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.
Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.
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