Should We Continue Paying for The Healthcare of Non-Citizens from First World Countries (Reciprocal Health Care Agreements) ?

This came up as I was chatting with my sister-in-law who is a pharmacist in one of the big pharmacy chains. She has a new patient from the UK who flies to Australia after the lockdown ended to get his regular anti-cancer meds, which apparently cost the Australian government (and taxpayers) tens of thousands every few months. This bloke isn't a dual Australian citizen or has ties to Australia, but apparently can get subsidised cancer meds for next to nothing despite not paying any taxes in Australia in his life. He says the reason is he makes these round trips down under a few times a year is because those anti-cancer meds are neither cheap nor funded under the NHS, which is the UK's version of Medicare (hence saving himself "quite a few quids" in his own words).

Now my sister-in-law doesn't mind her UK patient because she get's paid by Medicare regardless for dispensing those meds and he's a pleasant chatty chap to deal with who doesn't complain about the long wait times to order in his cancer meds, but it does struck me how we are essentially paying for non-citizens healthcare even though the UK is a developed country in its own right with its own free healthcare.

Apparently the British chap said the Australian healthcare system is much better funded than the NHS, which is also is why hundreds of UK doctors and nurses are migrating en masse to Australia for better pay and work-life balance every year (needs to be fact checked though). Not being from the UK myself I looked it up and we have Reciprocal Health Care Agreements for 11 countries, all of which are first world countries (United Kingdom, New Zealand, Republic of Ireland, Sweden, The Netherlands, Finland, Belgium, Norway, Slovenia, Malta and Italy).

https://www.servicesaustralia.gov.au/reciprocal-health-care-…

This doesn't sound too bad but then I read the news now with rising inflation and costs of livings, everyday Australians are not being able to afford even a $30-40 routine GP visit these days. I wonder if we should stop paying for healthcare of non-Australian citizens/residents and spend those saved on Aussies instead? Or at least restrict it to cheap generics medications instead of specialised drugs costing thousands of dollars, as these non-Aussies doesn't have any ties to Australia or pay taxes here.
I can't find any data on how much Australia spends on the healthcare of non-citizens through such Reciprocal Health Care Agreements , but I suspect we are not getting too much back in the way of fellow Aussies utilising their poorer-funded foreign Medicare counterparts (I think Norway is perhaps the only country with an equally well-funded healthcare system like Australia.)

https://www.abc.net.au/news/2022-06-21/medicare-rebates-not-…

https://www.abc.net.au/news/2022-07-21/tas-gp-bulk-billing-d…

Yay or nay to continue spending millions (or perhaps hundreds of millions?) on non-taxpaying foreigners' healthcare while some Australians potentially miss out on essential healthcare/GP appointments? Thoughtful comments are always welcome.

Poll Options expired

  • 232
    Yeah (We should aid other first world countries, and cross-subsidise their healthcare expenditure)
  • 424
    Nah (We should put us Aussies first, or at least limit costs spent on foreign citizens under RHCAs)

Comments

              • @ldt: Did you go home with a tube in your neck?

                • @Dalton: I was in hospital for a month so all the tubes were gone by the time I left.

  • +6

    Reciprocal healthcare is a great thing.

    We should be looking to forge similar deals with more countries, not stopping it lol

  • +2

    Yes because it works both ways you peanut

    If we go to the uk for example we get it, they come here they get it.

    Hence "reciprocal"… we arnt giving them anything for free

  • +3

    What you've described regarding Brits getting cheaper medication here than in their home town without being a dual citizen is not reciprocal healthcare.

    Has there been any fact checking on this guy's claim? Or are we going with a Sky News opinion piece outrage requiring no fact checks?

  • The obvious solution is to have the RHCAs but only treat holiday travelers for urgent/emergency care. If you travel here and already had a cancer diagnosis we shouldn't have to pay for it. I assume we could arrange a system to confirm with the other countries healthcare system if people were already diagnosed with a chronic illness before they travelled.

    If you are there on a longer term working visa or permenant resident then you have full access.

  • +3

    Wow what a negative view on a great agreement.
    The idea is that for the 11 countries we have similar levels of public healthcare (it will be impossible for them to be exactly the same). So if I go to Denmark and I get sick then I can be treated & I don't end up with a massive bill at the end of it. If someone from Denmark comes to Australia and gets sick then they can be treated and don't end up with a massive bill.
    I mean that's a great system. It would be nice if the poll could be recreated so its not completely pushing the OP's agenda . "We should aid other first world countries, and cross-subsidise their healthcare expenditure" LOL.

    P.S. The good news is that there are plenty of other countries left the OP might like to go to and really experience some shitty expensive healthcare.

    • +3

      I hear the usa has great health cover /s

    • So how do you feel about work visa holders like the poster some posts above who don't have access to Medicare (I believe they should be given Medicare access) and have to buy their own private health insurance despite paying taxes in Australia, which a person under a reciprocal agreement doesn't?

      The fact that a non-taxpaying non-Aussie UK chap can access the Medicare while those on work visas paying Australian taxes don't, doesn't sit too well with me personally.

  • +2

    In all fairness, this individual is trying keep himself alive and is wanting to save some cash to support a little bit of lifestyle. Without knowing the dent it is causing to the Australian system, we can’t really say how should Medicare look into not, knowing that it might affect the relations between the two countries.

    What really bothers me is that my tax money is being given to someone who charges me $450 cash/day to do a tradesmen job!!!

    • +1

      Or that we gave hardly normal 20odd million bucks for covid, and his sales skyrocketed and he wont pay it back as an act of good faith

  • +1

    This reciprocal arrangement as I believe it works 2 ways. If you are in UK, you'll get their Medicare coverage too.

    • ok, thats explained.

  • +1

    Correct me if I am wrong but isn't this a two-way street? This is a "you scratch my back and I will scratch yours" arrangement between countries. I got educated on this arrangement in another OzBargain post after I mentioned that a friend of my received free hospital treatments for over $30k while holidaying in the UK.

  • +3

    My wife and I were lucky enough to be in Italy a few years ago. One of my wife's teeth became very infected and painful very quickly, and we were staying out in a little village in Tuscany.

    We visited the village doctor, who had a look and gave us the name and details of a dentist in a bigger town nearby. He called ahead, arranged an urgent appointment for us, and explained what was going on. We went to pay, and he just laughed and said not to be ridiculous.

    We made it to the dentist, who cleaned up her tooth, did a full exam of the rest of her teeth, wrote a script for antibiotics, and told her what else needed to be done once we got home to Australia. Again, I pulled out my wallet prepared for the worst - and he just smiled and said "It was my pleasure, please enjoy the rest of your time here in Italy."

    Would like to think we'd extend the same attitude to anyone lucky enough to be visiting us here in Australia - "don't worry mate, we've got your back, we'll look after you".

    • That's really great to hear. Although dental care isn't free here.

  • And if theres a cheaper drug/treatment for something else in the UK, you would be ok with not being able to pull the same stunt?

    I'm sure it all evens out in the end, and thats why these agreements exist.

  • So how did he able to get subsidised cancer meds for next to nothing when he is not Australian?

  • +2

    I am not a pr/citizen here , I am currently on bridging visa for working visa, I paid my tax full, didnt get any medicare I have to rely paying for private insurance as one the requirement for the visa, during first 6months covid lockdown I my workplace shutdown I not qualified/getting any covid help from the government, I have to dip my super to survive. Even then they make it harder for my visa being approved. So hearing this made me sad.

    • Mate I just saw your comment and am sorry to hear about your plight. I do sympathise with you and think as a work visa holder you should have a right to Medicare regardless of this reciprocal agreement discussion.

      • Thanks mate , the sad thing I already living here during my study until working fulltime about 8 years paying my full tax still my visa hard to be approved

        • +1

          Best wishes buddy

        • +1

          See my post below.

          I pay taxes and I have no access to Medicare. I wonder what op thinks about this. Maybe we shouldn't pay any taxes?

  • When come to human life, there is no first , developing or third world. I'll say help as much as we can.

  • You're missing the point that this is a reciprocal arrangement. This benefits Australians when we travel. We shouldn't scrap it just because one person is exploiting the fact that a drug has been added to the PBS but not the NHS.

  • +1

    Why is Australia covering more than what their home country covers??
    Shouldnt our coverage be limited to their home base vs local - the minimum of the two

  • +1

    Extremely short sighted viewpoint - and not surprised to see the usual subjects jump right in. Plenty of Australians rely on the reciprocal arrangements offered in these countries and we should be thankful it exists.

  • +1

    So op, I have paid over 100,000 dollars of tax over the course of 9 years as a non resident and I have never had access to Medicare.
    So in your logic, I must be refunded what I have paid, right? How about this op?

    This is not the age to be so patriotic OP. This is not Germany and we aren't in 1938, take your bigotry and bias away.

  • +1

    everyday Australians are not being able to afford even a $30-40 routine GP visit

    Except it's free

    • +3

      Please call my local GP who doesn't bulk bill and let them know I was charged incorrectly.
      A lot of GPs don't bulk bill anymore

    • +1

      @bomberswarm2 If you bothered to read the ABC articles I posted, they are saying that bulk-billing GPs are a thing of the past. I'm sure if the Medicare budget is unlimited and the Australian government isn't a trillion dollars in debt all GPs would still be bulk billing when paid their fair share.

      I think bulk-billing GPs get paid like $30 by Medicare for a 20 minutes visit, which is what I pay my barber for a nice fade. Which is also why I let my hair grow out these days, in true Ozbargain fashion lol.

  • +1

    Healthcare isn't the only thing we're paying for.

    I'm all for Australians first, but healthcare is just the tip of the iceberg.

    • How do you mean? What else are we paying for?

  • +1

    To answer your question, should we continue to allow this -> No. If UK can't do their shit properly it must not come at our tax payer's expense.

    Other than that the whole incident around people flying in to different countries because of cheaper medical expenses isn't something new… People just look at how much it costs at A,B & C and make their decision which is quite normal. I personally know fair amount of people that either wait till they visit their home countries (migrated from) to carry out routine or non urgent surgeries and dental procedures & even get the medications.

  • +1

    This is so infrequent that the cost saving would be negligible after all the money spent on reviewing and legislating it. Why do cost-cutting suggestions always seem to come from the poor and the sick? If you genuinely want to save money in this country, there is so much low hanging fruit that is taxing the **** out of fast food and watching the health benefits ultimately flow on while collecting money, taxing the **** out of the fossil fuel industries and watching the health benefits ultimately flow on while collecting the money, and so on.

    These isolated cases (and they are) are so low-yield in the grand scheme of things but are really good at generating the least objective amount of outrage.

    (ETA: Wait til you hear about the Aussies living in Thailand for the entirety of their retirement while collecting a pension here and living like kings there, only flying back for medical things).

    • +1

      (ETA: Wait til you hear about the Aussies living in Thailand for the entirety of their retirement while collecting a pension here and living like kings there, only flying back for medical things).

      Most don't even fly back for medical. They stay in ex-pat retirement areas over there that have Western-grade hospitals that is still cheap to use for them, but expensive for your typical Thai citizen. Both my Uncle and father both sold up and moved up there and honestly they both live healthier lives now for it.

      I'm not fussed if the aged pension is used overseas to give them a higher standard of living. They should be able to enjoy it. Both worked hard for their adult lives. They deserve it IMO.

  • +1

    People are forgetting this is a reciprocal arrangement. If you're in the UK on a holiday and get seriously ill and need medical care, their NHS will take care of you.

    Given that Aussies travel quite a lot, I'd say we're probably actual net beneficiaries of these arrangements.

  • +3

    Yes we should.

    And we should increase the medicare rebate that everyone gets when going to the doctor to make it more affordable for everyone to access healthcare.

    We should also include dental in medicare.

    Just all in all - we should vastly improve medicare. Liberals have slowly been trying to strip it away since its inception.

  • +1

    I'm happy with reciprocal arrangements for emergency situations, or perhaps even stretching to where Australia is the place of initial diagnosis.

    That said, I would assert that absent being a citizen, once that initial treatment is provided and you then leave the country to return to your country of citizenship (or indeed once the visa conditions that were applicable at the time of the original issue have expired), that's it. I don't mind patching people up and sending them on their way under reciprocal agreements, but beyond that simply risks the taxpayer getting milked.

    The example supplied by OP is ridiculous and we should not be funding that. Frankly, I'd be tempted to tip off Border Force or whatever they call themselves these days about this case.

  • +1

    I used the NHS in the UK through our reciprocal agreement when I fell ill a few years back. I was treated well, spent a few days in hospital and didn't pay a cent.

    I am all for these reciprocal agreements.

    • +1

      Same here, imagine ending it because a small handful of people are doing the wrong thing. So many people benefit from it, and as maligned as the NHS is, it is an incredible system. There's a reason there is a tradition of Australian doctors going to train there for their final year of specialist training (although much harder these days).

  • I think there are bigger issues with the economy that could be focussed on than taking away healthcare for people, even if they're not technically Australians.

    At some point we're a relatively rich country so I think the onus is on us to give back and help others out. Otherwise you get into some dodgy closed borders racist type arguments which suck. There's a lot of immigrants in this country who built this country based on Australia's ability to provide support to them they didn't need to - to want to take that away now is quite selfish and hypocritical.

    Besides, it is reciprocal at end of day - I like the fact that if I went overseas I would be taken care of. It's not just a one-way street of people exploiting Australia.

    • I largely agree with what you said. However how do you feel about hardworking work visa holders who don't have access to Medicare (I believe they should be given Medicare access) and have to buy their own private health insurance despite paying taxes in Australia, which a person under a reciprocal agreement doesn't? The fact that a non-taxpaying non-Aussie UK chap can access the Medicare while those on work visas paying Australian taxes don't, doesn't sit too well with me personally.

      • So if the OP were to visit another country, you'd be happy to pay the full cost of treatment rather than nothing due to the reciprocal agreement?

        As obviously, if we were to stop to stop the agreement with the UK (or other country with reciprocal agreement) they'd stop it with us.

        Sounds like the chap in the UK must be doing alright being able to afford flights from UK to Australia every few months.

  • +1

    It's a reciprical agreement, we are only giving it to those citizens so that ours are covered overseas. There are plenty of Australians in the UK & we have exemptions for UK citizens if something isn't provided by the NHS reciprically. The only issue is that the system hasn't been updated with what is missing on their end, otherwise the whole point of a reciprical agreement requires us to participate.

  • +1

    At the very least at least have ties to Australia, ie, family members

  • +2

    Yeah I wouldn't want to foot the bill for someone who decides to come down here to leech. We can't save the entire world, when we are often neglecting our own people with budget cuts to health.

    I think Australia should stop dual citizenship as well or at least limit paid benefits to citizens who do not or have not lived in the country for more than x months. My partner's relatives has a dual citizenship for Australia and Hong Kong. Before covid, they'd come back here once a year for a full body check, and every single health check possible, as it's cheaper to do over here. But to me that's quite the BS. You don't contribute to this society at all, and you just come back over here leeching this countries resources. I feel that Australia is stupid a lot of the times and just get taken advantage of, at the same time we end up doing dumb shit to recoup on costs against our very own people who live in this country.

  • +1

    Something doesn't sound correct here. The reciprocal agreement is about patching you up if you break a leg or fall unwell whilst abroad. You can't just rock up with a NHS prescription and expect it to be filled here.

    • My understanding is that having access to Medicare he then sees a Australian doctor for it. That's why I think we are potentially subsidising other countries healthcare systems if we cover for treatments that the NHS don't, and ultimately Aussies taxpayers are footing his bill. I believe the NHS is poorly funded compared to Medicare and hence there may be potentially more 'medical tourists' coming our way if Reciprocal Health Care Agreements aren't changed to be limited in its scope to emergency situations (which is what I am for as a taxpayer). I also like the idea of complimentary travel insurance as some posters have pointed out.

      • +1

        It's a fancy cancer drug. He needs to book in with a GP, be referred to an oncologist, get the appropriate up to date tests before getting a prescription (possibly 1-2 months for all the above to happen). He then needs to have regular surveillance tests done here for the oncologist to continue prescribing. The pharmacist is also meant to issue a month's supply at a time. Unless this is a very unusual medication, the story of him flying down a couple of times a year for medical tourism doesn't add up. All of the above also means that it's pretty hard for tourists to exploit our system for non emergency medical care

  • Based on your poll all Permanent Residents who work and pay taxes here should not have access to the same quality healthcare as Australian citizens?

    Even when they have been living here for dozens of years and paid taxes like everyone else?

    • +1

      No I believe all Permanent Residents should have unfettered access to Medicare as they are taxpayers. Read my post properly.

      After some thought, I also think those on work visas paying taxes in Australia should also have access to Medicare too as they are funding it, I don't know why that isn't the case automatically as someone posted above they needed to get their own private insurance!

      The fact that a non-taxpaying non-Aussie UK chap can access the Medicare while those on work visas paying Australian taxes don't, doesn't sit too well with me personally. I'm sure there are Ozbargainers here who would agree with me that its actually fairer to provide Medicare to work visa types here instead of non-taxpaying foreigners, the former should actually have greater rights to Medicare than non-taxpaying foreigners (except refugees needing our critical aid and healthcare, which I'm for as a Greens voter).

      However this is the system we currently have in place and we have to live with it.

      • I did read your post :-)

        I wonder if we should stop paying for healthcare of non-Australian citizens/residents and spend those saved on Aussies instead?

        Later on you say:

        these non-Aussies doesn't have any ties to Australia or pay taxes here

        Perhaps you should not use the word Aussie to describe both PR and Citizens - a PR usually doesn't call him/herself an Aussie

        • Don't bother, whoever comes up with this ridiculous idea, probably has also no idea what they are talking about.

        • I think it makes sense if you replace 'non-Australian citizens/residents' with 'non-Australian citizens/non-residents" which I think was the intention.

      • Some people don't know they can apply for Medicare.

  • +1

    Not sure if was designed with this type of ‘fly-in fly-out’ treatment in mind.

    I’m all for fixing people up in emergencies, but I’m not really up for paying for this ongoing, expensive treatment that really should be paid for by the (in this case) UK government.

    • +1

      I agree. I also think those on work visas paying taxes in Australia should also have access to Medicare too as they are funding it, I don't know why that isn't the case automatically as someone posted above they needed to get their own private insurance!

      The fact that a non-taxpaying non-Aussie UK chap can access the Medicare while those on work visas paying Australian taxes don't, doesn't sit too well with me personally. I'm sure there are those who would agree with me that its actually fairer to provide Medicare to work visa types here instead of non-taxpaying foreigners, the former should actually have greater rights to Medicare than non-taxpaying foreigners.

      • 100% agree.

  • Well meds in NZ are even cheaper than here.

  • Well, the thing about “reciprocal” is we are getting the same thing back… and whilst there’s probably some examples of UK citizens rorting us… the way our populations are stacked we are probably rorting them even more.

    And with the slow, slow drug approvals process for PBS, I quite suspect lots of people needing cutting edge new drugs (re: the most expensive) are indeed travelling overseas for them.

  • +1

    Reciprocal healthcare systems are for emergencies.. This is abusing the system and shouldn't be allowed. The system should pay for emergency treatment or care needed for visitors until they return home. I think this is how it works for Aussies on Italy etc. Not everything is covered.

    This guy is abusing he benefit. If more people did this it will go away.

    • As it currently stands, this doesn't count as abuse as its entirely legal and above board under the straightforward eligibility criteria in the Reciprocal Health Care Agreements. Hence my discussion on whether the RHCAs should be amended to cater only for emergency situations.

      Also I wonder if those on work visas paying taxes in Australia should also have access to Medicare too as they are funding it, instead of buying their own private health insurance? There's a couple of posters here in that predicament which I sympathise with, which many of us fortunate Aussies have seemed to neglect in this debate concerning funding the healthcare of our fellow first world counterparts.

  • In oversimplified terms, he's getting subsidised meds and we're getting an influx of quality medical practitioners? Sounds like we've got the better end of that exchange.

  • -1

    Two points from me:

    1) The UK and Australia have reciprocal agreements on many things, including this, taxation, defense (AUKUS), and trade deals. Whilst this thread only focuses on the medical agreement, the question should be whether we get appropriate value from our relationship with the UK?

    If the answer is yes, you can't start unpicking the parts you may not like without the risk of impacting other, more valuable parts of our relationship.

    2) At a personal level, if someone is sick and in Australia at the time, regardless of their country of origin, we have a moral responsibility to help them out (whether we have reciprocal medical agreement or not). There are plenty of ways we can save costs. I wouldn't priortise this one.

    (By sick I mean in need of urgent medical attention)

  • I think it's reciprocal 🙄

  • I arrived here in 2011 from the UK. In 2012 I had a seizure and almost died due to a rare autoimmune disorder I didn’t know I had.
    If it weren’t for the reciprocal healthcare agreement I’d either be in hundreds of thousands of dollars in debt… or dead?
    I hope someone that has the same issues as me when they go to the UK from here is fully covered and it’s worth every cent.

    • +2

      If you read some if the post, many people stated it already, if you get sick then sure, 100% help that person. However, this person flight back and forth couple of times per year. That’s exploit the system

      • -1

        I have read the posts.
        Doesn’t mean the entire system should just be scrapped.
        Also where is the evidence of this guy? I’m not sure I believe it’s true.

  • +1

    I'm all for helping people in need. But this guy is taking the piss. He has found a loop hole to get something for next to nothing at our expense. The kind of person you would find on OzBargain. Oh wait… hang on.

  • +1

    I'm not against helping someone out who needs help but I'd rather help a third world country than a first world in this scenario. A classic example, Sri Lanka doesn't have a such reciprocal agreement with Australian yet all tourists or visitors get completely free healthcare if something happens over there. Regardless of the current economic issues they have over there, their healthcare system is excellent and I know of a lot of Australian citizens who go there once in a couple of years just to get their teeth done cheaper.. Now they don't pay no tax to that poor country but yet receive massive healthcare benefits for almost nothing. But any Sri Lankan visitor, even those who genuinely wants to stay here for the rest of their lives, will need to pay healthcare here (which is extremely expensive for them understandably). That's a stark contrast of how we treat different to different worlds.

  • so the person is from the UK, doesn't pay Australia tax and using our meds
    if this person was Australian, with cancer, chances are he won't be working, so then he'd be drawing even more money via aged care pension/Centrelink payment/disability payments as well? I imagine being from UK he'd have an easier process getting citizenship
    I think in some ways it helps persuade those people to consider becoming a citizen? or at the very least upcoming generations? seems like an attractive deal no?

  • +1

    It this is a very interesting post. To decide the answer to the question I’d have to know how many non-citizens are doing this annually, ballpark figures on the cost, what the proposed solution is for closing the loophole and what that would cost.

    If the solution involves changing a treaty or international agreement then no- the cos for this would be tens of millions in salaries for a couple of years.

    If the solution involves the creation of a ongoing policy team to monitor the register of drugs and adjust which drugs non-citizens can get…I mean maybe. That would only be a million dollars a year. But then you’d need some kind of mechanism to allow for special cases. Let’s say a non citizen forgot their cancer meds while traveling, you’d need a way for them to appeal to the director and get a decision pretty fast or you’d effectively be breaching your treaty duties to have reciprocal care. If it takes 14 days to get a decision and the average stay in australia is 7 days or something like that.

    I dunno, I think there’s a good chance that fixing this problem would cost several times what the problem currently costs. But without figures, who can say.

  • -1

    Are you saying this person flies half way round the world several times a year to save money on his medication? Have you seen the price of airfares to London?

    Also, how did he get a Medicare card? Without that he gets nothing.

    • You do not need a Medicare card just to prove you reside in a country with reciprocal rights.

  • Thanks to all who contributed their thoughts to this discussion thus far. It looks like the majority of Ozbargainers are not in favour of continuing the Reciprocal Health Care Agreement in its current form, and the consensus seem to be to amend the RCHAs only for emergency situations. Hopefully, those Medicare savings could then be channelled to funding things like bulkbilled GPs visits so Australia's own healthcare needs will be met first to give every Australian the right to access free GP appointments.

    Some posters who are work visas holders have also raised that even though they pay full taxes in Australia they don't get the benefit of Medicare, and instead have to shell out for expensive private health cover. Further to this discussion, I was wondering if such tax-paying work visas types should have full access to Medicare too as they are funding it like the rest of us working class Aussies, arguably more so than the UK bloke who is simply eligible for our Medicare by virtue of his passport?

    Should we expand Medicare to include work visas holders (since they fund it), and reduce Medicare spendings on RHCAs for non-taxpaying non-Aussies?

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