Scottish health boards owed £3.2m by foreign patients, report finds

Scottish health boards are owed more than £3.2 million by patients from outwith the European Economic Area who have not paid for treatment over the last five years, a Holyrood committee has found.

Health boards could also recoup more than £700,000 a year if they participated in a scheme to report usage of the NHS by holders of the European Health Insurance Card (EHIC), according to a report.

The Scottish Parliament’s Health and Sport Committee has raised concerns that NHS boards are missing out on “vital sums of money” because they cannot identify those entitled to NHS care.

Only those people who are not “ordinarily resident” in the UK are charged for using NHS services, however it is currently not necessary for a GP to establish a person’s country of origin before treating them.

The committee is calling on the Scottish Government to establish a standardised approach to identifying those not eligible for free NHS treatment, warning that boards are potentially losing out on “significant revenue”.

Lewis Macdonald MSP, convener of the Health and Sport Committee, said: “The Committee support the principle that anybody in Scotland can access GP services or A&E departments free of charge when needed.

“However, we are concerned that NHS boards are missing out on vital sums of money to which they are due by not being able to identify those entitled to NHS care.”

The report identified a varied and inconsistent approach from NHS health boards in Scotland, with some not reclaiming costs from those not entitled to free care.

The Scottish Parliament Information Centre has calculated that individuals who are not from within the European Economic Area (EEA) owe more than £3.2 million to boards for treatment which has not been paid for over the past five years.

Evidence gathered by the Committee also showed that not all health boards are participating in the EHIC Incentive Scheme, whereby NHS boards can claim back 25% of the treatment costs of EHIC card holders.

NHS figures provided in December 2018 showed that £5 million worth of treatment, relating to 4,841 individuals, had been reported to the Department for Work and Pensions by participating boards since the scheme was set up at the end of 2014, which resulted in £1.25 million being reimbursed to those boards.

The committee estimated that if all boards participated in the scheme the average amount coming back to them could be £710,000 a year.

Mr Macdonald said: “We believe the Scottish Government should begin a review of the current situation immediately and have asked them to adopt a clearer and more unified approach to ensure access to NHS treatment is applied fairly and consistently.

“Our research has also shown that the prices charged for NHS services to those not entitled to them vary considerably across the country without any justification for the differences in fees being provided.

“This is another issue which NHS boards and the Scottish Government must work to make simpler, clearer and more transparent wherever possible.”

The report also considered the healthcare costs for Scottish citizens abroad and outlined the importance of continuing with similar arrangements to those currently in place after the UK leaves the EU.

A Scottish Government spokeswoman said: “We welcome the committee’s report into this complex area of law, which is made more complicated by the uncertainty about ongoing arrangements after Brexit.

“The threat to reciprocal healthcare comes entirely from the UK Government’s Brexit policy and would be resolved by staying in the EU, in line with the wishes of the people of Scotland.

“We are committed to ensuring that life-saving care will be provided as a priority before checking residency.

“We will study the committee’s report and respond once we have clarity around new arrangements.”