ID cards could help validate access to Health, and have other benefits

The debate about ID cards seems to have died away. It was criticised as being illiberal by the media in our media led society.

ID cards could help validate access to Health, and have other benefits especially if they linked to National Insurance numbers, and possibly to Tax Code.

The row over the unclaimed debts from overseas patients benefitting from our 4 health care systems is due to run longer. If the libertarians have their way we will consider the cost a gift to tourists – of £1 each 2 years ago, now recalculated at £6 each. (health inflation or original error?) The Times editorial highlights the Perverse Incentives for staff not to complete the forms, and take the time and trouble to challenge the patient. If we are going to be mean, and to get better at charging NHSreality suggests 1/3 to the staff concerned, 1/3 to the hospital, and 1/3 to government for redistribution to hospitals that get no tourists.

Bill of health. Asking hospital patients to show their passports can help the NHS cut costs

The NHS was owed £367 million for treatment of foreign nationals visiting Britain in 2012-13. It recovered £73 million. No wonder the health department is considering asking patients to attend appointments with a passport and proof of their address. The cost of foreign nationals’ treatment can be more easily recouped if they are clearly identified in hospital.

When visitors to Britain become ill, the health service treats them. If they are from outside the European economic area (EEA) and Switzerland they will, in time, be expected to pay for that care themselves. If they are from within the area, their own government will pick up the tab.

That is how the system should work. The reality is rarely as simple. Once individual hospitals have worked out whom to charge and how much, the first stage is sending the bill. The second is actually recovering the money. Wrinkles form at both stages. According to a recent report by the National Audit Office (NAO), trusts recovered less than a fifth owed to them in 2012-13.

There are two main failings in the system, and introducing passport checks can help with both. The first is a failure to charge European governments for the care of their nationals. When those governments are invoiced, they are good at paying up. They are just not invoiced enough. In 2012-13, EEA governments should have been charged £305 million, but were charged only £50 million. Figures for more recent years are similar.

This is partly because of perverse incentives. Hospitals do not receive much of the money for which they invoice foreign governments. Whitehall does. The deeper issue is that setting up payment systems is not in the DNA of a health service ingrained into being free at the point of use. Without a dedicated process for assessing patients’ eligibility, the details needed to recoup costs can be sucked into a bureaucratic quagmire. Those trusts that have zeroed in on this issue with passport checks have seen results. Peterborough and Stamford trust, for example, which introduced ID checks for non-urgent care in 2013, now recovers 95 per cent of what it is owed. In 2012, the figure was 37 per cent.

The second big problem is that when non-EEA patients are billed for their care, they often do not pay. Trusts surveyed by the NAO in 2012-13 recovered just 37 per cent of the money they billed to those patients. Hospital staff say their best bet is to pass on debtors’ details to the Home Office, which can refuse them re-entry into the UK until they pay. More consistent, reliable information on the patients can only help in that effort.

Funding the health service is inevitably going to become costlier as the population ages. The service faces a deficit of £2.45 billion. It is grating, in such times, for some foreign nationals to take advantage of the system regardless of whether they do so by cunning or carelessness. The sense of injustice is only intensified by the knowledge that, while trusts claimed £50 million from EEA governments last year, they paid £674 million for the care of British citizens in those countries.

Under the proposals, patients would never have to prove their eligibility for emergency care, which they get for free anyway. They would simply have to bring a passport to an X-ray or a consultation, as patients in other countries must bring a credit card. That system would hardly be draconian. It would be more efficient, and fairer.

‘Health tourists’ run up unpaid NHS bill of £62m – less than £1 per capita…

Hospitals cheat NHS over health tourists

How to cause disenchantment with those who are badly needed – Brexit will make things even worse for staffing levels..

NHS hospital trust gags health tourism whistleblower

NHS ‘can save £500m’ on foreign care

The Benefits of ID cards in fighting fraud, criminal practices, and health tourism.

Image result for health tourism cartoon

 

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This entry was posted in A Personal View, Perverse Incentives, Political Representatives and activists, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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