| Verified against primary record | |
| Statutory definition of overseas visitor | A person not ordinarily resident in the United Kingdom[1] |
|---|---|
| Charge rate | 150 per cent of the price of the service[1] |
| Payment timing | Upfront, except where it would delay immediately necessary or urgent care[1] |
| Charged to overseas visitors (2015-16) | GBP 289 million, including GBP 164 million from the immigration health surcharge[2] |
| Chargeable EEA costs actually charged (2012-13) | About 16 per cent, GBP 49 million of GBP 305 million[2] |
| Estimated annual cost of deliberate health tourism | Between GBP 70 million and GBP 300 million[2] |
| UK residents travelling abroad for treatment (2022) | About 348,000, estimated by the Office for National Statistics[3] |
| British nationals who died in Turkey after procedures (2023) | Six, according to the Foreign, Commonwealth and Development Office[3] |
| Bands apply only to the rows beneath them. The United Kingdom does not count foreign patients. Its inbound figures are sums charged and recovered, not numbers of people, and the audit office describes the underlying data as incomplete and unreliable. The health tourism range is the audit office’s own plausible range, and it excluded the category from its estimate of recoverable amounts because the uncertainty was too great. No typical cost range is given because the statutory charge is set as a multiple of the national tariff rather than published as a price list. | |
Medical tourism in the United Kingdom is unusual in that the state measures it almost entirely as a debt-recovery problem. There is no official count of foreign patients treated in the United Kingdom. Instead there is a statutory duty to charge people who are not ordinarily resident, at 150 per cent of the national tariff, and a long record of auditors reporting that most of what could be charged is not charged and much of what is charged is not paid. The outbound direction is better counted: the national statistics office estimates that about 348,000 United Kingdom residents travelled abroad for medical treatment in 2022.
The charging regime
The National Health Service (Charges to Overseas Visitors) Regulations 2015 define an overseas visitor as a person not ordinarily resident in the United Kingdom. Regulation 3 requires a relevant body to charge overseas visitors for accommodation, services and facilities provided under the National Health Service Act 2006, once it has made reasonable enquiries and determined that no exemption applies. The charge is the price of the service multiplied by 150 per cent, with separate rules for certain residents of the European Economic Area and Switzerland.[1]
Payment is required before the service is provided, but not where securing it would delay an immediately necessary service or an urgent service. Immediately necessary services include antenatal and maternity care and treatment needed to save life or prevent permanent serious damage; urgent services are those that should not wait until the recipient can leave the United Kingdom. The regulations also name parties other than the patient who may be liable, including shipowners, employers of air crew, and the parents or guardians of children.[1]
The exemptions are extensive. No charge arises for accident and emergency services, excluding inpatient care after admission and outpatient appointments; family planning; sexually transmitted infection services; treatment for conditions caused by torture, female genital mutilation, domestic abuse or sexual violence; certain palliative care; and specified communicable diseases. Payers of the immigration health charge are exempt, as are citizens’ rights holders, holders of S1 certificates, refugees and asylum seekers, and people covered by certain healthcare agreements.[1]
One exemption speaks directly to medical travel. Treatment for the communicable conditions listed in Schedule 1 is free only if the visitor did not travel to the United Kingdom in order to seek it. The regulations therefore contemplate deliberate travel for treatment as a category and legislate against it, which makes the absence of any count of such travellers more striking.[1]
What the auditors found
The National Audit Office examined cost recovery in October 2016. Amounts charged to overseas visitors rose from 89 million pounds in 2012-13 to 97 million in both 2013-14 and 2014-15, then to 289 million in 2015-16, although 164 million of that last figure came from the immigration health surcharge rather than from treatment charges. Cash actually received from non-EEA patients was 19.6 million pounds in 2013-14, 25.1 million in 2014-15 and 29.3 million in 2015-16.[2]
Against a government aim of recovering up to 500 million pounds a year by 2017-18, the Department’s own October 2016 forecast was 346 million charged, which the audit office described as a shortfall of roughly 150 million.[2]
The gap between what could be charged and what was charged was the central finding. For 2012-13 the potentially chargeable amount was estimated at 367 million pounds, 305 million relating to visitors from the European Economic Area and 62 million to visitors from outside it. About 65 per cent of the non-EEA amount was charged, but only about 16 per cent of the EEA amount. Research cited in the report indicated that the health service charged less than a fifth of what it could have, and that only around half of the amounts charged to non-EEA patients were actually paid.[2]
The health tourism question
On deliberate travel to obtain free treatment, the audit office declined to produce a usable figure. It reported that health tourism could plausibly cost the health service between 70 million and 300 million pounds a year, a range spanning more than fourfold, and did not separate deliberate health tourists from other overseas visitors. It noted that the category mixes frequent visitors registered with general practitioners together with people who come specifically for free care. Because of that uncertainty it excluded health tourism from its estimate of potentially recoverable amounts altogether.[2]
It was equally direct about the data. No national data were collated on how many non-EEA patients are treated each year, or on direct invoices to EEA patients. Very limited data existed to predict how many overseas visitors a given trust might treat, and variation between trusts was only partly explained by size, type and region, so the report could not say from the data alone whether a trust was performing well. It also noted that international comparison was difficult because little data were available on other countries’ recovery.[2]
A separate estimate in the same report put the gross cost of treating irregular migrants at 330 million pounds, which the audit office called very uncertain and excluded from recoverable amounts.[2]
United Kingdom residents treated abroad
The outbound flow is counted, through the national travel survey rather than through health records. The National Travel Health Network and Centre records Office for National Statistics estimates of 151,609 United Kingdom residents travelling abroad for medical treatment in 2018, about 248,000 in 2019 and about 348,000 in 2022.[3]
Official safety advice has followed the volumes. The same source records that the Foreign, Commonwealth and Development Office was aware of six British nationals who died in Turkey in 2023 after medical procedures, with others needing further treatment or surgery, and notes a botulism cluster linked to weight-loss treatments in Izmir and Istanbul in February 2023 and possible HIV exposure linked to cosmetic microneedling. It identifies bloodborne infections including hepatitis B, hepatitis C and HIV, carbapenem-resistant Enterobacteriaceae, venous thromboembolism after long-haul flights following surgery, unnecessary treatment, counterfeit or poor-quality medicines, and complications that appear weeks or months later and are then presented to the health service at home.[3]
Its pre-travel guidance includes discussing plans with a United Kingdom clinician before committing, verifying the treating clinician’s qualifications independently rather than relying on sales staff, obtaining a written contract covering aftercare and complications, noting that the European and Global Health Insurance Cards do not cover planned treatment, and arranging insurance that includes medical evacuation.[3]
The former European route
While the United Kingdom was a member of the European Union, residents could in principle obtain planned treatment in other member states under the cross-border healthcare Directive. The European Court of Auditors found that about 200,000 patients a year used the Directive across the Union, fewer than 0.05 per cent of EU citizens, that spending under it amounted to roughly 0.004 per cent of the Union’s healthcare budget, and that fewer than 20 per cent of citizens surveyed in 2015 were aware of their cross-border rights. That route is no longer available to United Kingdom residents on the same basis.[4]
Limits of the evidence
The inbound figures here are monetary and dated. The most recent comprehensive audit located is from 2016, and its own conclusion was that the data were incomplete and unreliable, so the amounts should be read as indicators of administrative performance rather than as measures of patient volume. No official count of foreign patients treated in the United Kingdom was located. The outbound estimates come from a travel survey, which depends on travellers classifying their own purpose of travel, and the 2019 and 2022 figures are given as approximations in the source. The six deaths recorded in Turkey are cases the Foreign Office was aware of, not a complete count of harm.
See also
- Outbound medical tourism, the better-counted direction of United Kingdom medical travel
- Complication rates in medical tourism, the harm the official advice addresses
- Medical travel and waiting lists, a commonly cited driver of outbound travel
- Cross-border healthcare, including the European route no longer open on the same terms
- Hair transplant tourism, among the treatments behind the Turkey safety warnings
References
- United Kingdom. The National Health Service (Charges to Overseas Visitors) Regulations 2015. SI 2015/238. Verified against primary record: the regulations were opened and the definition of overseas visitor in regulation 2, the duty to charge in regulation 3, the 150 per cent multiplier in regulation 7(3), the upfront payment rule and its exceptions in regulation 3(1A), the liability of third parties in regulation 4, and the exemptions in regulations 9 to 15 including the Schedule 1 condition that the visitor did not travel to seek treatment were read directly. Retrieved 23 October 2026.
- National Audit Office. Recovering the cost of NHS treatment for overseas visitors. October 2016. Verified against primary record: the report was opened and the amounts charged by year, the cash received from non-EEA patients, the 500 million pound target and forecast shortfall, the 2012-13 potentially chargeable estimates and the proportions charged for EEA and non-EEA visitors, the 70 to 300 million pound health tourism range and its exclusion from recoverable amounts, the irregular migrant cost estimate, and the findings on data quality were read directly. Retrieved 23 October 2026.
- National Travel Health Network and Centre. Travelling for treatment (medical tourism). Published 27 March 2023, last updated 17 June 2024. Verified against primary record: the factsheet was opened and the Office for National Statistics estimates for 2018, 2019 and 2022, the Foreign, Commonwealth and Development Office figure for British nationals who died in Turkey in 2023, the named outbreaks and infection risks including antimicrobial resistance, and the pre-travel guidance were read directly. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the annual patient estimate, the share of citizens, the share of healthcare spending and the 2015 awareness finding were read. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. The inbound figures are amounts charged and recovered, and they are not converted into patient numbers, because no official count of foreign patients treated in the United Kingdom was located. The health tourism range is reproduced as the audit office’s own plausible range, together with its reason for excluding the category from recoverable amounts; no single point estimate has been derived from it. The outbound figures are travel survey estimates attributed to the Office for National Statistics as the factsheet reports them. Pre-travel guidance has been restated in the third person rather than quoted.