Many British people in other EU countries return to the UK for routine doctors’ visits, and many fail to register with a local doctor in their new country, particularly in the early stages following a move abroad. In some countries, bureaucracy means registering with local health authorities can take years.
But under new rules that come into force this month, people who make use of the NHS in the UK will be asked to declare that they are ‘ordinarily resident’ in the country. Those who live elsewhere in the EU, Norway or Switzerland, and who want planned treatment could find themselves forced to pay up-front.
Even expats seeking emergency treatment during short visits home could also face steep charges if they don’t have their paperwork from their new country in order, as the NHS seeks to claw back £500 million a year ($746 million, €695 million) in lost revenue.
The charges faced by patients without an EHIC card or proper insurance can be significant. Intensive care beds are charged at a rate of £1,800 a day, plus the cost of procedures and drugs. Even hospital outpatient visits can be costly, at £248 per visit.
The Royal Berkshire NHS Trust, one of 59 NHS Hospital Trusts in England, says on its website that patients who leave a debt could find their details registered with the UK Border Agency, meaning they could be stopped next time they try to enter or leave the country.
Claire*, from London, has lived in Italy for two years, but still isn’t registered with an Italian doctor. When she needed a smear test recently, she opted to have it with her old doctor in London.
“I wanted to speak to an English doctor who I could speak with, felt comfortable with and I knew. And I knew it would be swift.”
“I haven’t registered with an Italian doctor yet as I haven’t got a residence permit in Italy yet, due to the kinds of bureaucratic delays that are typical in Italy. Without residency, I can’t register with the health service.”
Long-standing European arrangements state that EU citizens should seek healthcare in the country they live in, regardless of their citizenship. They can seek healthcare in other EU countries, but this must generally be authorised and billed back to their country of residence.
But in a change to UK rules, expats who want treatment in the UK have to show a European Health Insurance Card (EHIC) issued by their new country. Until this month, former UK residents were automatically entitled to use the NHS for free if they fell ill during a visit. In practice, many expats use the NHS for planned treatment too. But now this right is being removed.
In an email to The Local, the UK Department of Health confirmed that there is no ‘grace period' following a move during which they can use the NHS - the moment they have left the country they lose their right to NHS treatment.
The new declaration could make it harder for expats to bypass the system, and new rules could leave expats with no option but to go private.
Joe Coaker of ALC Healthcare, a private insurer focused on expats, says Claire’s situation is not unusual.
“We often hear from expatriates who question the need for international health insurance as they imagine they can return to the UK and fall back on the NHS or the State healthcare in whichever country they come from,” he said.
There was better news for British retirees in Europe. Anyone living in the EU and receiving a British state pension will be entitled to free healthcare in the UK, as long as they hold a valid S1 form, which is obtained from British authorities before moving abroad.
The move comes after the British government decided last year that it would stop paying the healthcare costs of UK pensioners who lived in other EU countries, leaving many facing big bills.
In general, Austria offers excellent medical care for all citizens and expatriates. Medical services such as doctor’s appointments and hospital visits are generally free to anyone with a valid Austrian health insurance - and almost all employees are automatically covered by a public health insurance plan.
Those who work freelance and are self-employed have to pay their own contributions, and childless expats working in Austria with an unemployed spouse are expected to pay a contribution towards their health insurance, which varies according to income.
Austria is ranked 10th place in the European Health Consumer Index (EHCI), on a par with France and Sweden. Although abortion is not banned in Austria, it is not carried out in the public healthcare system, which is one of the reasons it doesn't rank higher.
*Not her real name