A Bitter Pill to Swallow

Photo credit: wikimedia commons

Features editor Emma Freer and deputy features editor Lara Guneri uncover student reactions to the NHS’ new policy: charging international students for access to care

Illustration: Olga Loza
Illustration: Olga Loza

The NHS has recently changed its policy for international students. Currently, overseas students enrolled in a course of study longer than six months are entitled to the same NHS services as any UK resident. The policy change, however, stipulates that from as early as next year, students from outside the EU will pay £150 per year for access to NHS care.

This change will obviously impact students at St Andrews. Flo Elisabeth, a UK citizen who has been assigned international student status because of time spent living abroad, told The Saint: “Any international student will be affected. This is a huge majority of people. My university, the University of St Andrews, prides itself on its diversity and the number of international students. With this NHS policy change, it might not be able to do so anymore.”

While the policy will not affect any current students at St Andrews, it raises important questions about the status of international students in the UK and especially at St Andrews, which is Scotland’s most international university.

Behind the policy change

So what was the impetus behind this policy change? In October 2012, the BBC published an investigation on health tourism in the UK. Their report revealed that ‘health tourists’ – foreigners who come to the UK in search of free health care – cost the NHS at least £40 million over a four-year period. The next year, Health Secretary Jeremy Hunt said to the BBC, “We have been clear that we are a national health service and not an international health service, and I am determined to wipe out abuse in the system.”

That same month, the Department of Health published a report entitled, ‘Sustaining services, ensuring fairness,’ which addressed migrant access to and payment for NHS services. In the report, the department called for new policies that would prevent such access without pay. While international students were not the focus of the report, the policy changes it called for have come to fall largely on their shoulders.

According to the report: “The proposals set out… do not challenge the provision of universal access to a comprehensive health service, but pursue the principle that everyone should make a fair contribution to the services they receive.” It continues: “[W]e propose that those who come for a limited period make an explicit contribution to the costs of their healthcare.” Just over a year later, the NHS announced its new policy regarding international students.

Evaluating additional costs

In terms of cost, the NHS’ new policy is hardly extreme. At £150 per year of study, it is frankly only a small fraction of what international students will pay to attend the University and to live in St Andrews. Armaan Joseph Ireland, an international student from Dubai, feels that the fee “is not that much.” For others, the new fee is a relative bargain. Dwayne Yin, an international student from China, attended boarding school in the United States, where international students are expected to pay up to $1500 a year for private health insurance. He said: “Personally, a surcharge of £150 for the NHS actually seems like a good deal in comparison.”

Regardless, the effects of this provision, as it currently stands, should not be overlooked. Isabelle Balard, an international student from Panama, says that even if the new policy had been implemented before her matriculation, she “still would have come to the University.” However, she admits that, “the free healthcare was definitely an incentive because it made [me] feel safe about moving to another country that cared enough for both international and local students” to provide them with equal access. With the new policy in place, though, international students will have to pay into the system for access to care.

There is a legitimate worry that it is not the cost so much as the principle that could prove harmful to the University in the long term. Currently, any international student is entitled to free consultations, routine and emergency treatments and prescribed medication through the NHS as a benefit of his or her student visa. Basically, international students enjoy the same access to NHS care as any ordinary UK resident.

A spokesperson for the University said: “The welfare system is a matter for Government. However, as Scotland’s most international university, it is vital that we have a policy environment that allows us to compete effectively in a global market. The University is concerned about the impact that a health care charge could have on our ability to attract the bright and the best from around the globe.”

It is not just the University that is concerned. One international student from Australia who asked that her name not be used, said of the policy change: “I think it will affect those who come to the UK without any prior knowledge of the British health system. It can be very confusing, and there isn’t a great deal of private health options in St Andrews, so I imagine that will be frustrating when the NHS puts up this barrier.” Ellie Kitman, an American student, agrees. She said: “To me, one of the best parts of St Andrews is how diverse the student body is and denying international students easy access to something so basic [as health care] would ruin that.”

(In fact, the new policy will not give international students the option to deny enrollment in the NHS as part of their visa application; the added charge will be mandatory.)

The National Union of Students (NUS) also has strong opinions about the new policy. According to its website: “Of those subject to visa controls, non-EEA international students are already the most heavily regulated, monitored and pay the most into the UK economy for the duration of their stay. The further monitoring and regulation proposed by the Government is unnecessary, will cost more than its benefits and will unfairly target a group that contributes a phenomenal amount not just economically, but also the strength of our education sector.’

International students already pay the highest tuition rates of any students at St Andrews, as at any other British university. In a speech delivered at Trinity College Dublin in 2010, Principal Louise Richardson touched on this. She said: “If we treat foreign students simply as cash cows, without adapting our institutions to meet the challenges they present, it won’t be long before the market will punish us. They will choose to study elsewhere, and we will have missed the opportunity to enrich our universities by their presence.” This new NHS policy might be exactly the kind of challenge that could turn the international student market away from British universities.

Omar Ali, the Students’ Representative Council Member for International Students, added:“When we shut off access for some of the best and brightest minds in the world, we detract from the attractiveness of a British degree by putting off future world leaders – all in the name of a more balanced budget.”

Explaining the policy change

But perhaps the real issue is neither cost nor consequence but rather why the NHS is choosing to charge international students in the first place. According to the University’s official statement on the matter, “It remains unclear as to how burdensome international students actually are on the NHS and therefore whether there is any justification for such a charge.”

A major impetus behind the new policy is the NHS’ attempt to crack down on health tourism. Of course, international students hardly qualify as ‘health tourists.’ Bea Chu, an international student from California, said: “It [the policy] is not the school’s fault; it is happening everywhere. I mean, it shouldn’t be too much of an important factor if you want to come study here. If you want to study here, there are other reasons for you to [do so] besides free health care.” Armaan added: “I am here because of [what] St Andrews [has to offer]. Everything else is secondary.”

It is certainly legitimate for the NHS to charge international students for health care on the grounds that they are provided access to care paid for by UK taxpayers without any contribution of their own. However, if this new NHS policy has been put in place to curb health tourism, it is misguided to target international students. Health tourism, while a serious drain on NHS resources as proven by the aforementioned BBC investigation, is a problem independent of the UK’s international student population.

In 2013, The Telegraph published an article on health tourism in the UK. The piece cites specific ethnic groups (e.g. East Asians in south London) clustered in certain hospital districts as an example of health tourists. It also uncovers a significant trend of West African women flying into the UK while heavily pregnant. Once landed, they give birth for free through the NHS. These women have the added security of knowing that the UK will not be able to send them back home before they have given birth due to airline protocol when it comes to heavily pregnant women on flights.

Needless to say, international students at UK universities hardly fit the bill when it comes to health tourists. Yet international students are apparently being asked to pay for this problem. The new policy that requires international students to pay for NHS care is part of a larger immigration bill passed by the UK Government. According to the NUS, the effects of this bill “will impact international students more than any others as they make up 75 per cent of those subject to visa controls.’ While the problem of health tourism is real, it does not seem a fair solution to charge international students simply because they are the easiest to regulate and charge.

And international students are certainly feeling the impact of the policy change, even those who will never be personally affected by the new policy. Isabelle said: “The free healthcare service allows us students from abroad to come to this University feeling safe that no matter what accidents we suffer, [we] are covered under national healthcare. By making us pay a fee for the service, I feel that students will become more insecure because we can’t ensure that we would receive the same quality of service as that of a local.” Even international students who have never used the NHS feel affected. Flo said: “It is not about how much I use the NHS, but when I will need to use it. It is a really valuable support system to have, and to take it away would be devastating.”

But Flo is especially concerned about what the policy will mean for future international students, both at St Andrews and elsewhere. She is in the unique situation of being a UK citizen with international student status because she had lived abroad for a certain period of time before returning for university. She said: “I worry for the future generation. I have three younger brothers who aspire to go to university in the UK. I would be furious if they not only had to pay the outrageous fee that I currently pay for my education, but if the NHS decides not to support them any longer.”

Furthermore, while current international students at St Andrews will not be affected by the policy change, it may later if they choose to remain in the UK for a postgraduate degree. According to the NUS, a postgraduate research student with a family of his or her own could have to pay up to £3000 in additional visa fees in adherence to the new policy before being allowed to step foot in the UK. This is hardly a nominal fee.

For Flo, everyone should be entitled to the same health benefits whilst at university. The NHS’ new policy regarding international students compromises this. And Flo, for one, is unimpressed. She said that the policy change “makes me feel limited. I feel like I’m being shouted at: ‘Health or education? You choose!’” No student – international or otherwise – should ever have to make that decision. It will be a real shame if the NHS’ new policy it drives any student to feel like he or she needs to.


  1. Added fees are never nice, but to be honest, if you’re already paying international fees, £150 isn’t going to break the bank.

    With return flights costing £300-£700, not to mention the absurd markup of prices in St Andrews (Tescos and accommodation mainly), and the whopping £4000 or so per annum EXTRA international students pay for tuition – sorry to say it, but if if you can afford to be an international student here, you’re already stacked (for the most part, EU fees excluded).

    In proportion, £150 is about a → ±1% ← increase in fees-per-year.No, actually, less: 13500(tuition)+2*500(average flight cost, often more, I’d know)+7000(conservative estimate of accommodation, food, balls etc.) = 21500, of which +150 is …. a grand total of … +0.70%. Yeah. Sorry, Math. No, you don’t have an argument.

    • I think it’s much more of a principle-thing than the actual cost. And it’s also about the what it is one is paying for. In Denmark, you don’t pay for health care. It’s always been that way for me. Paying for accommodation is much more normal for me, even if the fee is super high and outrages me.

  2. “uni hints’

    Check your facts – tuition is 16,230 for arts and 24,500 for medical sciences.

    Also take into account some internationals are on student loans / working just so they can stay here as an international student; they don’t all have an extra 150 pounds laying about. I know students who don’t go home at christmas or spring break as they can’t afford those expensive flights. Might seem like 1 % to you – to others, its just another financial burden on a hard road they’re already on.

    • Exactly. I just got denied financial support for being “international” as well, although I’m a UK/EU citizen (dual national). I really could use that 150 pounds. That’s pocket money for at least 6 weeks. Five weeks is just under half of a semester.

  3. My point is that, if you take into consideration how much money they’re already paying, it’s a negligible increase, since it’s 2-3 _orders of magnitude_ smaller than what they’re already paying.
    Its an equivalent cost to 1-2 weeks of accommodation and upkeep expenses. Which is barely anything compared to the cost of the whole year. Particularly considering the value of the NHS care they’d receive, £150 here is certainly cheaper than most anywhere else for medical fees.

  4. Affordability and budgets are determined by orders of magnitude. For a £10 weekly shop (conservative estimate), a 5p bag costs 0.5% more than what you’re already spending. If you can afford the bigger cost, it’s really hard to imagine you can’t afford a cost 2.5 orders of magnitude smaller.
    Here, +£150 is LESS THAN +0.5% of total costs (if tuition costs more, as you state). It’s not “1% to me”, its less than half of 1%, look at the numbers. You have to DOUBLE the percentage to even round up to “1%”. Therefore, it is necessarily a drop in the ocean.


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