Not everybody living in or visiting the UK is eligible for free NHS care. Individuals from outside the European Economic Area who have not paid the immigration surcharge are chargeable for NHS care at 150% of cost. In 2017, new regulations introduced upfront charging for non-urgent care. Following this, reports of individuals being denied treatment -in particular British people from the Windrush generation appeared. This research provides the first large scale dataset examining the demographics

more »

... of those charged. Methods A freedom of information request was sent to 135 acute non-specialist NHS trusts in England to create a database of non-EEA overseas visitors charges from 2016/17 and 2017/18. This cross sectional survey was analysed using multiple linear regression to explore the relationship between sex, age, nationality, ethnicity, urgency and the cost of health care. Results Of 135 acute non-specialist trusts in England 64 replied, providing a data set of 13,484 patients. Women were found to be invoiced higher amounts than men (p=0.002). Patients were more likely to be women (63% vs. 37% men), and within this group, almost half of patients were of reproductive age, with 47.9% (3165) aged 16 to 40 years old. Multiple linear regression by age group showed that age is significantly related to the cost of health care with patients over 65 paying more than those aged 16-40, and 41-64 (p=0.011), and children under 16 paying less (p<0.001). The urgency of treatment was significantly related to cost, with the most urgent (immediantly necessary) treatment costing the most (p<0.001). Conclusions The demographics of those charged as overseas visitors alligns with the pattern of estimated costs of care for NHS care overall, where women of reproductive age and older patients require a higher amount of medical care. This research reflects current concerns of migrants being left behind in the strive towards universal health coverage which should be based upon quality, equality, and financial protection for patients. A key limitation was the low response rate.. The limitation of missing data has meant that questions surrounding possible charging discrimination of ethnic grounds cannot be answered.