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THE IMPACTS OF THE IMMIGRATION HEALTH SURCHARGE ON

INTERNATIONAL STUDENTS: A HUMAN RIGHTS PERSPECTIVE IN UK

Student’s name

Institutional affiliation

Date
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CHAPTER TWO; Literature review

2.1. Introduction

The globalization of higher education has effectively resulted in a landslide of

international students into the United Kingdom which has significantly helped in deepening
cultural diversity and improving the academic level (Kadikar, 2021). Nonetheless, this migration
pattern has not been smooth-sailing, and one obvious levying has been the issuance of the
Immigration Health Surcharge (IHS) (Imiela et al., 2020). The new tax which was subsequently
introduced at the immigration stage, is known as surcharge and it refers to the hefty amount
international students are required to pay to access the National Health Service (NHS) in the UK
as they study there (Perreira et al., 2018). This dissertation aims to explore the complex effects of
the Immigration Health Surcharge on international students, analyzing the phenomenon
descriptively through a critical stance informed by human rights standards. The reason for
looking at the role that the IHS plays for the international students is based on the fact that health
is viewed as a human right. The concept of the right to health is inextricably linked with the
general conception of the human rights and, as highlighted in numerous international treaties and
conventions, it embodies the principle of non-discrimination and equitability in access to health
care resources.

Considering the fact that the UK is full of international students, who largely impact the
intellectual and cultural setting of the United Kingdom, grasping all the outcomes that are
associated with the IHS is vital (Kadikar, 2021). This study aims to address three specific
objectives: firstly to look into limitations that the IHS puts on the ability of international students
to access healthcare provision; secondly, the implications of the International Health Standard on
the socioeconomics of international students, and lastly, the IHS with international human rights
especially the aspects of non-discrimination and access to health care. In attaining these goals,
the study aims to offer more than just knowledge contribution, but provide evidence-based
information that may help in policy change, making life a rights respecting one for international
students in the country’s capital, United Kingdom.

2.2. Immigration health surcharge in UK

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The Immigration Health Surcharge (IHS) is a fee that most UK visa applicants, including
their dependents, must pay as part of their immigration application (Imiela et al., 2020). The
surcharge allows non-EEA migrants in the UK to access most NHS services with no further costs
in the same capacity as ordinarily resident British citizens. The exact amount of IHS you have to
pay depends on how much leave you are granted. Until the increased rates take effect, the UK
Immigration Health Surcharge currently costs £624 per applicant per year of leave granted, or a
£470 per year discounted rate applies for student visa holders, those on the Youth Mobility
Scheme and children under the age of 18 (Hiam et al., 2018). Adult dependents will usually pay
the same amount as the main visa applicant. The surcharge will be £1,035 per main applicant and
to £776 for dependents for visas issued for 3 or 5 years under the increased Immigration Health
Surcharge. The IHS reference number must be included on the application form, and the
surcharge must be paid before the visa or immigration application is granted (Lancet, 2015). The
IHS Surcharge was introduced in 2015 as a way to combat ‘health tourism’. Some of the services
not covered include eye tests, dentistry, and prescriptions.

The Immigration health surcharge applies to individuals desiring to stay in the UK more
than six months; which includes several visa categories namely work, and family visas (Giuntella
et al., 2018). A critical component of the visa application procedure, the IHS relieves the
pressure of the National Health Service, as these people receive only on the funds received
during their stay in the UK. The universality of the Immigration Health Surcharge across varied
visa types is one of the basic features. The IHS applies equally to one seeking employment
ventures, another pursuing any academicism, or even one coming home after separating
momentarily from his/her family (Kang et al., 2019). It creates a multidimensional view of
funding the healthcare through members of non-EEA nationals staying in Britain for a long
period.

The IHS financial obligation is brought by the moment of the visa application. Payment
is to be made online through the UK government’s website and amounts vary depending on the
visa type and the duration of stay (Kadikar, 2021). This subsidy, which is compulsory throughout
the duration of the visa, acts as such a preventive measure, wherein a person who enters into a
country needs medical attention during their stay. The law does not exempt the dependents as
spouses and children are also subject to the IHS. They are also expected to contribute
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individually hence highlighting the joining nature of the surcharge. This collectively binding
contribution emphasizes the rule that the state of access to healthcare services for non-EEA
nationals and those dependent on them is shared (Nellums et al., 2018). What is worth noting is
that the price for the Immigration Health Surcharge varies with inflationary changes but its
impact is much broader than financial aspects. Once the surcharge is paid, people obtain the
same spectrum of NHS services as UK citizens. These include primary care services, secondary
care, and different care services which are facilitative to the NHS system.

2.3. Barriers to Accessing Healthcare

Healthcare is a universal human right protected by several international conventions and

agreements. Yet, the Introducing the Immigration Health Surcharge (IHS), there appear to be
serious obstacles for international students studying in the UK to access basic healthcare services
(Kang et al., 2019). Most notably, the IHS imposed financial strain on the international students
which was one of the main limitations. The surcharge makes students pay a large amount in
advance which is a huge extra cost for a population that is already hard hit financially. Most
international students, who often bear their education costs, struggle to appropriate the required
amount to the IHS while still having other crucial aspects of their lifestyles, for instance,
accommodation, feeding, and educational supplies (Germain & Yong, 2020). Therefore, this
economic pressure serves as an obstacle that prevents one from having ready healthcare and may
aggravate the health condition.

One of the key challenges is the administrative problems associated with the IHS
payment (Lomer, 2018). Internationally practicing students are accustomed to foreign
environment administering in which they certainly also don’t promote the simplification in their
power of understanding the conditions needed for IHS payment. At times the system can be very
complicated such that the inaccurate delay could happen unintentionally that leaves the students
unqualified in direct access to health care. Other than contributing to the stress inherent in a
demanding academic climate, this bureaucratic hurdle also raises questions about the relative
fairness in which international learners are treated by the state’s healthcare system (Dorling,
2019).

In addition, the temporal restrictions resulting from the IHS only add to the existing
difficulties that international students face (Perreira et al., 2018). Individuals may be left without
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coverage during crucial period when they have to get used to living in a new country, studying
there etc., because the surcharge is only applied during the time of student visa (Juárez et al.,
2019). This temporal constraint however reveals itself to be rather challenging for scholars
pursuing extended academic programs such as postgraduate research, during the time in which
the surcharge’s time span does not correlate with the academic time flow.

The IHS is not as socially distributed among international students as people think.
Students from low-income families may therefore find the extra payment challenging, making it
difficult to cater for the financial requirements that come with the addition (Nellums et al., 2018).
This can be seen as a situation whereby the IHS takes part in widening income disparities that
already exist in the population of international students. It is necessary to analyze carefully how
the International Health System (IHS) complies with global human rights standards since its
economic consequences harm students’ welfare

2.4. Socioeconomic Impacts

As a financial contribution to the National Health Service (NHS), the Immigration Health
Surcharge (IHS) leaves implications so as socioeconomic for international students in the UK.
As this section reveals, the IHS does not only spell a fee burden directly for the student but such
have subsequent effects on socioeconomic standings of the concerned person. The first and
probably the most obvious impact of the international health surcharge is that it puts the
international student into direct financial stress (Imiela et al., 2020). Considering that the IHS is
another added cost to an already highly expensive enterprise of tuition and living costs, students
struggle to manage limited budgets, and that means that other basic needs are compromised
(Hiam et al., 2018). This severe economic burden may lead to an unsatisfactory lifestyle; added
stress levels, and in the most severe cases, such economic burden may affect students’
performance.

Additionally, the social-economic consequences are not limited to just monetary

limitation. The IHS may be a part of a wider trend of financial frailty among international
students (Anderson et al., 2021). The IHS is one of the many factors that affect the part-time
employment of many students in college. Most of these students take up part-time employment
as means to boost their income but the extra financial demands that they have stemming from the
IHS agenda can limit their capacity to indulge in that kind of employment (Lomer, 2018). As a
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result, these monetary restrictions have been limiting them from covering their basic living cost
while in the university and even minimize the whole university experience both academically
and socially.

The socioeconomic dimensions of IHS are further integrated with mental health issues.
There is a growing body of research pointing towards a relation between financial risk and
mental dysfunction among students (Murphy et al., 2018). By intensifying financial stress the
IHS can be shown to increase levels of stress, anxiety, and feelings of insecurity about the future.
The psychological impacts, on the flip side, can influence performance and general wellbeing as
well. The impact of such policy decisions on vulnerable subgroups, such as low-income students
or those who face intersectional challenges, has been well-documented in existing literature.
These include such people who may experience more intense challenges, involving delays or
non-use of health care services (Whelan, 2019). Hence, this implies that evaluating against
principles of non-discrimination and equitable healthcare provision becomes crucial when it
comes to access gaps.

2.5. Human Rights Principles

Since the United Kingdom imposing of the Immigration Health Surcharge to

international students, it is necessary to humanize the phenomenon using human rights
principles. The non- discrimination principle is inherent in the international human rights
framework. The IHS, in imposing a financial cost on international students seeking crucial
healthcare, raises issues about just treatment (Kadikar, 2021). Basing on the nationality,
surcharge creates a difference between domestic and foreign students, the former are not required
to pay such amount of money for healthcare. Such differentiators go against the pillars of non-
discriminations enshrined in various international legal contract such as the universal declaration
of human rights.

Also, the strong socioeconomic discriminatory implication of IHS on students from low-
income backgrounds creates more concerns. The hardship on the economic front, as described in
the previous portion, particularly affects some groups, intensifying the pre – existent injustices
(Hiam et al., 2018). This poses numerous ethical issues and human rights implications especially
with to respect and freedom from discrimination. The right to health is identified as a basic
human right which includes the right to receive needed medical services without prejudice. The
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IHS extends a financial prerequisite for getting health care, which by way of introduction
endangers timely as well as equitable health care delivery (Nellums et al., 2018). This implies
that, the very core of the right to health is questioned, in that by advice, access to services is
concerned with how much one has and not on the fact that this is a fundamental right for all.
Additionally, the scope of the limited time period of the IHS, applicable only for the students’
stay with the student visa, aggravate the right to been seen. As a result of engagement in lengthy
academic programs that international students might find themselves without coverage during
pivotal periods of transition, inability to receive medical care is hampered.

Among the international human rights treaties, as the International Covenant on

Economic, Social and Cultural Rights is noteworthy, the right to health is given not only in
general provisions of the law but also explicitly as a duty of the state to ensure the right to health
for everyone under its jurisdiction (Dorling, 2019). An appraisal of the UK’s IHS obligations
leads to questions regarding the alignment of the surcharge with the obligations entered into by
the United Kingdom using international law. In addition to legal requirements, ethical issues are
of primary importance. Since the IHS has deviated from the principle of nondiscrimination and
equal access to healthcare, its ethical aspects need closer scrutiny (Imiela et al., 2020). As such
the policymakers need to find a happy medium between distributing resources to public services
and how they are going to respect the rights of international students to promote ethical
policymaking.
2.6. Comparative Analysis

The comparative analysis shows valuable information on the effectiveness of the

Immigration Health Surcharge (IHS) through discerning health care and entry into Canada for
international students in other countries having and lacking analogous surcharges (Sá &
Sabzalieva, 2018). Various countries accommodate a lot of international student, each adopting a
unique way of providing health services. Comparing the IHS of the UK with policies such as
those practiced in Canada, Australia, and Germany widens the scope of our understanding of
how other nations manage the monetary factors of healthcare against the rights of international
students.

For example, Canada offers health insurance via provincial health plans which often
include international students (Lomer, 2018). Australia also provides access to health care
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through the public health system. In comparison Germany can be forced with the need of health
insurances for residence permits while the financial pain falls elsewhere. Examining nations that
do not carry surcharges such as Canada and Australia uncovers additional models which still
guarantee healthcare access to the international students without the extra burden of excessive
spending. These countries are based on inclusivity, highlighting the fact that healthcare ought to
be available to every resident, from the citizens to the foreigners alike.

By analyzing the systems consort in these nations one has a background for
reconsideration of IHS in the UK, whether its translucent punishment certifies the standards of
simple and equality upgraded by different nations (Sá & Sabzalieva, 2018). It requires policies
that not only take into an account bio-ethic factors but also show how to balance the financial
obligations to healthcare systems against the right of international students. In so doing, the
alternative models of other countries may be an incentive towards possible policy adjustments in
the UK to a more inclusive approach to healthcare for this specific population. Possible
alternatives might be to make appropriate changes in IHS to lower financial pressure, seek
public-private partnerships, to run and different clubs, or to incorporate universal understudies
into accessible well-being without explicit charge duties (Murphy et al., 2019). As much as
lessons are taken from international experiences, ethical considerations should inform the
comparative-analysis.
2.7. Gaps in Existing Literature

The current literature offers useful implications about the effects of the immigration
health surcharge on international students from humanity and visa human rights; however, some
noteworthy gaps remain (Imiela et al., 2020). The need to readdress such gaps cannot be
overemphasized as they further unveil the issue and point future researchers and policymakers.
There is a void in the broader context of immigration policies when compared to the literature
review that examines international student healthcare policies comparatively. It is important to
know how IHS related to other visa regulations and work restrictions or such like things ( Lancet,
2015). Further research should therefore study this in order to give a better understanding on how
various immigration policies affect the experiences of international students.

In many cases, the existing literature simply fails to consider longitudinal studies that
track how the impact of the IHS changes for students during their time of study abroad (Perreira
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et al., 2018). To fully capture these change patterns, long-term studies are needed on healthcare
utilization trends, financial stress levels, and overall wellbeing. Our understanding of long term
implications stemming from IHS policy for international students is hampered by lack of
longitudinal studies (Nellums et al., 2018). However, there remains an urgent need for more
qualitative research into international students’ life experience with regard to accessing health
care services through IHS. Qualitative methods including interviews and focus groups may
provide detailed insights into the daily struggles, coping mechanisms as well as resilience of
international students against the surcharge (Germain & Yong, 2020). There is a void in the
broader context of immigration policies when compared to the literature review that examines
international student healthcare policies comparatively (Kadikar, 2021). It is important to know
how IHS related to other visa regulations and work restrictions or such like things. Further
research should therefore study this in order to give a better understanding on how various
immigration policies affect the experiences of international students.

2.7. Summary of the literature review

The analysis of the IHS placed upon international students from a human rights point of
view leaves a tangled paradox of hurdles and implications. Such barriers to accessing healthcare,
socioeconomic impacts, their alignment to human rights principles, comparative analyses,
methodological considerations, as well as gaps in existing literature have been systematically
reviewed in this literature review. Integrating these results in a broader context several important
conclusions can be drawn. The IHS, which was meant as a financial support to the National
Health Service, is in reality a heavy burden for international students. The barriers to health care
access emanate from monetary difficulties, bureaucratic complications and temporal restrictions
which negatively affect the key human right to health. The socioeconomic impacts, for instance,
direct financial burden, possible implications for the psychology further distinguish the need to
strike the delicate balance between generating revenue and the student’s welfare.

Imperial Humanitarian Service aligns with none of the human rights pillars while there
are conflicts with non-discrimination and the right to healthcare. The comparative analysis brings
to the fore alternative models in countries which do not have surcharges holding out lessons for
the UK way forward. But there are gaps in the existing literature. There is little discussion on
social and economic consequences, temporal issues in access to health care, and it platform of
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vulnerable groups require additional study. The comparative analyses should not be limited to
healthcare policies but should be considered with regard to interactions with wider migration
policies as well. The longitudinal studies become important in comprehending the prolonged
impacts of the IHS over time, and qualitative exploration of lived realities sheds light on the
daily struggles of international students.

The literature review establishes a basis for further research as well as policies
modification. To deal with the magazine gaps and challenges, the researchers do the needful in
advanced studies that take into account the variant background of international students. IHS
should be reimagined through the lens of human rights principles, where an optimality would be
found that would leave this demographic without the punishment of wholesale disregarding of
their needs. With the spread of internationalization of education, the need to promote an
atmosphere that respects human rights, diversity, and everyone’s safety exists irrespective of the
student’s nation. The ensuing chapters will add to the above findings, suggesting that
recommendations for future research directions and policy changes that focus on the rights and
experiences of international students in the United Kingdom.
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