As the Department of Health makes clear, anyone who is “ordinarily resident” in the UK is eligible for free NHS treatment. However when it comes to overseas patients, the situation is more complicated.
The cost of care for EU-nationals (as well as those living in Norway, Switzerland, Iceland and Lichtenstein) is covered by European regulations (883/2004 and 987/2009) which allows the UK to recover the money from the country concerned. The UK also has bilateral agreements with many other nations to enable similar arrangements.
However patients travelling from countries not covered are not eligible for free treatment, and should be charged for any care they receive.
While in theory therefore the taxpayer should not be liable for the costs incurred by treating foreign patients, the reality is somewhat different. This is because while the NHS is bound by its constitution to attempt the recovery of money owed by visiting patients, it is not always possible or economical to do so.
When asked in the House of Commons for the sums lost in this way in March, Health Minister Anne Milton revealed that it had cost the public purse just shy of £7 million in 2009-10, some way short of Mr Littlejohn's estimate.
Where then does the £200 million figure come from, and what can explain such a wide divergence in the estimates?
After doing some digging, Full Fact found that the £200 million figure had been cropping up in discussions of health tourism for many years. We were able to trace its provenance back to an estimate made in 2003 by debt collection agency CCI Legal Services, which works with the NHS to recover payments owed.
As media reports made clear at the time, CCI had actually estimated that the costs could be anywhere between £50 million and £200 million (in choosing to report the higher figure, Mr Littlejohn is of course not alone).
The estimate is several times larger than the sums reported by Ms Milton because the Government's figure only considers recognised debts that have been written off, whereas CCI attempted to account for overseas patients that go undetected by the health service, and therefore claim free care for which they were not eligible.
We got in touch with CCI in order to try to put the £200 million figure into some kind of context, and while a spokesperson told us that the firm no longer held copies of the 2003 research, they were able to give us a bit more detail to the estimate.
Most significantly, the spokesperson told us that while they thought the likely costs incurred by overseas patients were still “significant”, they were likely to have fallen since the 2003 estimate was made, as there had been “greater awareness of the issue and greater effort to tackle it.”
The Department of Health has confirmed that it does not currently hold an official estimate of the cost of 'health tourism' although it has suggested that proposed reforms to overseas treatment should provide more information and clarity on the issue.
Conculsion
Therefore, while Richard Littlejohn isn't wrong to claim that it has been “said” that the costs may be as high as £200 million, we need to treat this figure with a good deal of caution: at best it is the upper bound of an eight year old estimate, at worst it is something of a stab in the dark.