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Migrants already ‘pay their way’ – why should they have to pay medical bills too?

Plans to charge non-EU nationals for treatment will undermine the NHS – and could force them to choose between their health and paying the rent, writes Michael Pooler

January 1, 2014
5 min read

Instead of the usual setting of family, food and merriment, this year I spent much of the festive season making visits to a hospital ward full of very sick people.

A week before Christmas, my partner went to the local A&E department complaining of faintness, blurry vision and a raised heartbeat, following two weeks of a persistent flu. It was clear that something was seriously wrong after she was admitted to the acute care unit for a series of tests, scans and examinations.

My blood ran cold that Thursday afternoon as she told me in a wan voice over the phone that the doctors believed a virus had infected her heart, causing inflammation of the wall and vastly diminishing its capacity, and that it might be in her brain, too. The heavy duty medicines needed left her intensely weak, unable to eat and with extreme nausea – a horrible sight to see a person in. It’s not the kind of thing you expect to happen to an otherwise healthy 29-year-old.

Things have gradually improved since. Although a full recovery is still far off, thankfully she is now (slowly) on the mend. This is in no small measure down to the impeccable care and treatment she has received over the last two weeks, from staff whose conscientious approach has set my mind at rest in the long hours between visiting times.

When a loved one falls seriously ill it can feel as though life is put on hold temporarily; and it is a virtue of British society that worries about paying medical bills do not add to the anxiety and stress. Yet for people like my partner, a Turkish national who has lived in the UK for around nine years on-and-off, that principle of free healthcare at the point of delivery may soon be a thing of the past – for no other reason than the lottery of birth.

A policy based on myths

Under new rules proposed by the coalition government, people from outside the European Economic Area – which counts the EU plus a few other European countries – staying legally in the UK would have to pay for some emergency services and other treatments as part of a drive to claw back £500 million from foreigners.

Nobody will be refused live-saving treatment and GP consultations will remain free for all. But in addition to a £200 healthcare ‘levy’ to be charged on top of visas, non-European migrants will have to pay for certain treatment and increased prescription fees. Hospitals will be forced to recover costs from those not entitled – which also includes asylum seekers, temporary visitors and unlawful migrants.

The government says the policy is about ensuring that migrants make a fair contribution to the NHS, as well as deterring so-called ‘health tourists’ who make short visits to the UK to gain access to services they aren’t entitled to. Legal migrants and people here illegally from outside Europe cost around £1.4 billion in expenditure annually, around half of which is currently recoverable from them or their governments. But its rationale is founded on and feeds into the popular myth that migrants take more from the UK than they give – a myth nourished by politicians and parts of the media that is poisoning the tone of political debate.

Take my partner for instance. She paid much higher tuition fees to study at a London university than EU nationals do and has since contributed to the exchequer through income tax and national insurance payments. She pays council tax, VAT and yet her visa stipulates ‘no state aid’ – meaning she is not entitled to any form of welfare benefits, except free NHS and GP services. It also effectively restricts her to self-employment, as few employers are willing to fork out the hefty sponsorship fee required to take on foreign workers like her.

‘Health tourism’?

This hardly adds up to the stereotypical image that the government is painting of a ‘scrounging foreigner’ jumping straight off the plane and into an ambulance. And yet her example is the rule rather than the exception.

Contrary to the common view of immigration as a drain on the UK economy, people arriving since 1999 are 45 per cent less likely to receive state benefits or tax credits than UK natives, according to a study by University College London published in November. Researchers also found that immigrants from outside the EEA contributed 2 per cent more in taxes than they received in the same period on average. By contrast, British people paid 11 per cent less in taxes than they received.

It’s a similar tale in healthcare. Department of Health figures show that while accounting for 4.5 per cent of the population in England, European and non-European visitors and migrants are only responsible for 2p in every pound of NHS expenditure (although this was 7p in the case of maternity services). Each year the average overseas visitors or migrant cost the NHS £690, compared with £1,730 a head for the resident English population.

Without doubt there are instances of ‘health tourism’, but even the government admits there are ‘very limited’ robust data to back its assertions of widespread abuse of the system. Cost estimates range wildly between £70 and £300 million. In the face of warnings from the British Medical Association that the revenues won’t even cover the cost of administration, ministers nevertheless appear hell-bent on driving the policy through.

The charges will inevitably hit those on lowest incomes hardest, punishing poor families and individuals entitled to little or no incapacity or unemployment benefit. A person like my partner who has long lived in and contributed to the UK could face the stark choice of paying a medical bill or the rent. Non-European migrants today, but who will be forced to pay next? If we don’t want to live in a country where financial consequences of illness can shatter lives and tear apart families and relationships, then the narrative must be reclaimed.


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