New restrictions on free NHS treatment for overseas visitors and failed asylum seekers have been outlined.
"Health tourism" could be costing the taxpayer millions
Ministers say "health tourism", where people visit the UK expressly for free treatment, costs the NHS dear.
From April these patients will have to pay in advance, unless the treatment is an emergency or for infectious disease.
Doctors have attacked the plans, saying they do not want to question sick people about their immigration status.
Opposition politicians have also questioned the proposals, calling on ministers to provide hard evidence that there actually is a problem.
One study has suggested health tourism costs the NHS up to £200m a year, but the Department of Health has admitted no firm figures exist.
There are already rules restricting free treatment, but the government says they are not being properly followed and loopholes are being abused.
Who are the new rules aimed at?
Failed asylum seekers and others with no legal right to be in the country
Heavily pregnant women who live overseas coming to the UK just to give birth even if their partner lives here
Business travellers to the UK and their dependants
Ministers cite cases of heavily pregnant women arriving in the country on a holiday visa, knowing they will get free treatment.
Some business travellers are even bringing their partners and children with them - and then "suddenly discovering" there is something wrong with them.
And hospitals are not asking people to prove they are entitled to NHS benefits, and not doing enough to chase up costs which could be recouped, the government says.
The changes follow a three-month public consultation exercise.
They also include a new regulation to allow British pensioners to spend up to six months out of the country every year and still be eligible for free NHS treatment.
Currently if someone spends more than three months out of the country
they are technically not eligible.
Health secretary John Reid said: "If there are bona fide tourists dropping ill in the street, of course we will do what we have to do, but we are not mugs.
"There is a difference between being civilised and being taken for a ride."
Mr Reid said the crackdown would also target failed asylum seekers who were "effectively stealing treatment from the people of this country".
"I am not talking about emergency treatment, matters of life and death.
"I am talking about routine treatment that causes the people of this country, who are legally and morally entitled to it, to have to wait longer."
Speaking on BBC Radio 4's Today programme, Health Minister John Hutton insisted there was a serious problem with the way the system was working, but when pushed admitted no hard figures were available.
However, he said: "The NHS has told us that the regulations need to change because there are abuses going on."
It is not yet clear how the new rules will be applied. The Department of Health says there will not be a need for new hospital managers.
The BMA later said it welcomed clarification from the Department of Health
that doctors would not have to determine who is eligible for treatment.
A spokesman said: "The BMA is pleased to see that the Department of Health has promised to take its
concerns into account when drafting the guidance, and the Association looks
forward to commenting on it."
Dr Edwin Borman, chairman of the BMA's international committee, questioned whether there was any evidence that health tourism was a significant problem.
He added that he did not want to see doctors becoming "state agents" for a discriminatory system.
"I have a responsibility to any patient to treat their illness, and care for them as much as is possible," he said.
"It is entirely appropriate that the citizens of the UK are treated to the very best extent possible by the NHS.
"But we also have an obligation to people who are visiting this country and
who, quite reasonably, from time to time might suddenly have an emergency, to
As for plans to deny treatment to failed asylum seekers, he described these as
A spokeswoman for the Royal College of Nursing said: "We would be extremely concerned with any government proposals that could affect the relationship of trust between nurses and patients and that would endanger patient care."
Shadow health secretary Tim Yeo said the plans would only "scratch the
surface" of the problem.
He accused the government of failing to analyse the problem properly, and said that until it did, the plans would fail to win support.
He called for consultation with family doctors and more education abroad on preventing
people not entitled to free NHS treatment from registering as patients.
The Liberal Democrats said the proposals could mean members of ethnic minorities being asked about their right to receive treatment when they turned up at hospitals.