Spain and the UK speak out against medical tourism

In recent weeks, both the Spanish and British health services have openly attacked medical tourism. (See Express article: Anger over NHS health tourists). But what they mean by medical tourism and what those within the industry mean are two different concepts. Even some people within the industry are very confused, due to not understanding the intricacies of the rights of EU citizens to healthcare in another member state.

With the financial difficulties in Europe in austerity, the private medical tourism industry must be careful to differentiate itself from the abuse of health systems by the “freeloading” health tourist.

The attacks on health/medical tourism arise simply because in many EU countries, the health services are struggling to deal with increased demand whilst suffering budget cuts. Forget some politicians’ claims that they have not cut budgets; even keeping them the same is not enough to cover the increased demand or to keep pace with medical inflation.

Health tourism attacked

When the UK and Spain attack health tourism, they mean people who get treated for free in their hospitals who are not residents in the country. Spain has gone one step further. With a few exceptions, from September, they will not offer free treatment to the 500,000 illegal immigrants in the country.

According to the medical magazine Pulse, NHS hospitals are owed as much as £40m in outstanding fees for the treatment of foreign nationals.The findings are set to reignite the debate over health tourism, and follow cases where GPs have been under pressure to register foreign nationals not entitled to secondary care. Where foreign nationals are not eligible for NHS care, they, their insurers or their country of origin will be approached for payment.

Pulse found that in 35 NHS hospital trusts, the average unpaid debt for the provision of care to foreign nationals was £230,000. If that figure is extrapolated across all 168 trusts in England, it puts the total owed to the NHS by foreign nationals or “health tourists” (as the media describes them) at £40m.

According to Pulse, “St George’s Healthcare Trust had the largest outstanding debts, totalling £2m from £3.55m invoiced to foreign nationals for health treatment from April 2009. Barnet and Chase Farm was next, with £488,000 outstanding from invoices worth £934,000.The most inefficient trust in collecting money was Royal Wolverhampton, which collected only 24% of the £419,000 owed, followed by Newcastle-upon-Tyne, which collected 36%. Other hospitals admitted to writing off fees. Northampton General said it wrote off £140,000, despite only having been reimbursed £87,300 to date. St George’s wrote off more than £95,000, while University Hospitals Coventry and Warwick, and Royal Wolverhampton wrote off £79,000 and £41,000 respectively.”

Complex rules for cross border healthcare

The EU and national rules on when a foreign patient is or is not entitled to treatment are not easy to follow.

The real problem is that they often give hospitals, governments and GPs discretion on which foreign nationals to charge and which not to. Hospitals are often confused about the rules or are simply not sure which category a patient falls into. In times of plenty this does not matter, but when times are tough – hospitals and governments will crack down.

If you read both the popular press and what some politicians say both in Spain and the UK, the rough interpretation is …..“these nasty free-loading foreigners are stealing healthcare resources from our own people.” Add to this the increased noise from Spain, France, Germany and the UK where many ills are being blamed on immigrants, whether legal or not. Facts, figures, rules and regulations do not matter to people making these statements.

Damaging to the image of medical tourism?

The problem is that there is a danger of the image of paid for medical tourism being damaged by this view of health tourism. The terms are the same but the meaning is different. So, what can we do about it?

Somehow, the industry has to up its game and improve its image. It’s the sort of problem where we do need action from associations and groups. If this were the travel or insurance trade, we would see spokespeople active in national papers, on television and online. I do not have a simple answer to this. The industry does not yet have the presence or the inclination to deal with such issues.