Controlling Immigration – Regulating Migrant Access to Health Services in the UK

Alongside the consultation on illegal immigration in privately rented accommodation, and over the period 3 July – 28 August 2013, the Home Office is reviewing migrant access to UK health services. The current rules are generous compared to other countries, with UK taxpayers meeting the healthcare costs of health tourists, illegal immigrants and temporary residents.

Temporary non-EEA migrants and illegal immigrants currently receive free and unlimited access to primary health care (the point of initial consultation, most likely a GP). Such migrants may then be required to pay for secondary health care (hospital/specialist treatment), but this is often not enforced in practice as GPs are often unaware that the patients should pay for such care when they make a referral.

An ‘ordinary residence test’ determines whether migrants are charged for NHS care. The nature of the test, however, is such that temporary non-EEA migrants with valid leave for over six months will meet the requirements of the test and qualify for free secondary care.

The government is making proposals for either:

  1. A Migrant Health Levy; or
  2. Mandatory private health insurance.

Migrant Health Levy

This system would require migrants to pay an up-front levy of not less than £200 for each year of leave granted in order to cover the costs of their health care. There may also be the potential to opt out of the levy by making provision for private healthcare insurance. The regime would entail the following:

  • The fee would be collected as part of the visa process;
  • Payment would be a condition for obtaining leave to enter the UK;
  • The migrant’s Biometric Residence Permit would be endorsed to prove payment; and
  • Once paid, it would entitle the migrant to most NHS services free of charge.

The levy would apply to migrants under Tier 1 (high value), Tier 2 (skilled), Tier 4 (students), Tier 5 (temporary workers) and family migrants, and may also be applied to applications to extend leave.


  • A minimal risk of discrimination as health risks of potential migrants would be pooled so, for example, those with existing health conditions would not be disadvantaged;
  • The system is easy to understand; and
  • The fee could be varied depending on the migrant’s circumstances or application category.


  • Full costs of migrants’ healthcare would not be recovered;
  • Migrants may be deterred from applying for visas based on the cost; and
  • Individuals with existing health insurance may view it as an unfair charge if they cannot opt out.

Mandatory private health insurance

Under this system, all applicants would be required to obtain private health insurance.


  • Allows migrants to choose the level of care they wish to receive;
  • Reduces the demands on the NHS; and
  • Creates savings for the taxpayer.


  • The NHS may end up footing the bill for underinsured patients;
  • May lead to discrimination against certain migrants (e.g. the elderly or those with pre-existing health conditions); and
  • Cost of private insurance may be high and deter migrants.

Also mooted is the possibility of migrants’ sponsors or educational establishments covering their healthcare costs. The consultation ends on 28th August 2013 and the final decision is bound to be contentious regardless of how the government elects to proceed.