would not assume that there is any less in Germany.

I would think there is more, Germans- having in all aspects of life- raised bureaucracy to an art form. Thing is in Germany it is usually , aside from the fairly archaic form of German used, a logical system ,whether it be to get a car registered or a new hip. You fill in forms A & B in triplicate ,they get you form C and with A&B&C you get D&E. Simples.

Living in Germany in the late 80s I was flummoxed by having present ID and fill in several forms every time I attended A&E. It wasn't until I returned to the UK and encountered the new improved NHS under Blair with exactly the same rigmarole at A&E that I really understood the reason for German hospital receptionists/doctor's secretaries having several years of training behind them and not, as in England, two weeks work experience on the meat counter at Tescos .

The NHS could cope with the added bureaucracy of a European style Health care scheme , if it employed European type trained clerical officers (Sachbearbeiter/Kaufmann) and accountants.

Bayard said...

£24M a year extra to keep DM readers happy? A bargain!

Mark Wadsworth said...

JK, no need to lecture me (I largely agree). I lived there for 9 years and qualified as a Steuerfachgehilfe (as the qualification was then called), final mark 1.6. I could sing the praises of their civil court system as well, but that's a few other stories.

B, indeed, I'm sure the DM readers won't mind being told to piss off home again and get their passport, driving licence and Council Tax bill, and then being told on their return that they've missed admission deadline and should book a new operation date with their GP.

jack ketch said...

JK, no need to lecture me

No lecture intended, sorry if it sounded thatway, I was just amused by the suggestion that Germany might have less bureaucracy than the UK and colour me much impressed that you (a native Brit?) qualified as a Steuerfachangestellter as I think it is now called. May I ask, if it isn't too personal, why you didn't go on to do the Fachwirt (1,6 in any Examen in Germany means you've got some aptitude)?

Mark Wadsworth said...

JK, I'm good with numbers and logic, that's independent of language skills. I did think about doing Fachwirt but then Thatcher got chucked out, I got homesick and house prices fell to affordable levels so I came back. Ended up getting worldwide silver medal in the ACCA December 1996 final exams :-)

Sobers said...

"Upper end of estimates of cost of health tourism = £300 million."

Made by people who have a vested political interest in not charging non residents for NHS services.

I know one Kiwi who was over here on holiday, got chest pains, had a complete heart op to insert a stent, went home, never paid a penny.

Sometimes its not about the money, even if the sums don't add up, its about the principle. When UK citizens go abroad, they have to pay either in cash or via insurance. When foreigners come here they get free treatment at our expense. Its just not right, regardless of the cash involved.

Bayard said...

S, Ah, but abroad they have ID cards and we don't.

jack ketch said...

but abroad they have ID cards and we don't.

.... but after Brexit.

Mark Wadsworth said...

S, OK, the "principle trumps logic" school of thought which has served us so well over the years.

B, JK, sod ID cards, but to be fair, the EHIC card system seems to work, maybe they could issue those to all, just like NI number cards? No card, no treatment? In which case, I have usurped my own post.

Sobers said...

"the "principle trumps logic" school of thought which has served us so well over the years."

We're humans, not Vulcans, and the emotional element has to be catered for in any way of organising society.
One of the most important things in all social insurance schemes is that you have to make sure that free riding actively discouraged, and is seen to be discouraged, because if people start to get the idea that their contributions into the system are being given to those not entitled to them, or who make no contribution of their own, then they lose faith in the entire system.

People who want the NHS to continue to provide free at the point of delivery healthcare should be very much in favour of making sure health tourism is stopped, because the more it continues, the more people will desire a change in how healthcare is provided, to some system that is less open to abuse.

Mark Wadsworth said...

S, in principle I agree with you, of course. Question is, do we want to roll out EHIC cards and demand they be presented before you get treatment in UK? I wouldn't mind because I always carry loads of cards with me. Others will very much mind and the Daily Mailexpressgraph will run stories every week about some poor pensioner who flunked the test and was left to die etc.

Depends what it costs, is all.

Bayard said...

"I can easily imagine that this will add £20 to the cost of a hospital visit. Some officious person will disappear with your passport and council tax bill for ten minutes just to check they are legit "

This looks like an overestimate to me. Everyone attending hospital has to give their name and address in any case. Despite the inglorious history of the NHS and IT, it is reasonable to expect that this should be able to be verified in the same time it takes to enter your details into the system which is being done anyway. At the moment the health tourists know that they will be treated, no questions asked. If they knew that they would have to impersonate a native to be treated without showing evidence of insurance cover, a fair proportion of them wouldn't do it.
In addition, even if some sort of ID is demanded in the form of an EHIC card or NHS card (AFAICR, these already exist), then the delays should only occur where someone is a) trying it on, in which case, good, the system is working or b) is old or forgetful, in which case they can come up with some other form of ID, like something that only they are likely to know, but which would already be on the NHS system. In any case, these people would be a small minority, so cost nothing like the £324M you quote.