Jeremy Hunt and his magic numbers
Jeremy Hunt is all over the media this morning saying numbers. The numbers do not mean anything, or rather – they do not mean what he suggests they mean. But that will not stop him.
He is inventing a problem, which he can then fix with a solution which anyway does not correct the problem he has invented.
The coalition is intent on addressing the problem of health tourism. The evidence suggests there is no health tourism problem, so they have invented some numbers to suggest the imaginary problem can be fixed. That sounds quite mad, and indeed that is a satisfactory description of what is being done.
Hunt believes £500 million can be recovered from overseas visitors and migrants by imposing a £200 levy on non-EU migrants. This would plug a quarter of the £2 billion gap in funding lost to health tourism, according to his report.
These numbers do not correspond to previous estimates of health tourism, which the NHS put at £12 million, roughly 0.01% of its budget. That figure was itself quite dodgy, being just the sum total of the £33 million spent on foreign nationals a year which is written off by the NHS. This could be for a number of reasons, not least because the patient died or cannot be traced.
But even the new numbers do not justify the reporting that has been devoted to them. The £2 billion figure is nonsense. It relates to the total cost of treating foreign visitors and temporary migrants, many of whom pay tax and are entitled to treatment, such as foreign students. Hunt's mock-compassionate, ever-so-reasonable 'we're only trying to claw back a quarter of it' message is pure hogwash. The new figures suggest those who come to the UK specifically for health care and then leave cost £70 million a year (0.06% of the NHS budget).
But even if this new figure is accurate – and there's no reason to think it is – it's far from clear the coalition proposals would do anything about it.
As Dr Chaand Nagpaul, chairman of the British Medical Association's GPs committee, points out, the £500 million figure does not include the cost of implementing the scheme.
And this is quite the project. GPS are being asked to implement and administer a charging system based on careful vetting of every patient. It does not sound cheap.
Furthermore, there is evidence that schemes such as this actually encourage service use.
Take this example, from Steven Levitt and Stephen Dubner's Freakonomics.
Economists did a study of ten day-care centres in Haifa, Israel, where parents were often late picking up their kids – much to irritation of the managers. For four weeks, the economists kept track of how many parents were late picking up their children. There were eight late pick-ups per week, per day-care centre. In the fifth week a $3 fine was enacted per child per incident, to be added to the parents' $380 monthly bill.
Once the fine was implemented, the number of late pick-ups shot up to twenty per week, well over double the original number.
Once people pay for something, they think they are entitled to it. They had turned an informal inconvenience into a commodity – a $3 charge for a bit of flexibility in a parent's day.
The same incentive will apply to non-EU migrants. Having already been forced to pay the not-insubstantial levy, they will be encouraged to make use of NHS services. And just one outpatient appointment costs the NHS £200, instantly negating any benefit the levy may have had.
Claire Gerada chair of the Royal College of GPs, said admin costs could actually outweigh the savings. She estimates staff costs alone would be £500 million. Furthermore, failing to treat people early means they are more likely to turn up at A&E, which costs the NHS three times as much as a GP visit.
Or worse, imagine they do not get treatment and spread the disease. The long-term costs to the NHS, and society at large, are much higher.
It is an absurd situation to be in, seeing cooked-up numbers create a problem for which a counter-productive solution can be applied. Welcome to the strange, disturbed world of Jeremy Hunt and Theresa May. One might think we have enough real problems for them to be dealing with.
