THE COST OF OVERSEAS VISITORS TO AN INNER-CITY ACCIDENT AND EMERGENCYDEPARTMENT

Objective-To estimate, in a metropolitan accident and emergency (A&E) department, the annual cost of treating overseas visitors whose countr ies of origin do not have reciprocal arrangements with Britain. Method s-The study was retrospective. A 24 h period (00.01 h to 24.00 h inclu sive) on consecutive days in consecutive weeks (that is, Monday in wee k 1, Tuesday in week 2, etc) was costed over 52 weeks (1.8.92-31.7.93 inclusive) and extrapolated to 365 days. All visitors between those da tes were divided into eligible (from countries with a reciprocal agree ment) or non-eligible (from countries without a reciprocal agreement). Costs were calculated for medical and nursing care investigation and treatment, and fixed costs. Results-The annual St Mary's Hospital A&E budget for the study period (01/08/92 to 31/07/93) was pound 2 612 200 ; the medical and nursing cost per or minor case was pound 66.88 and r espectively, Investigation, treatment, and fixed costs were pound 16.3 1 per patient. In total 2704 non-eligible patients (498 major and 2206 minor cases) were treated at a cost of pound 121 705 (95% confidence interval pound 114 234 to pound 129 176), which was 4.7% of the total annual budget. Conclusions-The cost of non-eligible patients to the NH S is substantial. One possible solution would be for visitors from cou ntries which do not offer subsidised emergency treatment to British na tionals to purchase health insurance compulsorily on or before entry t o Britain. The revenue could be used to improve standards of care for all A&E patients.