Devil’s Advocate: Should international students pay for access to the NHS?



In September, a friend of mine went to the doctor for birth control pills and came away with a year’s supply. For any (female) citizen of the UK, this is nothing new. You make an appointment, get matched with the right pill for you and carry on with your day. But, my friend is not from the UK. In fact, like many students here, she is American. In researching this article, I asked her what getting the pill would entail if she had stayed in the US for her college years.

The figures are steep: obviously this is dependent on her own insurance plan and hospital care but she told me she’d have to spend $250 on the appointment, $400 for a blood panel, and then the prescription itself could either be $50 with insurance, or $200 without insurance for only a month’s supply of birth controls pills.

I’m not suggesting that coming over to the UK for free birth control is her only reason for coming to St Andrews to study, but surely it helps not having that burden and worrying about yet another bill to come out of her bank account each month.

I should point out that my friend is not an anomaly; as I mentioned she forms part of the 15 per cent of Americans at the University, combined with the other 15 per cent of international students from around the world. That makes up 30 per cent, an approximate figure for the quantity of students not from the UK and one of the highest percentages of international student attendance in the UK.

From the standpoint of the Admissions Office, if you’re not from ‘Home’ (Scotland or the EU), you’re from ‘Overseas’. Even though English, Welsh and Northern Irish students have to spend £9,000 on tuition fees a year, the rest of the EU does not and have their tuition fees paid for by the government. Therefore, surely spending a measly £150 would be merely a courtesy charge for your stay here?

Say you had been invited to spend a few weeks at a friend’s house, surely you’d offer to contribute to grocery bills to ease their cost as host? It’s the same principle, especially when the stay is four years.

For those from ‘Overseas’, the tuition fees are the most for any student group, with your fees standing around £15,000 for arts students and £24,000 for medics per academic year.

For those from the States, this is a tremendous ‘discount’ for an academic experience with the same status as an Ivy League college. Therefore, surely £150 is a drop in the ocean for universal free healthcare which can save you thousands of dollars for the most basic of treatments, and for most girls, a necessary expenditure.

Moreover, it makes me cringe the amount of times I’ve heard complaints targeted towards the beloved NHS. The trouble in finding appointments, the waiting times for those unlucky enough to be in Ninewells’ A&E, and the irregularity of doctors and consultants that you may come across. But, if you’ve been keeping an eye on the news lately, this is a national problem that the UK have been dealing with for years, not just for international students.

Maybe it’s just that I, and other UK citizens, have been brought up under the care of the NHS and have fully understood the massive effect it has had on my life over the years and continuing into the present. I like to think of it as an aging grandma; always making sure you’re well looked after, and even under strain, will always make sure she knits you that jumper for Christmas. However, sometimes she needs a bit of looking after too.

150 pounds per student visa may not seem much to an aspiring student here, but to the thousands who come to the UK each year to take part in our world-class studying experiences, this money would be hugely useful to a government who is reforming the NHS in order to address the estimated £20 billion funding gap because of rising demand.

This is a national problem that we all face, and if you are expecting decent care then you should be expected to help support it. You may not live here full time, but while you are here, you are as much a citizen as any UK born person.



With the introduction of a £150 fee for access to the NHS for international students, I fear that studying in St Andrews will become less attractive for international students.

In itself, it may look like £150 isn’t that much for international students, but we cannot view the fee in isolation – we have to take into account the fact that international students already pay tremendous amounts of money to be able to study here.

Adding £150 to an already existing fee of at least £16,000 is less than a one per cent increase in fees, so it shouldn’t influence students much; however, I believe there is a lot that can be done with just £150 extra in a student’s budget.

We also need to take into consideration the projected increase in tuition fees for international students at the University of St Andrews; international students are experiencing increasingly demanding financial pressures, even if that pressure is just increased by £150 at a time.

It doesn’t seem to make a lot of sense to apply this fee to international students. Why would they come here to take advantage of free healthcare when they already have to pay at least £16,000 a year? The impact an increase in fees international students have to pay is without a doubt going to make studying in the UK less attractive.

International students are assets to the University. They diversify the community, and are without a doubt economic assets. By introducing a fee that only applies to international students, I am afraid we are at risk of pushing these valuable students away from studying here and contributing to the academic environment in St Andrews.

It will no longer be a matter of studying at the most attractive university, or the most attractive location, but a matter of where a student can afford to study. With the already less-than-optimal housing situation in St Andrews, matters concerning fees might drive valuable students away from studying here. Another fee and obstacle in the way of studying and living in St Andrews will not help to attract students from abroad.

Of course, a good education is more valuable than the money you put into it, but money does obviously play an important role in deciding where to study. For some, money might not come into the decision-making process when choosing a university, but others may not be lucky enough to have that mind-set. £150 can do a lot for a student, either by providing meals, rent, or books, given that tuition fees are not the only thing to worry about when going to university.

The fee could not only have a financial impact on the University itself, but it may also have a devastating impact on the diverse and fruitful academic and social community that St Andrews has today. If the University cannot attract students from abroad, diversity will suffer and the University will lose one of its most valuable aspects.

In addition, the introduction of fees and increase in tuition fess is not only risking reducing the international diversity of the student body, but is also likely to reduce diversity in economic backgrounds. How could we be able to shake the image of St Andrews as a posh, elitist place if students with a low-income background cannot afford studying here? Although the £150 fee for access to the NHS is not something the University itself is introducing, we have to view the fee in context of what students already are required to pay at university.

I find it repulsive that students will have to pay for something as basic and necessary as access to healthcare. Especially bearing in mind that the students are here to study, not to freeload on the NHS. Access to the NHS is a necessity for any student residing in the UK.

Considering international students contribute to diversity and how economically valuable they are, it is counter-intuitive to introduce another fee for international students to study in the UK.


What YOU thought:

47% for YES, 53% for NO


  1. Just to note – the healthcare subsidy is actually 150 pounds per year of your course, so actually, the total paid over the four years is six hundred pounds (the home office calculator gave me 675 for reasons I’m not entirely certain of). Payable when you apply for your visa, this triples the cost of that application for me – and is that really worth the two times that I’ve been to the GP since arriving in the UK? It also does well to note that family planning services remain free, whether or not a healthcare subsidy is paid, so that’s not a great example of someone freeloading off the NHS.


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