Public discourse on migration often emphasises the perception that migrants place more strain on the NHS than those born in the UK. But this perception doesn’t reflect reality. We’ve recently published new research, adding to the evidence that migrants use NHS services less frequently than those born in the UK. Here, we examine why and what it means for the NHS.

Having robust evidence around migrant use of health services is important to inform national policy, allow health services to properly plan for the needs of their population, and to ensure that the public discourse on migration is properly informed. At a time when the NHS is under unprecedented pressure from the COVID-19 pandemic, it is important to understand what the evidence tells us about how people use health services.

Quantifying current evidence

One big challenge is that there is no gold-standard way to measure health care utilisation among migrants to the UK. Previous estimates are typically based on population-based estimates of the age, health and numbers of migrants in the UK, rather than estimates per individual. The most recent person-level analyses of routine NHS data used information on first GP registration to identify those likely to have migrated to England, and registered with the NHS. The study found that migrants used less secondary care compared to the UK-born population. Data in this study is now over 10 years old, so more up-to-date estimates are needed.

How do migrants to the UK use health services?

In our recent study, in the absence of more up-to-date NHS data, we used data from Understanding Society, a large national survey. Measures of migration are reliable from this survey, with information on individuals’ country of birth and date of arrival in the UK. However, measures of health service utilisation from this survey are self-reported. This means that they are not gold standard. But by cross-checking this, we found that they do provide estimates that are broadly comparable with routine health care data sources for utilisation of both primary and secondary care.

In our analysis we found, on average, health care utilisation among migrants to the UK is up to 40% lower than utilisation among the UK-born population. This was true for six out of seven health care services (inpatient, outpatient, primary care, physiotherapy, mental health services and dental care). When we examined childbirth, we found there were no significant differences between migrants and non-migrants. We also found that utilisation was lower among those who have recently moved to the UK, increasing to the levels of the non-migrant population among those who have been in the UK for 10 years or more.

Why do migrants use NHS services less?

Our research shows that migrants were younger and reported better health than those born in the UK. Once this was accounted for, the two populations largely had the same usage of health care services. The exception to this was dental care, where even once age and health were considered, migrants use services less than the UK-born population. However, our study could not dig deeper into differences in access within the migrant population. Therefore, further work is still needed to examine whether recent negative media representations of migrants, uncertainty about eligibility for NHS care – or even concerns over immigration enforcement – may be barriers to some vulnerable migrant populations in the UK accessing health care.

What does this mean for the NHS?

Our research shows that as a group migrants are younger and healthier when they first arrive, compared to the UK-born population, and rely less on NHS services. However, that doesn’t mean that the NHS shouldn’t plan for the health needs of migrants, now and in the future.

This is important, as over the longer term it might not be beneficial for the health of people who have migrated to the UK or the NHS, that they use the health services less. For example, is the NHS missing out on important opportunities to provide preventative services, or storing up health inequalities for the longer term? More work is needed, and appropriate national data and analysis, to provide insights to policymakers on international migrants’ use of the NHS, their health needs, and quality of health care received.

Conclusion

Contrary to the dominant narrative around migration in recent years, the research evidence, including our study, has consistently shown that recent arrivals to the UK use the NHS less than the UK-born population. Migrants to the UK, including those working in the NHS, have provided a visible and evidenced positive impact on the economy and society. In the context of increasingly polarised public discourse on migration, objective, up-to-date evidence about migrants’ utilisation of health services should be informing policy and debate.

Sarah Deeny (@SarahDeeny) is Assistant Director of Data Analytics at the Health Foundation.

Dr Catherine Saunders (@DrCLSaunders) is Senior Research Associate in the Primary Care Unit at the University of Cambridge.

Further reading

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Immigration and the NHS: the evidence

19 November 2019
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