English NHS hospitals have been unable to collect healthcare payments totalling more than £252million from foreign patients over the past three years.
An analysis by Policy Exchange found that NHS trusts billed overseas patients £384million between 2021 and 2024, but managed to collect only £131million of these charges.
The remaining uncollected amount comprises £167million still outstanding and £84million that has been formally written off as irrecoverable.
These figures emerged from Freedom of Information requests submitted to 202 NHS trusts across England, including hospital trusts, mental health services and community healthcare providers, with 82 providing complete responses and five offering partial data.
The Policy Exchange investigation specifically requested data about fees collected "for the provision of any episode of care for a foreign national", defined as individuals not entitled to free treatment at the point of use.
Researchers also sought information about written-off debts and outstanding payments that trusts had been unable to recover during the three-year period.
While international visitors receive free GP consultations and emergency department treatment, those not classified as UK ordinary residents face charges for other NHS services.
Current regulations require upfront payment for non-emergency treatment, though urgent care cannot be delayed or refused regardless of payment ability, with patients remaining financially responsible for costs incurred.
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English NHS hospitals have been unable to collect healthcare payments totalling more than £252 million from international patients during the past three years
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Britain maintains reciprocal healthcare agreements with various nations, allowing their citizens access to certain services without charge, though trusts must still record these cases for potential reimbursement claims from the patients' home countries.
Former Health Secretary Sir Sajid Javid, writing in the report's foreword, said that the NHS is "not a charity (or) an international aid organisation".
He calculated that the £84million permanently lost could have funded "3,200 more GPs or built 70 new GP surgeries".
London-based trusts recorded the highest levels of unrecovered overseas patient charges.
A Policy Exchange study analysis found that NHS trusts billed overseas patients £384 million between 2021 and 2024
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The report's authors emphasised the scale of the issue, writing: "This results in a combined total of £252,401,866 in overseas charges that remain unrecovered, of which over £84million is permanently lost."
Sir Sajid, who was health secretary between June 2021 and July 2022, wrote: "NHS trusts in England failed to recover more than a quarter of a billion pounds over three years from overseas visitors.
"That’s enough to pay the salaries of 3,200 more GPs, or build almost 70 new GP surgeries.
"Asking those who pay for the NHS to shoulder the cost for those who haven’t made the same contribution is fundamentally unfair.
"When a taxpayer in Manchester or Birmingham is denied timely treatment, yet sees resources diverted to write off millions in unrecovered costs from overseas patients, confidence in the system is corroded.
"Many of those who are cared for by the NHS without paying for it do, in fact, have the means to pay. Some will have insurance policies that would cover the cost of their treatment.
"By failing to collect what is owed, NHS trusts are effectively boosting the profits of private insurers while passing the bill to British taxpayers."
Former Health Secretary Sir Sajid Javid, writing in the report's foreword, said that the NHS is 'not a charity (or) an international aid organisation'
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He added: "The NHS is not a charity. It is not an international aid organisation. It is a public service – funded out of the hard-earned money of British taxpayers, for the benefit of British taxpayers."
An NHS spokesperson said: "The NHS is committed to delivering the best possible value for taxpayers’ money and, in line with regulations, providers of NHS-funded services must identify chargeable overseas visitors and take all reasonable steps to recover costs.
"For non-urgent care, payment must be secured in advance; and urgent or immediately necessary treatment will be provided without delay, in line with the NHS’s commitment to patient care.
"The NHS has recovered more money so far this year compared to previous years but we are determined to go further and are working on a variety of measures to achieve this."