Wednesday, 22 February 2017

Metal Nurse: Health Tourism, Red Herring.

During the whole Brexit election I got into some heated debates, especially about the National Health Service. For years and years there has been this myth that the UK was being flooded with health tourists, who would take advantage of the free care provided by the NHS. Never mind that one of the founding principles of the NHS is "Free to the point of delivery" and never mind that the whole "Health Tourist" concept is a red herring. This is generally to distract people from real problems that actually affect their lives, like austerity. Because in the last couple of years mortality rate has risen, while NHS and Social Care has been getting less funding.

It should be noted that immigrants use less services within the NHS than their British counterparts. The reason for that is immigrants (like myself) tend to be younger and healthier. Even being admitted to hospital is rarer amongst immigrants.

But let's for a moment pretend that health tourism is a problem. To do that I'll just check out some numbers... Now currently the NHS budget is around £116.4 billion (2015-2016), the best estimate that the Department of Health can come up with regarding the cost of health tourists is somewhere between £110 - £280 million. Now those do sound like big numbers, and they are. But that accounts for 0.0945% - 0.24%. Are we seriously going to worry about those numbers?  Now those are for what DoH call deliberate health tourists, i.e. those who come to the UK specifically to obtain treatment. Should they be charged, sure of course they should be and most are. But on the other side of the coin is how much they bring into the economy whilst they come to the UK for treatment. Health Tourists also bring somewhere around £219 million back into the economy, by paying into hotels, shopping, transport and suchlike. All of those are VAT'd so that gets back into the economy, and those who work in the industries get paid and thus also pay taxes. So swings and roundabouts. These are people who come to the UK for specific treatments as well.

But then what to do with health tourists from the UK? Because according to this rather interesting research published by PLOS entitled "Medical Tourism: A Cost of Benefit to the NHS" they state:
Our analysis of data suggests that the UK is now a net exporter of medical tourists. While incoming medical tourists may be less likely to declare treatment as primary purpose for their visit to the UK than outbound tourists, data over time clearly shows a greater acceleration in outbound over inbound medical tourists. Despite the variations in numbers of patients visiting different hospitals and in the income per patient, the number of medical tourists was comparatively smaller than the percentage of income generated by them (7% of patients generating close to 25% of private income). These figures suggest that non-UK residents travelling to the UK for medical treatment seek high-end specialist expensive procedures, and may generate substantial revenue. Additional numbers of patients for specialist procedures may also help NHS doctors with surgical learning curves.

But let's take a case study on one of these awful health tourists. As mentioned above I got into some heated debates with a lot of racist people regarding the NHS usage by foreigners. Their favourite story was about this Nigerian lady who came to England to give birth to four children and then left with an unpaid bill. The one issue they didn't seem to understand is that Nigeria isn't in Europe, let alone in the EU. But they also either deliberately left out details or never got around to reading the full story because their lizard brains couldn't handle it. This story has since been touted by media outlets like The S*n, Daily Heil and Sky. Talking about the horror of the cost to the common man, even the BBC headline is focused on the financial cost, as opposed to the human cost. For those who need a quick update on the actual story I'll summarise it:

Nigerian woman was pregnant with 4 children. She got told by her doctors that she'd be better off giving birth elsewhere as it would be safer for her. So she decides to go to the US where a large portion of her family lives. She gets there only to find out that her paperwork is wrong. So she has to turn back, with a stop in the UK, where she has no relations. While en-route she was taken ill. As the plane lands she is taken to hospital, where she gives birth prematurely. One child died at birth, the remaining three were taken into Intensive Care. Another child dies shortly after. The patient herself got discharged after 6 weeks. Quite frankly the headlines shouldn't be about the cost, the headlines should read about how well the NHS staff did in saving both mother and children. She didn't want to give birth in the UK. She didn't want two of her babies to die whilst in a land she doesn't know and has no one in.

But then you do have those who come to travel to the UK, because you know people like to travel. And you can't always account for if you get ill during your travels or not. Now this is where it gets a little bit trickier. Because when you are travelling in a different country you don't really expect to have to get any sort of treatment. But normal use is estimated to be around £1.8 billion, still a tiny 1.15% of the total NHS budget. And most of that can be recovered through European Health Insurance Scheme (well for now anyway). Other countries do seem to be better at claiming money back for when British tourists take ill in the EU, then the NHS. But that is more due to administration costs.

Now let's compare those numbers to something that does have real impact on the NHS. According to the latest numbers I can find (from 2012) diabetes and diabetic care costs £13.750 billion. 85% of which Type 2 Diabetes is accounted for. And this is expected to be increased to £39.8 billion by 2035/36. T2DM is largely preventable through healthier living and better lifestyle choices.

Obesity is also largely preventable through healthier living and better lifestyle choices and that costs the NHS an estimated 
£6.8 billion. Within the EU the citizens of United Kingdom have the highest rate of obesity.

Alcohol costs society as a whole £21 billion per year, £3.5 billion of those to the NHS. Again this is through lifestyle choice of those who live in the UK.

Then there's smoking. Which costs the society upwards to £14 billion, with £2.7 billion costing the NHS. Bear in mind that those numbers were calculated in 2010.

In conclusion is it really worth hounding and demonising people coming into the UK for medical treatment when the UK citizens themselves take it for granted and should we not also be as disparaging to the UK citizens who leave the country to seek treatment elsewhere? In my opinion, as a healthcare professional and as an NHS employee, the fact that people actually want to come to the UK to receive their treatment makes me proud. And it should make the citizens of the UK proud because it shows that we are doing something right.

Other sources include:

Full Fact

The Conversation

King's Fund.
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