Why an NHS levy for immigrants is wrong

This post originally appeared on Dr Helen Williams’s blog.

Jeremy Hunt has announced a consultation period for a new policy that would require a proposed bond of £200/year for the first five years for non-EU immigrants to access the NHS. He claims that this is ‘fair to British taxpayers’. This policy is neither fair nor evidence-based. Here are some of the reasons why:

1.    Immigrants already pay to access the NHS. Not only do they pay a visa fee to come, they then pay National Insurance contributions, just like the ‘British taxpayer’ to whom Hunt refers.

2.    There is no evidence of ‘healthcare tourism’ to the UK, despite government discourse. The better-researched estimates are that unpaid treatment for foreigners in the NHS costs £30-50m/year. This is compared with an annual NHS budget of around £104bn, meaning that such costs equate to around 0.15% of the annual budget, which makes the proposed levy seem like using a sledgehammer to crack a walnut.

3.    Even with the levy, the NHS would not reach full recovery of unpaid foreign debts, as an increased focus on enforcement will cause higher legal and administrative costs. Debt collection is not free.

4.    Limiting immigrants’ access to emergency services only will have the undesirable effects of sending people who could be treated easily and affordably by a GP to A&E and of people delaying treatment for conditions until they are much worse. Early treatment is effective and affordable; emergency treatment is not.

5.    The government insists that ‘Britain is open for business’, despite placing ever-greater restrictions on student visas and other deterrent policies in pursuit of the seemingly-arbitrary goal of reducing net migration to ‘tens of thousands’. The proposed levy would only apply to non-EU nationals, who already have to prove greater wealth and a secure job in a highly-skilled industry.

6.    Despite Hunt’s claims to the contrary, such a policy very much turns GPs into border agents, just as universities have been saddled with increasing immigration policing, and there are proposals that landlords should also be responsible for checking the immigration status of tenants. GPs already have to check passports and visas for every new person registering at their surgeries. Doctors now express concerns that this policy could cause conflicts with their Hippocratic oath and that it could lead to outbreaks of epidemics from untreated illnesses.This is by no means an exhaustive list but provides some of the most glaring errors in the policy proposal.

Helen Williams

Does the public really want choice when it comes to health care?

Political Studies

Political Studies is the flagship journal of the Political Studies Association of the UK and one of Britain’s longest established and most widely respected generalist journals in politics and international relations. In July 2011 editorship of Political Studies moved to the School of Politics and International Relations at Nottingham.

The third issue of the journal sees publication of research on a range of topics from video games to climate change by way of the debate over ‘realism’ in political theory, Labour’s youth citizenship programme, and the impact of conviction on policy actors. The issue opens with a paper by John Curtis and Oliver Heath that examines the impact of choice on the public’s perception of the health care they receive. 

In the last decade of incessant reform of public services in the U.K., one of the most keenly contested issues has been the question of consumer choice.  Do people really want choice (or just a good level of service) and does choice really deliver a better quality of service (by providing suppliers with the incentives of competition)? This is a topic that has been endlessly debated but often without a compelling evidential basis.

In their paper Oliver Heath  and John Curtice provide the evidence that has been so lacking in this debate. Drawing on the British Social Attitudes Survey, they find that patients do indeed value choice. But they also find that they value this choice not as an end in itself but because they see it as the means for delivering what they really value – which is to be listened to, to be involved in their own treatment and to be treated with respect. Thus, Heath and Curtice insist that ‘the widespread demand for choice is not so much a demand for choice per se as a wish to see the NHS organized in a way that will meet people’s high expectations of what constitutes a good service’

They conclude that politicians wishing to maximize satisfaction with the health service should focus not on choice but on ‘identifying the best ways of ensuring that health professionals are attentive to the needs and wishes of their patients’.

The full article can be downloaded here and is available free online until the end of January 2013.