The government is expected to fall well short of its target of recovering £500m a year from overseas visitors treated in NHS hospitals in England.
The Department of Health has “refined” to £346m its target for 2017-18, says the National Audit Office. Some £289m was paid in 2015-16; £73m in 2012-13.
A new “surcharge” for non-EU patients accounts for much of the rise, but only about half of debts owed are recovered.
The Department of Health said the increase showed “very good progress”.
NHS Trusts in England are legally obliged to check whether patients are eligible for free non-emergency NHS treatment and to recover any costs from overseas patients.
People from the European Economic Area (EEA), and Switzerland, are usually covered by agreements such as the EHIC scheme – where their government is billed for their treatment – while those from outside the EEA are invoiced directly.
But the National Audit Office report estimated that only half of debts were recovered from patients from outside the EEA and found that only 58% of hospital doctors knew some people were chargeable for NHS healthcare at all.
The Department of Health’s “ambitious” £500 m recovery target was aimed at reducing NHS trusts’ deficits, which reached £2.45 bn in 2015-16.
That year, an extra £164m was raised from a new £200 a year surcharge on visa applications paid by temporary migrants from outside the EEA.
That year also saw a 53% increase on the amount NHS trusts in England charged directly to patients, mostly to visitors from outside the EEA – much of which is thought to be due to new rules that allow hospitals to charge up to 150% of the cost of treatment, rather than a case of more people being charged.
And although amounts charged to people visiting from countries within the EEA increased slightly, they remain “well below” the ambition to recover £200m a year by 2017-18. The latest forecast for EEA income for that period is £72m.
The report found some hospitals were better than others at recovering money – 10 NHS trusts in London accounted for half of the total amount charged to non-EEA patients in 2015-16. Twenty trusts said they had no patients using the EHIC scheme.
It praised the Department of Health for using IT systems to help trusts find patients who should be charged and for visiting 60 trusts to promote its “cost recovery programme”, and said new financial incentives for reporting and charging overseas visitors had had an effect.
But it estimated that “trusts recover around half of the amounts they charge directly to patients, mainly visitors from outside the EEA”, with recovery rates varying widely – and it was not really understood why.
Head of the National Audit Office, Amyas Morse said: “Hospital trusts remain some way from complying in full with the requirement to charge and recover the cost of treating overseas visitors.”
He said much of the increase in amounts charged and recovered over the past two years was due to changes to charging rules: “If current trends continue and the charging rules remain the same, the department will not achieve its ambition of recovering up to £500m of overseas visitor income a year by 2017-18.”