Incentives Matter – Charging Immigrants For NHS Treatment Reduces NHS Treatment

This is one of those things that should be greeted with a healthy “Well, what the hell did you expect?” If we charge immigrants upfront for their National Health Service treatment then fewer immigrants gain less treatment on the National Health Service. Only those ignorant of reality would ever think otherwise of course.

Sure, that’s entirely different from whether we should be trying to insist that immigrants gain less treatment on the NHS than they perhaps might need. You can swing any way you like on that political question. But the idea that asking people for cash now for treatment tomorrow reduces the amount of treatment demanded is so obvious that surely this isn’t in fact news to anyone?

Upfront charging for NHS care is deterring immigrant patients from seeking treatment, including for serious illnesses such as cancer, fresh evidence from doctors reveals.

Well, yes?

Again, whether we should be so dissuading is different from the obvious fact that charging for something is going to reduce demand.

A report published on Thursday by the British Medical Association said pregnant women were going without antenatal and postnatal care for fear of being charged, and that patients were being informed of four-figure charges just before having surgery. In one case, a patient reportedly did not seek cancer treatment because she was ineligible for free NHS care, and died as a result. The NHS introduced upfront charging for elective care in 2017 as part of the government’s “hostile environment” towards immigrants. Under the policy, patients who are not entitled to free NHS care – including overseas visitors, but also undocumented immigrants and rejected asylum seekers in England – must pay the cost of treatment upfront unless it is urgent or immediately necessary, or falls within exempt categories including maternity care, accident and emergency and infectious diseases.

And on the subject of so dissuading, well, what should we be doing? There’s some group of people who are entitled to that free at the point of use NHS care. Largely, but not entirely limited to, those of us who have been paying into the tax system to gain access to that free at the point of use NHS care. There are those who are not entitled. Largely those who haven’t been paying in. What actually should we be doing about those two groups?

Obviously, those of us who have paid should be getting what we’ve paid for. Those who haven’t, well?

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