Health Services: Foreign Nationals

Department of Health written question – answered on 6th December 2016.

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Photo of Lord Marlesford Lord Marlesford Conservative

To ask Her Majesty’s Government what is their estimate of the cost to the NHS of treating non-EU citizens during the year 2015–16; and how much of this is recovered from (1) the patients, and (2) the governments, of the countries concerned.

Photo of Lord Marlesford Lord Marlesford Conservative

To ask Her Majesty’s Government what steps they are taking to obtain a higher level of repayment from other EU member states for NHS treatment of non-British EU citizens.

Photo of Lord Prior of Brampton Lord Prior of Brampton The Parliamentary Under-Secretary of State, Department of Health

It is not possible to provide data of an estimate of the cost to the National Health Service of treating non-European Union citizens during the year 2015-16 as patient nationality is not reported by NHS provider trusts.

An independent report by prederi, entitled Quantitative Assessment of Visitor and Migrant Use of the NHS in England: Exploring the Data was commissioned by the Department to better understand the impact of treating visitors and migrants and was published on 22 October 2013. A copy of this report is attached

The report estimated the gross value of NHS-funded healthcare provided to non-European Economic Area (EEA) visitors and temporary migrants was approximately £1.4 billion per year.

The Department has been collecting data on the amounts recovered from patients subject to the National Health Service (Charges to Overseas Visitors) Regulations 2015 that have been directly charged for their treatment. These relate to invoices raised in current and previous years.

Figures for financial year 2015-2016 are shown in the table below:

Income recognised this year

Cash payments received in-year (relating to invoices raised in current and previous years) 2015-16

£ Millions

£ Millions

NHS Trusts



NHS Foundation Trusts






Source: NHS Trust and NHS Foundation Trust Annual Accounts 2015/16

We do not recover costs directly from patients covered by the terms of the reciprocal healthcare agreements that the United Kingdom has with certain non-EEA countries. The terms of the reciprocal healthcare agreements allow for each country to absorb the cost of providing immediately necessary and urgent care provided to visitors between those countries.

Under the terms of the Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004, other EEA member states and Switzerland reimburse the UK for healthcare treatment provided to the citizens for whom they are responsible. Reimbursement is contingent on the NHS frontline identifying patients for whom we can recover costs and reporting the necessary information.

All EEA countries, including the UK, have a legal obligation to pay agreed claims relating to healthcare treatment provided. Once both sides are satisfied that such claims are accurate, they are paid in full.

In October 2014, the Department introduced a European Health Insurance Card (EHIC) incentive, meaning NHS provider trusts would be paid an additional 25% of all EHIC activity they correctly record. This has led to a significant improvement in collection of EHICs as shown in the table below:

October 2013- September 2014

October 2014- September 2015

European Health Insurance Card (Volumes)



European Health Insurance Card (Amounts)

£9.1 million

£17.6 million

Source: Department of Work and Pensions Overseas Healthcare Team.

Quantitative Assessment (PDF Document, 3.04 MB)

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