Health Services: Reciprocal Arrangements

NHS care is provided free at the point of use to people who are ordinarily resident in the United Kingdom, including people who were born abroad if they are not subject to immigration controls. Where the person is not ordinarily resident, the National Health Service recovers costs for healthcare provided in the UK through the immigration health surcharge (IHS), directly charging individuals for care provided and charging countries responsible for their healthcare costs through reciprocal healthcare agreements.

The UK’s reciprocal healthcare agreements with the European Union, European Free Trade Association states and Switzerland allow for the reimbursement of costs at a country level. The UK pays for healthcare costs of eligible people visiting or living in these countries under these agreements. For other countries, the UK does not fund overseas treatment and NHS costs incurred are recovered through the IHS or directly charging the individual.

The following table shows the Department’s income and expenditure on overseas healthcare from the United Kingdom’s reciprocal healthcare agreements for 2023/24, the latest year for which figures are available:

The figures in the table above relate to all reciprocal healthcare agreements where costs are exchanged between the UK and other countries. These figures are not directly comparable to the figures quoted in the Department’s accounts, which are not broken down by country and include accounting treatment and aggregation of other costs. Negative values in the table above reflect adjustments to prior year forecasts compared to actual receipts/payments received from member states.