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Privatisation not migrants puts up cost of healthcare

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Issue 2377
British and migrant workers come together to defend NHS
British and migrant workers come together to defend NHS (Pic: Guy Smallman)

Screaming headlines across the media last month claimed that migrants and visitors to Britain cost the NHS £2 billion a year. It was meant to be a shockingly high figure and we are supposed to understand from it that foreign people are to blame for an overstretched NHS.

It happened in the same week as the second reading of the Tories new immigration bill that wants to turn NHS workers into immigration staff (see below). Socialist Worker believes that everyone has a right to health care wherever they come from and however they got here.

The government claims that to help offset the cost and stop “health tourism” it must charge migrants £200 to use health services. But what the Tories really want is to introduce charging throughout the NHS—and they see migrants as a soft target. 

The £2 billion figure is largely made up through combining estimated and out of date figures. One of the source reports carries a warning not to rely on its figures. It is certainly not the figure for “health tourism” as a Daily Mail front page last week suggested.

But even if the figure was reliable it is barely 2 percent of the NHS budget of around £91.5 billion. Government figures show that migrants tend to be younger and healthier and so much less likely to use the NHS than the “host population”. 

Figures from the Census and International Passenger Survey show that 76 percent of the non-UK born population is aged 15 and 44—the age-range least likely to use the NHS. It’s true that because they are younger and healthier migrants and visitors are slightly more likely to have children. But only 3 percent of the cost for treating migrants and visitors is spent on maternity services.

And most migrants work which means they already pay towards the cost of the NHS. In fact the government would be between £7 billion and £16.5 billion a year worse off without migrant workers, an Organisation for Economic Co-operation and Development report showed last month.

Not only do the overwhelming majority of migrant workers pay income tax and national insurance contributions, but they actually pay more in than they use in public services. The Tories are trying to scare and divide people while they deflect blame for their NHS cuts onto migrants.

What’s worse is that if their scapegoating plan works then vulnerable people will not be able to access NHS services. Life-threatening conditions like HIV and tuberculosis will go untreated.

The real threats to the NHS are private medical companies who see our health service only as an opportunity to make enormous profits—and their friends in government. The Tories have already cut £10 billion off the 2010 NHS budget of £109 billion a year and they plan to cut at least another £10 billion by the end of 2014.

NHS market creates costs

There was a time when hospitals paid no charges on their land, buildings and assets. But now some hospitals built under the Private Finance Initiative (PFI) pay more than 18 percent of their income just to service their debts. The market “reforms” brought in by the Tories in the 1980s and expanded by Labour under Tony Blair are expensive to run.

Before then the cost of managing the health service was about 5 percent of the total budget. But the market brought new costs including commissioning services from private companies, writing and monitoring contracts, marketing, paying for insurance, invoicing, and accounting. 

Allyson Pollack has researched the increased costs with the move from state built hospitals and those built under PFI since 1990. For instance, Octagon Healthcare’s PFI Norfolk and Norwich hospital made 60 percent profit in its first three years. The 2012 Health and Social Care Act meant every part of the NHS can now be privatised and costs will only mushroom.

Introducing pay-for-health

The government’s new immigration bill aims to make doctors, nurses and NHS admin staff check everyone’s immigration status. It wants GPs to start collecting £200 from migrants for access to health services.

The government knows it is not possible for NHS staff to collect and process all this information. They are already massively overstretched. Such a system would require a new layer of people working for private health and insurance companies—as happens in the US. 

It is no coincidence that Simon Stevens has been appointed as the new head of the NHS from next April. He spent ten years working for US health giant United Health. Before that he was an advisor to Tony Blair as Labour privatised chunks of the NHS. Stevens offered to take a pay cut due to spending pressures” so he would “only” get paid £189,900 for his first year.

In the US 48.6 million people—15.7 percent of the population—didn’t have health insurance in 2011, mostly because it was too expensive. So the attack on migrants isn’t just about scapegoating. It comes across as part of a plan to normalise the idea of patients paying for treatment.

‘Health tourism’ makes money 

The NHS makes huge amounts of money from migrants and visitors who pay—up to twice as much as those who need health care but can’t pay. New research from the London School of Hygiene and Tropical Medicine and University of York found that 18 NHS trusts made £42 million in 2010-2011 from so-called health tourists.

Migrants keep the NHS going

Around 30 percent of doctors and 40 percent of nurses now working in the NHS were not born in Britain. Around 87,000 of the 660,000 nurses working in 2012 were from abroad, mainly from the Philippines, Australia, India and South Africa. The NHS would collapse without migrant workers.

Who doesn’t pay for care?  

Unpaid fees for health services to migrants and visitors came to £11,556,564 in 2011-12. That was just 0.012 percent of the NHS budget. Defaulters included people too poor to pay for emergency treatment, private health insurance companies who refused to pay and people who couldn’t pay because they died.

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