British expatriates are now no longer entitled to free healthcare under the UK 's National Health Service following a crackdown on what has been termed 'health tourism'. But as the UK shies away from the health tourism phenomenon, countries like Thailand are welcoming it with open arms.

As of this year, British nationals resident outside the UK are no longer automatically eligible for free expat health treatment through the National Health Service, according to the controversial proposal made earlier this year by UK Health Secretary Jo hn Reid.

The changes came about as part of the UK government's crackdown on what has been labelled in the press as 'health tourism'. As a result of growing concerns and criticism, a three-month public consultation was carried out late last year to determine how to amend the system. This followed fears that the accession of 10 additional states in May 2004 to the EU would lead to a further increase in 'visitors' taking benefit of the free health service and claims that the National Health Service was already under extreme pressure from asylum seekers needing medical attention. The result, from 1 April 2004, is that only employed, tax-paying residents and their dependants are entitled to free services from the NHS and non-residents are not.

Since the original announcement early this year, little up-to-date information has actually been released by the government. However, according to the Department of Health press releases and their website, there are new guidelines as to the eligibility for free treatment. British expats who spend less than three months a year in the UK will no longer have automatic free access expat health clinics, hospitals and GPs, except for emergency treatment, such as for a heart attack. Those seeking medical treatment could be asked to prove their residency status by showing council tax bills, pay slips and records of National Insurance contributions. However, there are further guidelines stating that to be exempt from medical costs, British nationals living abroad need to have lived continuously in the UK for 10 years and either have not worked abroad for more than five years, or if they have, they need to have taken home leave to the UK once every two years.

Confused yet? So is the NHS it seems. To make matters worse, there have been reports in the press that some expatriates have been refused free access to treatment whereas others have not had such difficulties. How this will be checked and administered is not known, though it seems that the decision to accept or to refuse free treatment is left to the treating medical establishment. Furthermore, support from the British Medical Association is unlikely as the profession is split on the subject. They feel that it is not the job of a doctor to decide who is to be given treatment but realise that non-UK residents are taking advantage of free treatment while visiting the country.

While it is doubtful that those who choose to go back to the UK for non-urgent care such as a hernia operation will face a bill at the moment, it could only be a matter of time before free medical treatment becomes a thing of the past. With this in mind, expat health insurance that is valid overseas, as well as in the UK, either for temporary visits or permanent return is likely to become of more importance.