Upfront charging deterring immigrant patients

The British Medical Association is calling for urgent action to address the impact of charging rules for overseas patients, on both NHS staff and the patients themselves.

A report, published by the medical association, warned that pregnant women were going without antenatal and postnatal care because of growing fear of being charged, whilst other patients were being informed of four-figure charges just before having surgery.

Under 2015 regulations, NHS bodies were given new powers to charge overseas visitors not eligible for free treatment. In 2017 the regulations were updated to introduce upfront charging for non-urgent care and the requirement for NHS providers to record patients’ eligibility for free treatment.

While the Department of Health and Social Care launched a review into the regulations in December 2017 – just two months after they came into effect – it continues to reject calls to publish the full findings of this review. This is despite government admissions that the review received evidence of 22 cases of patients being wrongly charged upfront for care that was deemed immediately necessary and its own acknowledgment that there is ‘work to do’ in the application and communication of the regulations.

A BMA member survey found that many doctors have faced pressure from administrative staff called Overseas Visitors Managers when making clinical judgements regarding a patient’s need for care, and that regulations, and particularly upfront charging, are deterring patients from seeking care, including for treatments that are not chargeable.

The BMA believes that urgent action is needed to address this, which should include simplification of charging criteria and exemptions to improve clarity for patients and providers and reduce instances of their misapplication and rigorous testing of the cost-effectiveness of the regulations.

John Chisholm, BMA medical ethics committee chair, said: “The role of doctors – and all of their healthcare colleagues – must be to treat and care for patients, not to act as border guards, policing patients’ access to and payment for treatment. While it may be appropriate to charge overseas visitors for certain NHS services in some circumstances, it is vital that the system is cost-effective, practical and does not unduly burden NHS services or staff. Crucially, urgent treatment must be prioritised over administrative process and safeguards must be put in place to protect vulnerable groups and ensure that patients are not deterred from seeking care.

“This is particularly important to mitigate risk to the individual patient, to avoid their health worsening considerably, but also to protect the wider public’s health, as infectious conditions can spread quickly if not treated at the earliest possible stage. The government must take urgent action and come clean over the evidence they have on the impact these rules are having on the ground. The public has a right to know what the evidence shows.”

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