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People moving to the UK for longer than six months are required to pay an Immigration health surcharge. I.e., they pay a tax when they request a Visa to be allowed to use the National Health Service (NHS) for free. According to Wikipedia this was introduced to offset the costs of medical tourism.

I never heard of a similar law applied in other countries. So I would like to understand it better. In particular:

  1. Other countries that have similar functioning health care systems (i.e., in layman terms free healthcare) fund healthcare with the general taxation. And immigrants pay normal taxes, so such law would not be needed. Is the NHS funded in a different way that would make necessary such law? Or is the NHS more accessible to foreigners than the typical healthcare system, so it is more easily exploited?
  2. Is the law unique in the world, or there are other similar laws?
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    It's a way of increasing the cost of a visa without increasing "the visa fee" – Caleth Mar 11 at 15:58
  • The point about taxation is that immigrants haven’t built up a history of taxation to pay for immediate care - and the fee they are required to pay is extremely low (£400 a year). So if you come on a 1 year visa and have a baby, that baby is going to cost the NHS around £10,000 but it’s going to cost you £400. The taxpayer picks up the rest. There’s no guarantee the immigrant will ever pay enough in tax to offset their cost to the NHS, so an average charge is front loaded for most visa types. – Moo Mar 11 at 18:20
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    @Moo everything you say about immigrants is also true of British citizens returning to the country from years of living abroad, but they don't have to pay the health surcharge. – phoog Mar 11 at 18:59
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    @Moo the scenario you describe might happen, but it can also happen the opposite: a young migrant pays taxes for years before needing to use NHS. Besides, that does not seems unique or more likely in the UK. By the way, £400 a year, per person and upfront is not extremely low: for a family of 4 and a 5 year visa is £8000. The average UK salary is around £30,000. Also, this is together with other moving costs, so you need to have at least £12,000 on hand. – gabriele Mar 12 at 6:56
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    @Moo it may be reasonable to say "if you don't like the surcharge, don't come," but it is not true that immigrants paying the healthcare surcharge are bearing their own costs. They're paying a flat fee to help fund the system, on top of the taxes they pay as workers and consumers. It's impossible to correlate individuals' tax payments with their use of healthcare resources; the government doesn't even segregate NHS expenditures from fuel duty revenues (see for example fullfact.org/election-2019/nhs-surcharge-tax-contributions). – phoog Mar 12 at 14:04
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I think the key difference is here how the NHS operates, compared to health care in most continental European countries. Being a UK resident is sufficient to qualify for NHS access, there is no additional paperwork required, a rental contract or even say bank statement mailed to you at a UK address suffices. This is not the case in most continental European countries. There, if you are a foreigner residing in the country you need to actively sign up for health insurance (you might be legally required to do so if you work there or are a student). So the NHS will treat a lot of people that would not get (free non-emergency) health care in continental Europe, so these countries don't have a need for a similar law.

So while I didn't do a proper check, I suspect this law is unique to the UK because of the unique way the NHS operates.

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    The Italian "Servizio sanitario nazionale" works in a similar way. You might be required to enroll for non-emergency care, but it is free (not all treatments are free though). – Denis Nardin Mar 11 at 17:16
  • @DenisNardin I don't know how the Italian health service works, but the 'having to enroll' is exactly the point that I believe to be the crucial difference. – quarague Mar 12 at 7:37
  • I'm not too familiar with it either, but I assume even in the UK you need some kind of paperwork to be assigned a GP? The laws explicitly say that some form of care is guaranteed even for people illegally present in the country, including emergency care, care for pregnant and underage people, vaccines and diagnosis of infective diseases (source ). People without a residence permit get release a special document by the hospital. – Denis Nardin Mar 12 at 7:59
  • @DenisNardin If I recall correctly in the UK you don't need any paperwork. GPs are assigned to postal codes, you can look up online which GP is assigned to a specific postal code. If you life there and have some proof of it, you can go to GP and get treated for free. – quarague Mar 12 at 8:01

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