Charging migrants and visitors to the UK upfront for NHS care may be a false economy, say health experts in Sheffield.
Since last October, patients who are not entitled to free healthcare have been required to pay in advance for non-urgent treatment, under rules brought in to counter so-called 'health tourism'.
Sheffield Teaching Hospitals received £528,000 from overseas visitors in 2016/17, the most recent year for which figures are available, and wrote off £143,000. Those figures represented a tiny fraction of the trust's £1.06 billion annual income that year.
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A discussion organised by City of Sanctuary Sheffield, as part of the ongoing Festival of Debate, examined the impact of the new regulations on both migrants and the wider population.
Dr Jeremy Wight, Sheffield's former director of public health, warned of the negative implications.
Although infectious diseases are not chargeable, he explained, individuals may not realise they have TB, for example, and fail to seek help when they fall ill.
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Their condition could deteriorate, as a result, costing the NHS more in the long run.
Dr Wight described healthcare as a human right, which should not depend on financial contributions, legal status or nationality.
Dr Jo Buchanan, a GP who volunteers with the charity Doctors of the World, helping vulnerable people, told of a cancer patient who had been refused treatment until the charity took up his case and found he was entitled to free care.
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Sarah Eldridge, of City of Sanctuary Sheffield, said refugees and asylum seekers were often afraid to seek treatment even when they were entitled to free care, due to fears over deportation.
Until this month, when the controversial arrangement was suspended, the NHS had shared patients's details with the Home Office so it could trace people breaking immigration rules.
Ms Eldridge said: "Since 2017 failed asylum seekers have had to pay, with some exceptions, for hospital and community healthcare upfront – even though they may not have any funding.
"Because the rules are so complex, along with fear of deportation, language barriers, unsympathetic treatment by officials etc, even those who are entitled to free healthcare may not seek it."
She explained how this meant a pregnant woman may not receive ante-natal care, despite upfront payment not being required in this case, with women seeking asylum being three times more likely to die in childbirth than the general population.
"More broadly, the hostile environment around asylum seekers and refugees erodes trust and social values," she added.
"Upfront payment for healthcare currently applies only to a few, easily targeted groups, but it could spread – what about smokers, obese people etc."
Kirsten Major, deputy chief executive at Sheffield Teaching Hospitals, told how the trust interprets the rules 'compassionately', ensuring patients can access free health wherever possible.
Decisions about charging are made by a separate team, she said, leaving medics free to concentrate on clinical matters.
The debate was held at Sheffield University's Diamond Building on May 9 and chaired by the university's professor of public health, Sarah Salway.
The Festival of Debate runs until Friday, June 29, with more than 70 events taking place across the city.