A new report into so-called “health tourism” makes for a shocking read. Not because the costs of migrants deemed to have travelled to Britain primarily to enjoy free NHS services on British taxpayers has spiralled to £2 billion, but because it exposes serious concern about the government playing politics with both immigration and the NHS.
Consider the facts. The government has yet to provide a reliable estimate of how many such migrants have actually used the NHS. In July, Health Secretary Jeremy Hunt admitted on the BBC Today programme that “the truth is we don’t know the number” of health tourists in Britain.
This failure to know the number of migrants benefiting from the NHS without contributing to its costs hasn’t prevented Hunt from claiming that health tourism costs the UK about £12m - a figure manufactured from the rounded up sum of £11.5m, which related to unpaid charges for treating migrants. When we talk about the costs of health tourism, what we’re actually talking about is any use of the NHS by migrants for any reason. And so we begin to expose the mythical health tourist problem.
The new report, published by the Department of Health, makes for interesting reading. Its purpose is clear: to provide a more reliable evidence-base for estimating the number of migrants using the NHS and associated costs.
A ‘true’ cost?
The report was celebrated in the Daily Mail for providing the “true cost of health tourism” and claimed this was now up to £2 billion per year and far beyond previous estimates. The Home Office plans to introduce a levy of £150 on foreign students and £200 on temporary migrants to help recover these costs.
The problem is that the report is a product of considerable guesswork where assumptions drive the data. This is clear from the first few pages. It claims to consider only “the expected uses of services”, but not the actual services that were used. These assumptions about predicted uses were then “weighted to adjust” according to the assumed “demographic profile” and estimated “health needs” of health tourists to determine the costs incurred.
And it gets worse. The report admits its figures on illegal migrants is “very uncertain” and lacks “up to date statistics from the Home Office”. It likewise claims the number of health tourists – you guessed it – is also “very uncertain” and the report’s “numbers should be used with caution”. In fact, the estimates used in the report to provide a figure on the cost to the NHS by migrants are “based on incomplete data, sometimes of varying quality, and a large number of assumptions”.
Cost-benefit analysis 101
And there’s yet more. As every student in my lectures about public policy knows, any cost-benefit analysis must not only includes the costs, but also the benefits. All migrants studying at universities in the UK are permitted to work and would pay National Insurance contributions. Most migrants in the UK possess a visa permitting them to work and they also would pay these contributions.
A serious flaw of this report is its failure to note any benefits paid by migrants through National Insurance contributions that also financially support the NHS. Any cost-benefit analysis must include these contributions in its estimates.
The failure to include benefits, such as National Insurance contributions, in assessing the costs of so-called health tourism seriously undermines the value of this report to inform debates. It is deeply concerning that such a fundamental omission could go unnoticed by the Department of Health and the mainstream media.
It is bad enough the government continues to lack secure statistics about the numbers of migrants and that it would trumpet as fact assumption-fuelled speculation about migrants and the NHS. But it is even worse where cost-benefit analysis is a consideration of costs alone.
If we want to expose the reality of migrants use of the NHS, then we require better data and less guesswork. And the government would do this debate a great service if it showed half as much care in trying to identify the benefits that migrants contribute to the NHS as it is on claiming costs. Otherwise, the government appears more willing to peddle myths as facts to push policy change.