Verified case study

How much do visitors and migrants cost the NHS

by Sarah Rollason | 23 November 2016

How much do visitors and migrants cost the NHS

Client testimonial

"The most thorough research there has ever been in this area" - The Secretary of State for Health


The use of the NHS by visitors and migrants brings together two of the most highly charged topics in British public life. 

However, the true costs of providing healthcare for visitors and temporary migrants, or even the scale of losses and 'health tourism', have been extremely difficult to estimate. 

The Department of Health (DH) therefore needed a realistic estimate of the current cost to the NHS in England of spending on services for those who are currently eligible for free NHS treatment but may be liable for charging in the future and also those who are currently not entitled to free NHS care. 

Prederi were commissioned by the Department of Health to estimate these costs and this study formed part of the ‘audit’ announced by the Secretary of State in July 2013. The report was published in October 2013.

Project approach

The work needed to be done at pace, ready in September 2013 to be published with other evidence, and robust enough to stand up to politically biased public scrutiny. 

Putting together a team of a qualified GP, a public sector costing specialist and a modelling expert, Prederi carried out a top-down analysis, and for the first time came up with a comprehensive view of the costs of visitor and migrant use of the NHS in England. The Department arranged for peer review of the Prederi results and reports. 

The work combined a research review of the medical literature, analysis of health costs and charging processes, and modelling large quantities of data from the Census 2011, the International Passenger Survey and Home Office immigration statistics. The modelling broke down types of EEA and non-EEA visitor and migrant, by age and gender, for each country for which there is sufficient data (about 40) and for regional groups of countries for the remaining 160 or so nations in the world. 

The understanding about propensity to use the health service is mapped on to these nations or groups, informed by our analysis of the data and our research in the medical literature. Additional analyses were undertaken for irregular migrants and 'health tourists'.


The Secretary of State for Health announced the results on 22 October, saying that the work was the "most thorough research there has ever been" in this area. 

The statement also announced that a new cost recovery unit would be set up in the NHS. This was tangible evidence of a shift of a debate from preventing "health tourism" to how best the NHS should recover up to £500m a year. 

The Department's Cost Recovery Programme is now up and running, helping trusts to increase revenue for the NHS.

Prederi's work for the Department of Health was shortlisted for the Management Consultancies Association Awards in 2014.


Sarah Rollason

Sarah is a Project Manager and Researcher with 7 years professional experience. She has worked across multiple sectors, including education, training, health and regulation.


Health, Government

Success factors

High growth


Project lead

Ian Bennett

Project status


Start date

November 2015

End date

October 2015

Project value