NHS hospitals recovered just one third of the £91m billed from overseas visitors last year, an analysis reveals.
Overall, £35m out of £91m was reclaimed by the health service for care it provided to citizens from countries not in the European Economic Area.
The amount billed in 2018-19 is up £4m on 2017-18, while the amount received has increased by just £5m, according to the Health Service Journal.
The British Medical Association has been calling for an independent review of the charging system.
Its medical ethics committee chair, John Chisholm, said the system not working and, given the difficulties in recouping charges and assessing a patient’s ability to pay, “it is not cost effective or beneficial to the NHS”.
NHS Providers deputy chief executive Saffron Cordery said recovering costs can be challenging and efforts to do so must not compromise patient care.
“We need to bear in mind the workforce and demand pressures that make this a difficult task for frontline staff,” she added.
HSJ analysis revealed providers in London wrote off more debt than they received in cash last year. These providers charged £51m, 56% of the total in England, but received payments of £16m and wrote off £19m.
Barts Health issued £10.2m in fees – the most of any provider – but received just £1.1m in payments.
An NHS Improvement spokesperson said: “The NHS recovered an additional £20m last year from overseas patients compared to two years ago, and continues to provide expert support to trusts to ensure as much money as possible is recovered so it can be reinvested into frontline care for patients.”