The Daily Mail uses a handful of stories in a bid to construct a picture of systemic failure in the European health insurance card scheme. Is there any truth in it?

Are foreigners really gaming the NHS to pay for their medical treatment abroad?

Monday’s Daily Mail splashed on the revelation that foreigners were charging the NHS for care in their own country.



Is that true?

The newspaper claims the NHS is handing out 5 million European health insurance cards (Ehics) per year. It also seems to imply that Ehics are intended for Britons.

MP Sarah Wollaston, a GP and chairman of the health select committee, is quoted in the piece as saying: “Ehic cards should only be issued to British citizens ... you should not be offering Ehic cards to overseas citizens.”

Facebook Twitter Pinterest Monday’s Daily Mail front page.

This is incorrect.

Anyone who is “ordinarily resident” in the UK, and of British, other EU/EEA or Swiss nationality, is eligible for the Ehic – that’s a pool of nearly 60 million people according to ONS data, the vast majority of whom are British (for example, there are 2.6 million EU citizens in the UK and 23,000 Swiss nationals).

An Ehic is valid for up to five years, after which it needs to be renewed.

In light of all this, the 5 million figure without details of who the cards are issued to is meaningless, and quite possibly negligible.

Moreover, the Ehic isn’t a perk of the NHS. The card exists in all EU/EEA countries and is issued by the health service provider of each country. For example, a Briton resident in Spain or France can apply for one through the Spanish or French health or social security service.

To obtain the card (the form is here), the applicant must provide a national insurance (NI) or NHS number. Temporary NI numbers aren’t valid, and it should be noted that it takes two to six weeks to get a NI number. An Ehic application takes about seven days to process.



The Mail says its undercover Hungarian reporter “obtained the card after visiting the UK for less than one day” after another journalist posed as her landlord and presented a GP with the tenancy agreement of a property that neither occupied in order to get an NHS number.

The Ehic, according to the NHS website, covers:

Medical treatment you may need during your visit if you’re ill or have an accident.



Treatment for long-term (chronic) conditions and existing illnesses, such as kidney (renal) dialysis.



Routine maternity care, as long as you aren’t going abroad specifically to give birth.



It does not cover:



Planned treatment in the member nations.



Non-emergency surgeries.



Dental treatments which are not emergency.



Air ambulance (although these are available in some nations).



Over-the-counter medicines.

The Mail story goes on to state that using the card, the reporter could have “registered for a consultation with an optometrist costing a potential £150 or one with a dermatologist for £130 – or even antenatal and birth/maternity care for one pregnancy at £9,500, or a £47,000 liver transplant”.

However, the article neglects two important points.

First, the purpose of the card is to provide access to emergency or necessary health services and treatment to Europeans abroad. The key factor isn’t the type of treatment, but the reason why a treatment is required.

In other words, in the case of an emergency, a Briton who is travelling anywhere in the EU can access that country’s health service if in need. Vice versa, an Italian resident can do the same when visiting Britain.



In most countries, including in Hungary, the patient needs to be referred by a doctor for any hospital treatment just like in the UK.

Second, the Ehic allows to access healthcare from state providers on the same basis as a resident of the country you’re visiting. The card doesn’t grant additional services or special treatment.

This means that a Briton in Hungary is entitled to the same level of services as a Hungarian resident. And vice versa, a Hungarian holidaying in Britain can access the NHS on the same conditions as a UK resident.

The same applies to all member states of the EU, Iceland, Liechtenstein, Norway and Switzerland.

In most cases, the cost is picked up by the country that issued the card.

Any bills incurred for private healthcare or private medical treatment are non-refundable. And the card serves as a complement to travel insurance, not a replacement.

As of 1 July 2014 in any EEA country where that country requires its own citizens to pay a patient contribution, a foreign user will also need to pay for this.

As the Ehic website states:

Each country’s healthcare system is slightly different. With your Ehic, you should be able to get the same treatment as a resident of the country you’re visiting. In some countries you may have to pay a patient contribution, also known as a co-payment.

Finally, the Mail singles out healthcare in eastern Europe as particularly expensive due to insurance-based systems, compared with the free service provided in Britain. Although this explains differences in funding models, it says little about point of delivery. For example, the NHS is funded from general taxation and national insurance contributions.

The Ehic system is a multilateral agreement, which is implemented across multiple countries and is inherently complex. And as with all complex systems there are bound to be loopholes and there is potential for fraud. Make no mistake: governments and institutions should work to halt these.

In the case of the Daily Mail story, the NHS issued an Ehic to an individual that wasn’t eligible to receive the card because a GP was duped into issuing an NHS number.

What the investigation does expose is the ease with which proof of residency can be claimed and the challenge faced by any process that depends on proof of residency as a primary mode of identification.

Moreover, had the reporter gone on to receive treatment, it is likely the NHS would have incurred a cost it shouldn’t have.

Undoubtedly there are other similar examples of abuse or maybe others of outright fraud. The Mail itself cites a few quotes by “Romanians, Poles, Lithuanians and Slovakians”, taken from online forums.

However, it is not clear what incentive users would have to replicate such behaviour at scale; Ehic applicants would need to go to great lengths with no evident gain at the end. The treatment wouldn’t have been any different from that of a Hungarian resident using their own country’s healthcare.

So this raises the question:

Why would anyone partake in a similar exercise when there is no clear benefit?

The Mail piece uses a handful of stories in an attempt to construct a partial picture of systemic failure and allege that eastern Europeans are extensively exploiting the NHS. But there is simply insufficient evidence, in the newspaper’s story or otherwise, to support such a claim.

On the contrary, as with the cost of treating UK tourists in Europe or the number of Britons claiming unemployment benefits across the EU, the reality is far more nuanced and the bill being picked up by several richer EU countries is often higher than that footed by the UK.