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Raising the stakes of cost-efficiency: The NHS (Charges to Overseas Visitors) (Amendment) Regulations 2017

Raising the stakes of cost-efficiency: The NHS (Charges to Overseas Visitors) (Amendment) Regulations 2017

The new NHS (Charges to Overseas Visitors) Regulations 2017 amend the 2015 Regulations and come into effect as of 21 August and 23 October 2017.

As a consequence of the 2015 Regulations, the policy changes brought by the Department of Health’s Visitor and Migrant Cost Recovery Programme raised NHS income from £89 million in 2012/13 to £290 million in 2015/16, much of it from the Immigration Health Surcharge. However, the 2017 amendments have been intended to heighten NHS cost-efficiency even further. From 23 October 2017, NHS-funded secondary care will be required to charge in advance of treatment, based on estimated costs. Should it later be found that a patient has been either overcharged or undercharged, costs will be recovered or subtracted after treatment. In addition, it will require non-NHS organisations to charge overseas visitors. The logic behind these new additional charges is to maintain the NHS as a service to be prioritised for those ordinarily resident in the UK. The Regulations themselves create legal obligations for all NHS providers to monitor the use of its services by Overseas Visitors. The Department of Health has thus recommended that NHS bodies have a designated person, or ‘Overseas Visitor Manager’ to ensure that the new provisions are properly enforced.

Key changes in force from 21 August 2017:

  • No more free assisted conception services
    Assisted conception services will no longer be free for those who have paid the Immigration Health Surcharge (unless provided by NHS England to armed forces members or where treatment began before 21 August 2017).

Amendment of Part 4:
“In Part 4 of the Principal Regulations (overseas visitors exempt from charges), before regulation 10, insert “chargeable assisted conception services” means any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child, other than...a service provided as part of a course of treatment, where that course of treatment began before 21st August 2017.”

  • Recording overseas visitors
    Requirement for NHS Trusts and Foundation Trust bodies to record overseas visitor status alongside their NHS numbe

Insertion of new regulation 3A:

“An NHS foundation trust or an NHS trust that, in meeting its obligations under regulation 3, determines that a person is an overseas visitor must, as soon as it is practicable to do so, record against the overseas visitor’s consistent identifier-

(a) The fact that the person has been determined to be an overseas visitor;
(b) The date on which that determination was made;
(c) Whether Part 4 (overseas visitors exempt from charges) provides for no charge to be made"

Key changes in force from 23 October 2017:

  • Extending ‘relevant body’
    Relevant bodies will extend to NHS-funded community and secondary care, including from non-NHS organisations.

Amendment 2 of regulation 2:
“omit the definition of relevant NHS body” and insert “relevant body” to include “any other person providing relevant services.”

  • Recovering charges in advance
    Relevant bodies must recover charges in advance of treatment or care, unless this would otherwise delay or prevent urgent or necessary treatment.

Amendment of regulation 3:
“before providing a relevant service in respect of an overseas visitor, a relevant body must secure payment for the estimated amount of charges to be made under paragraph (1) for that relevant service unless doing so would prevent or delay the provision of—

(a) an immediately necessary service; or
(b) an urgent service.”

Despite these efforts, the long-standing conjecture that ‘health tourism’ has crippled the NHS budget is difficult to prove and remains unsubstantiated. This is because there is insufficient data which clearly identifies the extent of NHS use by immigrants and other overseas visitors. In any case, research indicates that their use of the NHS on average, is lower than that of people born in the UK. Previously, research by the Department of Health estimated the cost of visitors and immigrants at £2 billion, a figure inclusive of countries with which the UK has a reciprocal agreement. Moreover, the cost of ‘health tourism’ i.e. those who come to the UK with the sole purpose of receiving free NHS treatment is estimated at £80 million out of the £2 billion figure, which only accounts for 0.6% of the 2017/18 NHS budget of £124 billion.

The Guidance on implementing the new changes by the 2017 Regulations highlights “the Department of Health strongly recommends that relevant NHS bodies have a designated person...to oversee the the implementation of the Charging Regulations.” No doubt, concerns will be raised about the cost of administering the Overseas Visitor managerial system and whether it will outweigh the savings intended to be recovered from putting an end to health tourism. Much of the debate surrounding immigrants draining the NHS has been fuelled by speculation and fear as opposed to facts and figures. Only time will tell whether the new Regulations will make the NHS more cost-effective and resourceful.

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