Why The Daily Mail Is Wrong About Health Tourism

Does health tourism cost us £2billion a year? Spoiler: no.

Today the papers are full of claims about how much health tourism costs the UK, like this:

The figures come from a study by a firm called Creative Research, commissioned by the Department of Health. But are they trustworthy? And do they support some of the claims being made?

Short version:

- The figure of £2billion is nothing to do with "health tourism"
- It really isnt "100 times more then previously claimed", as the Daily Mail suggests
- The figures are very rough estimates, and make some questionable assumptions

The £2billion figure doesn't refer to "health tourism".

The £2billion - around 2% of the NHS's total budget - is a rough estimate of the total cost of treating everybody who isn't ordinarily resident in the UK (around 30million people visit a year, most of them on short-term trips).

That's not the same as health tourism, which is "people who have travelled to England with the deliberate intent to obtain healthcare to which they are not entitled". The bulk of that £2billion covers people who are here legally and are using health care services to which they are perfectly entitled.

You can see the Mail quietly acknowledges this - they put the £2billion figure prominently up near the headline words "health tourism" (without explicitly linking the two), but further down the article use the much lower figure of "up to £300million" for genuine health tourism.

The estimates for the actual cost of health tourism are really unclear, but probably less than £300million.

gov.uk

That "up to £300million" actually means "somewhere between £70million and £300million, we think, maybe." There's virtually no good evidence on how much health tourism actually costs; these figures are guesstimates that cover a massive range. Obviously, the papers are reporting the highest possible figure.

The study explicitly warns that "the numbers are very uncertain and are plausible ranges rather than distinct estimates. These numbers should be used with caution."

Basically, this is the government trying to work out the cost of health tourism:

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This really, really isn't 100 times more than previously thought.

£20million was a figure given by the government previously for the amount of money lost over five years due to written-off debts. £2billion is certainly 100 times more than £20million! That's because it's a figure for a completely different and much larger thing. It's the total cost of treating non-residents, not the amount of recoverable money we didn't recover - which is a fraction of a fraction of that total.

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Some of that £2billion is already recovered; a large amount of it is never supposed to be recovered, and nobody is proposing that it should be. We provide services like GP and Accident & Emergency care for free to everybody - partly because this has long-term benefits, and partly because we don't think that it's right that if someone gets hit by a bus we make them go through a credit check before saving their life.

Not all of these costs go on foreigners!

gov.uk

Almost £100million is ascribed to British expats who - not being resident in the UK - don't qualify for the full range of NHS care. As they've still got ties to the UK, they're also a significant part of the guesstimate for actual, proper health tourism - deliberately coming back to visit so they can access health care they aren't entitled to.

The study is an estimate - and one that's super uncertain:

gov.uk

The study isn't a direct audit of how much non-residents cost to treat - it's a guess, based on making assumptions about the number of visitors, and how likely they are to use health care services. It's a back-of-the-envelope estimate - just on a really, really big envelope.

The study does account for many factors - such as the fact that migrants are generally younger and in better health than then general population, and so cost the health service much less per person than long-term residents. However, it makes a couple of questionable assumptions - for example that women who are short-term migrants are as likely as non-UK born long-term residents to have babies while here, which seems unlikely.

The estimate actually has a range of over £1.5billion.

gov.uk

There's so much uncertainty in the study that the real costs could be as little as £1billion, or as much as £2.7billion. As they say in the report, "the simulation suggests that it is 50% likely that the result is in the range £1.53 billion to £1.94 billion". That's... pretty vague.

tl;dr - This is what someone trying to work out the real data about non-resident health costs looks like:

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