Health warning on ONS 2017 data about British medical tourist volumes

 

According to a recent headline article in the British newspaper The Sunday Express, the number of British patients flying overseas for private medical treatment has quadrupled in four years as NHS waiting times reach record levels.

It reports that long waits for surgery such as hip, knee and cataract operations, together with the growing cost of dental care, are fuelling the rise.

International Passenger Survey (IPS) data is published by the UK's Office for National Statistics (ONS). They are not actual figures but grossed up estimates. The IPS surveys have been running since 1961 and 750,000 to 800,000 passengers entering or leaving the UK are interviewed. From this 250,000 interviews are used to produce estimates of overseas travel. The figures are used to provide information on international travel and how it has changed over time.

The IPS monitors departures and arrivals at UK ports and airports and surveys a sample of travellers, asking them about the main purpose for their travel e.g. business, holiday, education and medical travel, the last of which is within ‘any other reason’.

The IPS data must however be viewed with caution. Medical travel represents a tiny proportion of travel in general, and the sample size in the IPS data is very small. The figures might include people recuperating from illness in addition to people travelling for medical procedures. If they are combining medical treatment with a holiday they cannot tick ‘holiday’ and another reason, plus there is not actually a box for medical travel. The IPS numbers also do not include those travelling to spas and other wellness centres. Finally, passengers are only allowed to pick one country so can get confused between where they are ending up and the country they are initially travelling to from the UK before changing planes.

International Passenger Survey data

2003 - 32,000
2004 - 25,000
2005 - 59,000
2006 - 77,000
2007 - 71,000
2008 - 51,000
2009 - 54,000
2010 - 63,132
2011 - 63,635
2012 - 66,672
2013 - 63,989
2014 - 48,190
2015 - 100,338
2016 - 143,986
2017 - 150,000 estimated
Source IPS October 2017

The figure published by the Sunday Express, provided by the ONS, cover the period up to September 2017. The paper assumes that the trend continued through the final quarter of last year, and from this it calculated that 211,000 people travelled abroad for treatment in 2017.

Provisional IPS figures published by ONS for October and November and December 2017 on total outbound tourism show a 2% decrease in October, a 4% decrease for November and a 1% decrease for December.  So the Sunday Express assumption of increases for these three months is at best rash.

The published IPS figures for the first 9 months of 2017 totalled 117,383. If you use a rough and ready calculation that the trend continues for the final three months, and not allow for the usual late year decline, then the most optimistic figure for all of 2017 is closer to 156,400.  Allowing for the usual seasonal decline, this would give a figure of 150,000, which while still a substantial increase on 2016, is rather less than the Sunday Express figure of 211,000.

According to the IPS for the period January to September 2017, medical treatment trips by country were:

Belgium - 2,360
Bulgaria - 4,048
Czech Republic - 1,021
France - 8,361
Germany - 4,361
Greece - 4,369
Hungary - 17,800
India - 5,318
Ireland - 1,039
Israel - 484
Italy - 930
Latvia - 2,643
Lithuania - 5,600
Malta - 872
Netherlands - 2,344
Pakistan - 3,998
Poland - 16,899
Portugal - 2,309
Romania - 7,981
Russia - 309
Slovakia - 734
Spain - 7,826
Switzerland - 661
Turkey - 10,967
USA - 3,331
TOTAL - 117,383
Source IPS October 2017

Further to a user request, the ONS recalculated and reissued all total inbound and outbound figures from 2003 to 2016. Most changes were minor, but the outbound estimate of 91,000 was amended to 144,000.

Countries seeing higher figures include Bulgaria, France, Germany, Netherlands and Portugal. Countries with lower numbers include Italy, Latvia, Poland and Slovakia.

Country figures rarely show trends and if you study the actual numbers over the last seven years there are wild variations up and down from year to year, while countries appear and disappear off the list with no obvious reason.

For 2016 and beyond, there are other factors coming into play. Tighter rules on who can access the NHS, plus British politicians and news media blaming foreigners for NHS woes and using unsubstantiated claims about the costs of healthcare for people who are not British, have probably led to more foreign nationals working in the UK to return to their homeland for treatment. Many of these workers are self-employed, contract or agency workers who do not get paid if they do not work. They cannot afford to wait for treatment in the UK, and for non- EU/EFTA workers losing work can even mean they risk being sent home.

According to 2017 statistics from the ONS, the current non-British population living in the UK breaks down as:

Poland - 1,002,000
India - 362,000
Ireland - 335,000
Romania - 328,000
Italy - 233,000
Portugal - 213,000
Lithuania - 203,000
Pakistan - 195,000
France - 183,000
Spain - 165,000
Belgium - 30,000
Norway - 18,000
Iceland - 2,000
Lichtenstein - 40

The IPS does not ask for nationality as the survey applies to all UK residents. Thus the increasing numbers travelling to Pakistan, Poland, Portugal, Romania, Lithuania, France, Spain, Belgium etc. may partly be down to expatriate workers going home for treatment.

It would be fascinating to take out of these figures those expats and Brits travelling for cosmetic surgery and other treatment not covered by the NHS. It would help us to discover whether it is a fact or a myth that long NHS waiting lists are driving British patients to treatment overseas.

Daniel Horsfall at the University of York has done some work on the IPS figures and found that over 70% of those going to Poland in 2013, 2014 and 2015 were Polish nationals.  His research points out problems with IPS, but that over time it is a good comparative guide of who goes where, as long as you understand its limitations. 

Unlike what the papers say, there is no single statistic for waiting time, as it varies between the four UK countries and by type of treatment. NHS England statistics for January 2018 show 88.2% of patients waiting to start treatment were waiting up to 18 weeks. The number of patients waiting to start treatment was 3.73 million, and of those, 1,869 had been waiting for 52 weeks. The average waiting time is 7.6 weeks.

The conclusion is that more British people are indeed travelling overseas for medical treatment, but since much of this is for fertility treatment, dentistry and cosmetic surgery, arguing a direct causal link between NHS waiting lists and increasing numbers is making statistical assumptions that are unproven.

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