How much do visitors and migrants cost the NHS?
The use of the NHS by visitors and migrants brings together two of the most highly charged topics in British public life. However, the true costs of providing healthcare for visitors and temporary migrants, or even just the scale of losses and ‘health tourism’, had been extremely difficult to estimate. The Department of Health (DH) therefore needed a realistic estimate of the cost to the NHS in England of spending on services for those who are currently eligible for free NHS treatment but may be liable for charging in the future and also those who are currently not entitled to free NHS care. Prederi were commissioned by DH to estimate these costs as part of the ‘audit’ announced by the Secretary of State in July 2013. The report was published in October 2013.
The work needed to be done at pace, ready in September 2013 to be published with other evidence, and robust enough to stand up to politically biased public scrutiny. Putting together a team of a Consultant in Public Health, a public sector costing specialist and a modelling expert, Prederi carried out a top-down analysis and, for the first time, came up with a comprehensive view of the costs of visitor and migrant use of the NHS in England. The Department arranged for peer review of the Prederi results and reports. The work combined a research review of the medical literature, analysis of health costs and charging processes, and modelling large quantities of data from the Census 2011, the International Passenger Survey and Home Office immigration statistics. The modelling broke down types of EEA and non-EEA visitor and migrant, by age and gender, for each country for which there is sufficient data (about 40) and for regional groups of countries for the remaining 160 or so nations in the world. The understanding about propensity to use the health service is mapped on to these nations or groups, informed by our analysis of the data and our research in the medical literature. Additional analyses were undertaken for irregular migrants and ‘health tourists’.
The Secretary of State for Health announced the results on 22 October, saying that the work was the “most thorough research there has ever been” in this area. The statement also announced the establishment of the Cost Recovery Programme in the NHS. This is tangible evidence of a shift of the debate from preventing ‘health tourism’ to how best the NHS should recover up to £500m a year. The DH Cost Recovery Programme and other reforms have already generated well over £100m extra revenue for the NHS. Prederi’s work for the Department of Health was shortlisted for the Management Consultancies Association Awards in 2014.
The report has subsequently been used by Full Fact and others to check on assertions made during the General Election in 2015 and during the 2016 EU Referendum debate.
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