Expert in health economics Dr Jonathan Cave comments on how expatriates returning to Britain for healthcare after Brexit could set the NHS back £1 billion a year.
“Residence rights without access to healthcare are seriously diminished. The EU has placed residence at the top of its agenda, so one would expect this to be negotiated on a reciprocal basis”.
“There is a countervailing consideration (NHS costs for EU visitors and residents). Current evidence suggests that they may be healthier (especially as a higher proportion are here for work rather than retirement) than UK expats in Europe, but it isn’t clear whether they cover their costs when the settlement payments among health systems are taken into account”.
“Age-related costs go both ways; the recent discussion of residence rights for children of current EU residents in the UK post-Brexit that will push up per-capita costs for the NHS. In relation to this, if rights are allocated on a similar basis to that used in Germany (8 years’ permanent residence of parents), this may be less”.
“The mobility of both young EU workers in the UK and UK retirees in Europe may be an issue. If the retirees have to sell up and come home, they may be poorer than they are at the moment. They may also be less willing and able to move than young expat workers. Hard to guess what this will mean either for the facts or the negotiations”
“The symmetry of the issue (EU citizens here, UK citizens there; healthcare cost pressures throughout Europe) should encourage both sides to negotiate this seriously; perceived asymmetries (the generally poorer health of UK citizens abroad compared to EU citizens here) may stiffen EU resistance. But any such offer should come with a continuation of the current settlement arrangements, which lowers the stakes (and hopefully the temperature)”.
“An important element will be the establishment (and mutual recognition) of a suitable accounting system for measuring and costing utilisation. The technology exists, the political will is another matter”.
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