Health boards owed £1.8m by overseas patients

The amount owed by foreigners to Scottish health boards increased by £700,000 over the last 18 months Image copyright Thinkstock
Image caption The amount owed by foreigners to Scottish health boards increased by £700,000 over the last 18 months

Scottish health boards are chasing overseas patients for £1.86m in unpaid hospital bills, according to data obtained by BBC Scotland.

Most debt is for treatment given in the past year, but one boards is still pursuing a bill from 2003.

The bulk of outstanding charges are due from citizens of the USA, Canada, Nigeria and India.

The Scottish government said it represented a small proportion of the NHS budget.

Half of the overall debt - £893,368 - is owed to NHS Greater Glasgow.

The figures, obtained by BBC Scotland through a series of coordinated freedom of information requests, also reveals the total of unpaid bills has more than doubled over the past two years.

Debt backlog

In April 2013, it was reported Scottish health boards were owed £1.1m by overseas patients - compared to £712,182 in 2012.

And the data shows part of the problem is the exponential build-up of patient debt from previous years.

NHS Fife is still chasing a US citizen for £2,602 for treatment dating back to 2003; NHS Grampian is trying to recoup £2,485 from an Indian citizen for treatment they received in 2007.

A spokeswoman for NHS Grampian said the overdue debts were often due to "claims against the estate of deceased persons, insurance companies disputing charges, lack of insurance or an ability to pay."

"Occasionally a write off is processed, for example when the person is deceased, and we have tried all legal recourse or it would be uneconomical to pursue the estate."

Image copyright Thinkstock
Image caption The amount of debt owed to Scottish health boards by foreign patients has more than doubled since 2012

A NHS Greater Glasgow and Clyde spokeswoman said: "Despite our best efforts some bills remain outstanding."

She added: "A proportion of the current outstanding monies is owed by patients who have pending insurance claims or who have every intention of paying their bill and we have already recouped over £250,000 in owed monies since April 2013."

However, the data obtained by BBC Scotland reveals that since April 2013, an additional £337,368 has been accrued in unpaid bills.

And the amount owed to NHS Lothian has nearly trebled to £493,533 since 2008.

The board has written off 8% of unpaid bills in the past five years and is still owed more than £180,000 from as far back as 2012.

Susan Goldsmith, director of finance at NHS Lothian, said: "Our invoice and collection systems have improved vastly in the last six years.

"It means that while the amount of money owed has increased during that time, it is a direct result of more invoices being created within a streamlined and more effective system.

"Figures show that the money owed by overseas patients once stood at 50 per cent of our expected income. Since we improved our systems, that figure has fallen to 16 per cent.

NHS Lothian says it has recovered £1.4m in the last five years.

A Scottish government spokeswoman played down the figures, saying the outstanding bills represented just 0.02% of the country's £12bn health budget.

She said: "Scotland does not have a significant problem with overseas visitors failing to pay for NHS healthcare, and we welcome that the vast majority of overseas visitors settle their healthcare bill promptly.

"In addition, a proportion of the current outstanding monies will be owed by patients who have pending insurance claims or who have every intention of paying their bill."

'Health tourism'

Some of the costs incurred will never be recoverable by Scottish health boards because certain services in the UK - such as ambulance services, A&E care, and wards associated with A&E - are free to everyone.

But patients whose condition was not life-threatening, and whose normal residence is outside of the European Union, have to pay for services with certain exceptions.

Health boards must then try and recoup other treatment costs from individuals or insurance companies.

The UK also has reciprocal agreements with most European countries and 28 other nations, including countries such as Canada and Australia.

But travelling to the UK deliberately for health treatment - so-called "health tourism" - is not allowed.

A 2013 report estimated health tourism in the UK cost the NHS between £20m and £100m.

Scottish health boards can pursue debt via the Central Legal Office which has a contract with an international debt recovery company.

Boards are also required to pass details of those with outstanding bills to NHS Scotland's Counter Fraud Service (CFS), who liaise with the UK Border Agency.

Non-payers can then be refused re-entry to the UK until they settle their outstanding health bill.

A spokesperson said that in 2014-2015 so far, 129 cases have been referred to the CFS from various sources including health boards, GP practices and the UK Home Office.

How much is each Scottish health board owed by overseas patients?
Health board Amount owing Largest, or oldest, outstanding amount
NHS Ayrshire and Arran £29,607 £6,329 owed by a US citizen for orthopaedic treatment
NHS Borders £17,409 £8,568 owed by a US citizen
NHS Dumfries and Galloway £9,685 £6,770 owed by a Canadian citizen
NHS Fife £22,268 £2,602 owed by a US citizen since April 2003
NHS Forth Valley £15,176 £11,104 owed by a US citizen
NHS Grampian £153,830 £2,485 owed by an Indian citizen since July 2007
NHS Greater Glasgow and Clyde £893,368 £184,804 owed by US citizens; £162,459 by Pakistan citizens
NHS Highland £87,831 £12,200 in outstanding debt from 2012
NHS Lanarkshire £19,810 £3,736 owed by a US citizen from 2011 for maternity care
NHS Lothian £246,000 (latest figure provided by board after their initial FOI response) £180,058 in outstanding debt from 2012
NHS Orkney £12,856 £3,406 owed by a Brazilian citizen from September 2011
NHS Shetland £0 N/A
NHS Tayside £111,815 £51,216 owed by a citizen of unknown nationality
NHS Western Isles £333 £333 owed by a Canadian citizen from May 2013

Related Topics

More on this story