Whether patients in the British National Health Service (NHS) will receive better service as a result of the United Kingdom’s vote to exit the European Union could hinge on the country’s negotiation for international insurance cards and cross-border movement of health care workers.
In the weeks before the June 23 Brexit vote, “Leave” campaign leader Nigel Farage called for reinvesting into NHS some of Britain’s current annual contribution to the European Union, which Farage said surpasses £350 million ($458 million) a week and would be enough to pay for one new NHS hospital per week.
Advocates of leaving the European Union also called for stemming the flow of mainland immigrants to the United Kingdom.
Days after the vote, Farage disputed claims he had pledged to repurpose funding for NHS or restrict immigration, The Independent (London) reported on June 25.
Approximately 130,000 health care workers in the United Kingdom, including 10 percent of current doctors and 5 percent of nurses, are nationals of mainland E.U. countries, BBC reported in June. This number could plateau or diminish if the country implements immigration policies consistent with the statements of some leave advocates.
Britain is facing a possible health care workforce shortfall of up to 50,000 doctors, nurses, midwives, and ambulance crews, as officials transition NHS to serving patients seven days a week by 2020, BBC reported in May.
$458 Million Chin Wag?
Kristian Niemietz, head of health and welfare studies at the London-based Institute of Economic Affairs, says NHS never was destined to receive an additional $458 million a week as a result of Brexit.
“That promise of [$458 million] a week of extra spending for the NHS was never realistic,” Niemietz said. “This figure refers to the United Kingdom’s gross contribution to the European Union. What matters is the net contribution, which is a bit less than half a percentage point of GDP—still quite substantial, but not quite the magic money tree that was promised.”
The United Kingdom’s net contribution is the difference between the amount it gave to the European Union in a year and the amount the European Union spent that year on the United Kingdom.
Cross-Border Competition ‘Desirable’
Britain’s ongoing negotiations with the European Union will determine whether British citizens can continue to use a European Health Insurance Card (EHIC) to receive emergency treatment abroad, Niemietz says.
“Everything now depends on what the post-Brexit settlement will be,” Niemietz said. “The EHIC can be used in [non-E.U.] Norway and Switzerland as well, so if we go for a similar settlement, there will be no change. Failing that, it could indeed become quite complicated.”
Niemietz says establishing real cross-border competition among providers would benefit NHS patients, whose options are generally limited to providers in the United Kingdom as a function of British policy.
“I’d agree that cross-border competition between health care providers would be desirable, but that doesn’t happen even under the EHIC system, which is mostly about emergency treatment,” Niemietz said. “You cannot normally request a referral to, say, a French hospital. This is a national policy choice. In the Dutch system, which is a much more market-oriented one than the British NHS, such cross-border referrals are an option.”
Labor Immigration Concerns
The European Union’s “free movement” policy allows citizens of one E.U. nation to move to, reside in, and work in another E.U. country.
Niemietz called the possibility of Britain restricting the free movement of labor “the major risk we’re facing at the moment.”
“If the British side insists on ending free movement and absolutely refuses to sign up to any deal that preserves it, then it is very unlikely that the United Kingdom will retain full access to the European market,” Niemietz said. “Under those circumstances, there would indeed be an economic contraction and very likely fewer health workers coming in from abroad. [There will] be less money to spend on the NHS and less staff. That would be the worst possible outcome.”
Michael T. Hamilton ([email protected]) is The Heartland Institute’s research fellow for health care policy, managing editor of Health Care News, and author of the weekly Consumer Power Report.
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