Foreign private patients provide a lucrative source of NHS income

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London School of Hygiene & Tropical Medicine
Foreign private patients provide a lucrative source of NHS income Foreign patients coming to the UK for private medical treatment are a lucrative source of income for the NHS, according to a new study by researchers at the London School of Hygiene & Tropical Medicine and the University of York. The study, published in PLOS ONE, also suggests that more UK residents currently travel abroad for treatment than international patients travel to the UK for private or NHS treatment.

The phenomenon of people travelling abroad to access medical treatment, commonly known as 'medical tourism,' is receiving increasing attention from politicians and the public, but to date there has been very little reliable information available.

Medical tourism is where people leave the UK or come into the UK with the intention of paying for treatment. They are typically treated as private patients and the costs are fully recouped. The new study is the most extensive analysis yet of UK medical tourism and looks at its impact on the NHS economy.

As part of the study the researchers analysed the International Passenger Survey, conducted interviews with returning UK medical tourists, policymakers and NHS managers, and reviewed published literature.

They also made 28 freedom of information requests to NHS foundation trust hospitals in the UK to obtain figures on foreign private patients; 18 of these hospitals provided useable data. The researchers found that, despite the small numbers of international private patients being treated – 7% across this sample – these patients were responsible for almost a quarter of total private income in these trusts. This represents an income of £42 million across the 18 hospital trusts during 2010-2011.

13 of the hospitals that provided data were in London, and the largest numbers of foreign patients were at hospitals which are internationally known for their specialism.

Lead author, Dr Johanna Hanefeld, Lecturer in Health Systems Economics at the London School of Hygiene & Tropical Medicine said: "Our analysis shows that private foreign patients may be more lucrative than UK patients treated privately within the NHS. This could be a strategic area for growth for NHS Trusts wishing to expand private patient activities and increase income, especially following the NHS reforms which removed the cap on income generated from private patients.

"We can also see from our research that – contrary to some popular media reports – the UK is a net exporter of patients. In 2010 an estimated 63,000 UK residents travelled abroad for treatment, while around 52,000 patients came for treatment in the UK. The level of patients travelling to the UK has remained relatively stable over the last decade, while there has been a substantial increase in the number of UK residents travelling abroad for medical treatment."

The study also noted that UK residents travelling abroad for treatment could themselves represent costs for the NHS on their return. For example, the cost of complications resulting from so called 'cosmetic tourism' undertaken overseas, or the increased cost of caring for pregnant women expecting twins or triplets as a result of travelling abroad for fertility treatment.

However, the researchers stress that the quality and quantity of data available on medical tourism is poor, and better monitoring and more rigorous assessment is needed in order to effectively analyse the impacts on the NHS and inform policy.

The research forms part of a wider study, looking at the implications for the NHS of inward and outward medical tourism, which was funded by the National Institute for Health Research Health Service and Delivery Research (NIHR HS&DR) Programme.

The wider study was led by Dr Neil Lunt, from the University of York's Department of Social Policy and Social Work.

He said: "This study concentrated on medical tourism as health trade, rather than 'health tourism' where there is not always an intention to pay or where hospitals decide not to pursue charges. The study is important as it helps us to understand one aspect of cross-country patient movements, providing insights for NHS policy-makers, managers, regulators, commissioners, providers, clinicians and consumer interest groups.

"In current times where many NHS Trusts are trying to increase efficiency, medical tourism is a way for them to increase income from non NHS sources."

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Notes to editors:

1. Hanefeld J, Horsfall D, Lunt N, Smith R. Medical tourism: a cost or benefit to the NHS? PLOS ONE. DOI 10.1371/journal.pone.0070406

2. Once published the paper will be available at http://dx.plos.org/10.1371/journal.pone.0070406

3. This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number HSR 09/2001/21).

4. The National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) Programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR Programme is funded by the NIHR with specific contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. http://www.netscc.ac.uk/hsdr

5. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are hose of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

6. The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk

7. For further information on the University of York's Department of Social Policy and Social Work visit http://www.york.ac.uk/spsw