Re: Are migrant patients really a drain on European health systems?
Arie's summary (1) of the economic consequences of healthcare of migrants to and from Britain is informative, but, perhaps for reasons of space, fails to capture important aspects of the overall situation. If we are to analyse it in its totality, we must consider factors which are important but difficult to quantify. For example:
More than 30% of NHS staff were trained overseas, at substantial cost saving to the NHS and losses to their (largely underdeveloped) countries of origin (2); against this we need to set the cost of emigration of (far fewer) British-trained clinicians.
Advice from the Department of Health has been highly ambiguous about the right and duties of GPs to register irregular migrants, resulting in recurrent failures to provide timely and effective community care. This has caused many migrants to present as emergencies to secondary care, followed by expensive hospitalisation to repair preventable damage. Restricted access to care may also have contributed to the spread of serious communicable diseases, particularly TB and HIV, putting the rest of the population at risk (3).
The term “illegal immigrant” inadvertently perpetuates beliefs that the UK is being swamped by tides of demanding, undeserving (and largely mythical) foreigners. Asylum seekers with a well founded fear of further torture if returned are, and should be, entitled to NHS care while awaiting a decision as should visitors working and paying tax in this country.
The costs of implementing further charging mechanisms will be large, need to be, and have not been, realistically estimated, as the linked editorial (4) points out. The proposals would also require doctors to act as immigration police, undermining patient trust and potentially putting us in violation of our duties of confidentiality, as defined by the General Medical Council (5).
The totality of the evidence (and its absence) strongly suggests that arguments for imposing a healthcare tax on migrants are not supported by economic or humane considerations or concern for the native or migrant populations' health, but driven by a desire for political advantage.
Rapid Response:
Re: Are migrant patients really a drain on European health systems?
Arie's summary (1) of the economic consequences of healthcare of migrants to and from Britain is informative, but, perhaps for reasons of space, fails to capture important aspects of the overall situation. If we are to analyse it in its totality, we must consider factors which are important but difficult to quantify. For example:
More than 30% of NHS staff were trained overseas, at substantial cost saving to the NHS and losses to their (largely underdeveloped) countries of origin (2); against this we need to set the cost of emigration of (far fewer) British-trained clinicians.
Advice from the Department of Health has been highly ambiguous about the right and duties of GPs to register irregular migrants, resulting in recurrent failures to provide timely and effective community care. This has caused many migrants to present as emergencies to secondary care, followed by expensive hospitalisation to repair preventable damage. Restricted access to care may also have contributed to the spread of serious communicable diseases, particularly TB and HIV, putting the rest of the population at risk (3).
The term “illegal immigrant” inadvertently perpetuates beliefs that the UK is being swamped by tides of demanding, undeserving (and largely mythical) foreigners. Asylum seekers with a well founded fear of further torture if returned are, and should be, entitled to NHS care while awaiting a decision as should visitors working and paying tax in this country.
The costs of implementing further charging mechanisms will be large, need to be, and have not been, realistically estimated, as the linked editorial (4) points out. The proposals would also require doctors to act as immigration police, undermining patient trust and potentially putting us in violation of our duties of confidentiality, as defined by the General Medical Council (5).
The totality of the evidence (and its absence) strongly suggests that arguments for imposing a healthcare tax on migrants are not supported by economic or humane considerations or concern for the native or migrant populations' health, but driven by a desire for political advantage.
References:
1) Arie S. Are migrant patients really a drain on European health systems? BMJ 2013; 347: f6444. http://www.bmj.com/content/347/bmj.f6444
2) Goldacre MJ, Davidson JM, Lambert TW. Country of training and ethnic origin of UK doctors: database and survey studies. BMJ 2004;329:597. http://www.bmj.com/content/329/7466/597
3) Gazzard B, Anderson J, Ainsworth J, Wood C. Treat with respect: HIV, public health and immigration. UK. Coalition of People Living with HIV and AIDS, 2005.
http://www.irr.org.uk/pdf/HIV_Treat_With_Respect.pdf
4) Hanefeld J, Neil Lunt N,Smith R. Paying for migrant healthcare. BMJ 2013;347:f6514. http://www.bmj.com/content/347/bmj.f6514
5 ) General Medical Council. Confidentality. 2009.
http://www.gmc-uk.org/static/documents/content/Confidentiality_0910.pdf
Competing interests: FWA frequently provides medico-legal reports about asylum seekers who have survived torture an is sometimes paid for doing so.