Making private medical insurance a requirement for all non-EU citizens obtaining visas for more than three months.

The UK is the only EU country to provide totally free healthcare. The National Health Service (Charges to Overseas Visitors) Regulations 1989 say NHS charges may not be made to people unless they are 'not ordinarily resident'.  The current definition of 'ordinarily resident' however includes anyone (plus their spouse, civil partner and children, under the age of 16 or up to 19 if in further education, if they are living with that person):

• accruing 12 months lawful UK residence, even if the Home Office has not granted leave to remain on a settled basis
• taking up permanent residence from the time of their arrival: if someone states that they intend to live permanently in the UK and have the requisite visa.  
• in UK employment or self-employed with their principal place of business in the UK even if not in the UK for 12 months
• given leave to enter the UK by the Home Office to marry or become the civil partner of someone ordinarily UK resident
• granted refugee status or who has made a formal application to the Home Office for asylum while their application is being processed.  The definition continues if the initial application is rejected.  If any appeal is finally rejected any course of treatment which began before the application was finally rejected will continue to be free of charge

Regardless of residential status, emergency treatment is free of charge.  GPs also have a measure of discretion in accepting applications to join their patient lists. A practice is not able to refuse an application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.  More than 600,000 people from abroad signed up with a GP in the past year, of whom only about 70,000 were British people returning from overseas.

In Ireland the government takes a more robust view and requires most people entering the country, if they plan to stay more than 3 months (even if they are from the EU), to have sufficient medical insurance.  

Despite the apparent dislike of the current government and of certain NHS stakeholders for private health insurance as being a socially divisive measure, the NHS website already states that those from overseas not covered for their health costs: 'are strongly advised to take out private healthcare insurance that will cover you for the length of time you are in the UK.'  

On the 20th July 2009, Ann Keen (Parliamentary Under-Secretary, Department of Health) said in the House of Commons: 'The Government are also attracted to the principle of visitors (who are not covered by EEA or other reciprocal health agreements), being required to have personal health insurance provision, as is already the case in some other countries. We intend initially to seek views on the merits and feasibility of such a scheme that will inform further work to evaluate possible options.'

There would be substantial cost savings.  Out of a resident UK population of 60.6 million, there are now estimated to be 4.2 million (6.9%) foreign nationals, of which 1.8 million (2.9%) are from the EU and 2.4 million (4.0%) from the rest of the world (India 297K, Pakistan 176K, USA 126K, South Africa 101K, Nigeria 93K, Australia 85K, China 82K, Philippines 79K, Bangladesh 74K and Somalia at 69K are the 10 largest).  

These people will have broadly similar health care costs to the rest of the population although there may be some variations (e.g. fewer older people but a higher birth rate: 24% of babies are born to mothers themselves born outside the UK).  On this basis, requiring these non-EU nationals to have health insurance will save the NHS about £4 billion (extending this to EU nationals will save a further £2 billion).

Visitors to the UK for less than three months would be unaffected by these measures as to try to apply them to this group could have a serious effect on tourism and on short-term exchanges for educational or business reasons.

The cost of health insurance will vary depending on the age and medical history of the person. However for most people it is likely to be in the £1,000-2,000 range. The insurance would have to be with licensed UK insurance companies who would be required to report to the Border Agency if premiums fell into arrears.

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