Under a variety of different circumstances, foreigners do pay for access to health care already. The proposed legislation would seek ways to extend the scope for foreigners to contribute financially for NHS services, and to increase the incentives for debt recovery. The NHS would save significantly by simply collecting on what it is owed under current exchange schemes with foreign governments.

UPDATED 25/10/2018

On 19 May 2016, Sammy Wilson’s response to the Queen’s Speech was quoted in the Belfast Telegraph. He commented on many of the proposed bills, including legislation that will “ensure that overseas visitors pay for the health treatment they receive at public expense.” Sammy Wilson claimed that Northern Ireland will “especially benefit” from this bill, as all foreigners, including those from the Republic of Ireland, would have to pay for hospital treatment.

The current regulations on access to health care for foreigners

Under current legislation, all ordinary residents have free access to the (National Health Service) NHS. In layman’s terms, anyone who has been, or intends to, live in the United Kingdom (UK) for six months or more, out of their own free will and for a designated purpose, is considered an ordinary resident. The actual requirements for someone to be considered an ordinary resident under the law are somewhat more stringent. Anyone who is not a European Economic Area (EEA)citizen must also be granted indefinite leave to remain, or a right of residence for a limited period, in order to be treated as an ordinary resident.

Any visiting non-EEA citizen is chargeable for their use of the NHS, apart from a few exceptions — such as accident and emergency services or treatment for the most infectious diseases. Just as all other foreigners, EEA nationals would be chargeable for any treatment they received in the UK, but EEA countries have developed the European Health Insurance Card (EHIC) scheme, under which necessary treatment will be reimbursed by the patient’s home country through the use of their EHIC issued by their home country (including EHICs issued for free by the NHS in the UK). This means that under most circumstances, EEA nationals can receive free treatment.

Data from 2013/14 show that the cost of treatment for EEA citizens amounted to £340 million, while the corresponding figure for non-EEA citizens amounted to £1,070 million. Under current regulations the £340 million could be almost fully recovered, but the NHS only followed up on 20% of these charges. Irish citizens, which Sammy Wilson mentioned in the claim, would fall under this category.

Proposed legislation and its expected impact

The Overseas Visitors Charging Bill is intended to “ensure that overseas visitors pay for the health treatment they receive at public expense.” This includes multiple components, such as improving cost recovery methods, limiting free services, and extending limitations on EEA citizens who get free access as ordinary residents. The Department of Health (UK) has recommended that the rules granting residency for EEA nationals need to change. By following a steady transition the Department of Health (UK) has estimated that the NHS could save £500 million by 2017/18.

Considering the relatively low presence of foreign residents (5.9%) in Northern Ireland, the impact would not be as drastic as in other parts of the UK. Furthermore, until legislative consent motions are passed, it is unclear if the changes would apply in Northern Ireland.


A previous version of this article linked “European Health Insurance Card (EHIC)” to a commercial site; this link has been replaced with one from the European Commission, describing the EHIC scheme.

Image: “Hospital do Coracao de Alagoas” by Michel Rios licensed by CC BY-NC-ND 2.0

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