The financial vulnerability estimate has increased partly due to an increase in the financial vulnerability rate.
Emerging trends and prevalent threats
It is highly likely that false applications are made for UK Global Health Insurance Cards (GHIC)/UK European Health Insurance Cards (EHIC). Therefore, cards can likely be issued without the application originating from a genuine individual.
£0.99m
vulnerable from an expenditure of £127.3 m
Similarly, it is probable that an application could be made with false information to prevent a genuine individual obtaining a GHIC.
Areas reported to have been targeted by a bad actor
It is highly likely that an individual may use a GHIC or UK EHIC abroad, or an EHIC in the UK to access care without charge or at a reduced rate whilst knowing they have moved abroad permanently and are no longer insured by the issuing country.
It is a realistic possibility that a fraudulent application for a healthcare entitlement certificate (S1) could be made. An S1 entitles an individual to state provided healthcare cover in the country in which they are residing.
Theft of a GHIC was also likely, including at the airport both in the UK and France. An individual’s GHIC may be stolen in amongst other items, for example when in a bag or mail/post. Alternatively, theft of the GHIC may be targeted, with other items left untouched. GHICs enable access to necessary state healthcare whilst abroad in certain countries, however, in some cases corresponding identification is required, like a passport.
Locations in which fraud or theft was reported to have occurred
PESTLE analysis
Political: Electronic Exchange of Social Security Information (EESSI) can be used for the reimbursement claims for costs incurred from providing care; however, some claims are making cross-border detection of fraud more difficult.
Economic: Websites charging for GHIC applications continue to exist, however a media outlet recently attempted to make the public aware that the card is free and to avoid these websites.
Technological: The NHSBSA introduced a residency checker in 2021 for UK EHIC, GHIC, PRC and S2, ensuring applicants are ordinarily resident in the UK.
Environmental: To access reciprocal healthcare an individual will likely have to travel abroad, this could involve various types of travel including an airplane, car and train etc. All of which will have an impact environmentally, as well as the footprint of healthcare generally.
Legal: The GHIC has wider coverage, for example a UK EHIC cannot be used in Montenegro, Saint Helena, Ascension Island or Tristan da Cunha. Additionally, UK residents are entitled to state healthcare in the Republic of Ireland and vice versa, a driving license or passport would instead be presented.
Organisational: The NHSCFA has recently closed an intelligence gap through analysis of the reciprocal healthcare agreements outside of the EEA.
Media Factors: The media, including consumer finance websites, continue to report on the application and use of the GHIC.
Reporting
During this reporting period the NHSCFA received 12 reports compared to 6 last year.
| Thematic area | 2020-21 | 2021-22 | 2022-23 | 2023-24 | 2024-25 | 2025-26 |
|---|---|---|---|---|---|---|
| Reciprocal healthcare | 21 | 11 | 4 | 7 | 6 | 12 |