Public Release: 

Proposed health charges for migrants fail test against government's own principles


Proposals by the UK government to charge non-EEA residents for access to the NHS fail to abide by the government's principles for the NHS, are ideologically driven and unlikely to result in substantial savings. These are the conclusions of an essay published today by the Journal of the Royal Society of Medicine, written by public health experts from the London School of Hygiene & Tropical Medicine.

The government's consultation document, entitled Making a Fair Contribution, proposes that while consultations with GPs and nurses in primary care remain free for non-EEA migrants, those using ambulances, or accessing emergency departments or inpatient services would be charged 150% of the tariff paid by NHS purchasers.

The essay's authors tested the proposals to assess if the changes are consistent with the four principles set out for the NHS by the government. These principles, say the authors, are subtly adapted from those on which the NHS is based, which were that it meets the needs of everyone, that it be free at the point of delivery and that it be based on clinical need, not ability to pay.

Dr Lucinda Hiam, of the London School of Hygiene & Tropical Medicine, said: "The imposition of charges sends an implicit message that migrants do not already contribute to the NHS. Yet between 2001 and 2011 non-EEA migrants contributed 2% more in taxes than they took out, amounting to a net fiscal contribution of £2.9 billion."

The authors believe that most NHS staff will find the proposals offensive and unworkable, creating further tension in an environment already suffering from low morale. The criteria for charging are confusing and assessment would be time-consuming, imposing a huge administrative burden. Furthermore, the authors anticipate that primary care is unlikely to be able to cope with the surge of attendances due to charging for A&E, eye care and dentistry.

Professor Martin McKee of the London School of Hygiene & Tropical Medicine, added: "The notion of a 'fair contribution' is ultimately flawed and against the founding principles of the NHS which strives to protect the most vulnerable." He pointed to the founder of the NHS, Aneurin Bevan, who noted, 'Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the costs of which should be shared by the community.'


Notes to editors

Making a fair contribution: is charging migrants for healthcare in line with NHS prinicples? (DOI: 10.1177/0141076816638657) by Lucinda Hiam and Martin Mckee will be published by the Journal of the Royal Society of Medicine at 00:05hrs (UK time) on Thursday 7 April 2016.

For further information or a copy of the paper please contact:

Rosalind Dewar
Media Office, Royal Society of Medicine
DL: +44 (0) 1580 764713
M: +44 (0) 7785 182732

For interviews with the authors please contact:
London School of Hygiene & Tropical Medicine press office
DL: +44(0)20 7927 2802

The JRSM is the flagship journal of the Royal Society of Medicine and is published by SAGE. It has full editorial independence from the RSM. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE is a leading international provider of innovative, high-quality content publishing more than 900 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company's continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne.

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