OBJECTIVES: Many NHS hospitals have developed an Acute Medicine Unit to streamline all non-elective medical admissions. The cost of providing this secondary care service is funded by the local primary care team, who in turn receive funding from central government. However, teaching hospitals in the capitol would also care for a considerable number of international and national patients. We sought to examine if health care costs were reimbursed for these patients. METHODS: We undertook a retrospective audit of all admissions over a 6 week period at a central London teaching hospital. We collected patient demographics, ICD-10 diagnosis and length of stay. We identified all “out of area” patients and calculated costs incurred based on bed days, diagnosis and re-admission within a month. The ICD-10 codes were converted to cost (HRG) codes through the finance office. RESULTS: A total of 864 admissions and 124 readmissions were analysed. In all 28% (n=242) of admissions were “out of area”. This cohort accounted for 25% of bed occupancy, and cost the hospital £390,300. Further, 1% (n=8) of patients were of no fixed abode (homeless) and cost £7,200 in bed occupancy. The international patients account for 1% (n=6) and cost £4,500 in bed occupancy. The top 3 presenting complaints with disease management costs were; Sickle cell anaemia (n=27- £34,899) chest pain (n=24- £16,757) and lower respiratory tract infection (n=19- £69,288). We went on to compare the income generated from these admissions on an individual basis. Initial analysis point to a deficit in income generated. This has significant implications for the financial viability of secondary/ tertiary care hospitals in the NHS. CONCLUSIONS: Our analysis point to a considerable financial burden from “out of area” patients to the capitol’s hospitals. Reducing this financial burden does raise clinical and ethical challenges to the receiving hospital.