When we take ill, require medical help including admission into hospital we do so without having to worry about how much our treatment costs. This is because we have a National Health Service which is paid for through our taxes and free at point of need.

If we go to an EU country we can use a European Health Insurance Card (EHIC).

The EHIC is a free card which “gives you access to medically necessary, state-provided healthcare during a temporary stay in any of the 28 EU countries, Iceland, Liechtenstein, Norway and Switzerland, under the same conditions and at the same cost (free in some countries) as people insured in that country.”

It “does not guarantee free services. As each country’s healthcare system is different services that cost nothing at home might not be free in another country.” EHIC

A Scotttish Parliament Committee has been looking into the charging of patients from outwith the UK using NHS services and the reciprocal processes for when Scots are abroad.

The Healthcare (International Arrangements) Bill 2017-2019 is currently making its way through the UK Parliament. The Bill has become necessary because when the UK leaves the EU it will also be leaving the EHIC and arrangements have to be made so that people will continue to receive health care. The Health and Sport Committee of the Scottish Parliament have taken evidence and published their report because Health is devolved to Scotland.

The cost of paying for the treatment of UK citizens who are visiting or who have retired to EU countries comes in at about £630million every year:  £468 million of this being for UK nationals who residents, £156 million using EHIC cards.

It recovers about £50million from EU citizens requiring care here. This is because very few EEA citizens choose to retire to the UK.

15,000 Scottish pensioner migrants  who now reside in  EU nations cost around £48million a year. For other Scots requiring treatment in an EU nation it costs £2million a year.

Lewis MacDonald, MSP Convener of the Health and Sport Committee, said:

“The evidence we had gathered in our earlier report into reciprocal healthcare arrangements had raised a number of issues regarding the operation of the current scheme.”

Patients who are not  ‘ordinarily resident’ in the UK are supposed to be charged for using NHS services (with some exceptions, such as A&E treatment and treatment for certain infectious diseases). If they are citizens of the EEA the cost is recovered through the Department of Work and Pensions (DWP). If they are citizens from the rest of the world, the cost is recovered by the local health board which provided the treatment.

When a person registers with a GP they do not require to produce documents confirming their address. Although GPs were encouraged to determine a patient’s country of origin it was not mandatory. Anybody in Scotland may access primary care services with a GP without charge.

Lewis MacDonald 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.

“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 states:

NHS boards have a legal duty to adhere to charging regulations. However, we believe there may currently be instances where NHS boards’ assessment process for patient eligibility to services may be resulting in inconsistencies in application.

A further complication was identified in that NHS England revised its regulations:

These changes to NHS England policy can result in someone from England who, for example, works abroad, being unable to access free NHS care in England, but is eligible to receive free treatment in Scotland when visiting.

There are no figures for this taking place.

NHS Orkney was the only health board in Scotland which provided the committee with a break down of what it charges.

Some Health Boards are members of the EHIC Incentive Scheme which encourages ‘healthcare providers to record and report to the DWP usage of the NHS by EHIC card holders.’ Scottish Health boards in this scheme are refunded by the DWP.

£5 million worth of treatment, relating to 4,841 individuals, had been reported to the DWP by participating boards since the scheme was set up (at the end of 2014). This had resulted in the reimbursement of £1.25 million to those boards.

It is estimated that if all Health Boards in Scotland participated in the EHIC Incentive Scheme that it would be worth  £710,000 a year to each of them.

The report states:

If there are boards that continue to consider the scheme too administratively cumbersome when compared with the financial benefits we ask the Scottish Government whether consideration has been given to centralising the system at a Scottish Government or regional NHS board level to reduce administrative costs. 

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 EU withdrawal. Discussions are ongoing between the UK and Scottish Governments about having a memorandum of understanding inserted as a clause into the UK Bill because Health is a devolved issue and changes in regulations would impact on NHS Scotland.

Reporter: Fiona Grahame