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Health Umbrella for One and All

dubai — Like others of their age, 12-year-old Rann-Mark and four-year-old Ronaldo-Miguel are playful, hence prone to accidents. And their 38-year-old father, Ronaldo Balas, is a worried man.

“Boys need extra attention, and God forbid, if they injure themselves, it means immediate medical attention,” he says.

That could also mean rushing to the hospital and bearing the entire cost of treatment because the family does not have medical insurance.

The Balases are among the hundreds of UAE residents who know the importance of medical insurance, but do not have the financial capacity to pay the premium under the prevailing medical insurance schemes.

Others simply think medical cover is not a necessity since the current health services are available on as-you-pay basis.

However, the UAE government looks at the issue differently. With a dramatic change in the demographic, epidemiological and socio-economic profile over the past three decades, providing affordable and quality healthcare to all has become a necessity and a major challenge for the authorities.

As a sustainable and long-term solution, the government recently announced that it would roll out a mandatory health insurance system tailored from existing models such as in the United Kingdom, the United States, Singapore, New Zealand and Australia.

The burning question is: Is the upcoming system affordable and will it really work? Currently, since the country’s health sector is being run on dissimilar systems governed by separate health authorities for each emirate, the solutions, too, are in dissimilar formats.

The Health Authority - Abu Dhabi (HAAD) and the Dubai Health Authority have already modeled suitable systems for residents of the two emirates. However, Sharjah, Ajman, Umm Al Quwain, Fujairah and Al Ain fall under the purview of the Ministry of Health (MoH), which is also expected to announce the compulsory federal health insurance system by October end. Minister of Health Humaid Mohammed Obaid Al Quttami has said that the federal insurance will not overlap, but enhance the other systems in Abu Dhabi and Dubai.

With hopes pinned on the upcoming system, Ronaldo says that it may lessen the strain on him. “Rushing to a hospital at the drop of a hat means unforeseen spending,” he feels.“Since insurance is going to be compulsory for all, I hope that my company or the government would pay for the bulk of my health spending,” he hopes, adding that his company was not footing the bill for his family, currently.

While health authorities are thinking on the same lines, they are, in fact, sharing the burden of rising healthcare costs with the private sector.

Health Funding Plan

Under the Dubai government’s upcoming Health Funding plan, the employer or sponsor will contribute the bulk of the premium estimated between Dh500-800 per person each year. However, patients will also have to make a co-payment of Dh25 upon each visit to the general practitioner, a fee subject to change, say authorities. Although, the UAE nationals will enjoy subsidised access to comprehensive healthcare, expats can only access basic health services such as primary outpatient care, prescription drugs, childhood immunisations, children’s dental care, mental health, ambulatory specialist care, accident and emergency, outpatient lab tests and diagnostic radiology and X-rays.

The plan would leave would-be-mothers and newborns requiring special care to fend for themselves. The would-be mothers will continue to pay for maternity packages ranging from anywhere between Dh2,500 and Dh6,000. At present, the UAE government finances 81 per cent of the total healthcare costs. The MoH has indicated that the current Dh2.5 billion health budget is not sufficient to upgrade health facilities in the country that are under considerable pressure.

Despite this huge spending, the ability to access healthcare differs across the population. Currently, the UAE nationals have access to a government health card system and can access private care, if required, in Dubai or abroad at government expense. Expatriates, too, can get treated at government hospitals, but by buying health cards for Dh300 and also paying up to 50 per cent from a price list.

Those enjoying medical cover, either company sponsored or privately bought, say it is an absolute must. A young Australian family, which set up home in Dubai three years ago, says even basic health cover is a boon.

With Jack, 5, and Sasha, 2, Julian and Geraldine Wilcock feel that if their family did not have basic insurance, they would have no choice but to bear the entire costs like they had to during Sasha’s birth. “Despite the fact that we had to pay for maternity during Sasha’s birth, we feel blessed that my husband’s company takes care of the major portion of our medical bills,” says 35-year-old Geraldine.

She says, “With children, accidents are just waiting to happen. Once, my son had to get stitches after he hurt himself once. At that time, we rushed to a nearby hospital without actually thinking of the costs, thanks to the medical cover that we enjoy. We really think that everyone should have access to basic healthcare at least.”

Industry experts evaluate that though the affluent may not benefit much, the upcoming insurance would change the lives of those from the low-income bracket, a fact that Ronaldo and his 37-year-old wife Marites agree to.

“Compulsory health insurance is the ideal solution to the country’s healthcare needs,” says Dr Ajit Nagpal, a former principal advisor, Health Policy and Hospital Affairs, Ministry of Health.

Dr Nagpal, who, along with top health officials, conceived the federal health insurance process eight years ago says, “The common man with low income and savings will benefit most because of the risk-pooling and government subsidy.”

Need for the system

The UAE has emerged as one of the top 20 high-income world economies since the foundation of the federation in 1971. Its population has increased 15-fold from 360,000 in 1972 to over five million at present. The healthcare infrastructure, too, has grown from seven hospitals with 700 beds to over 9,000 beds during the same period.

In 2002, the MoH reviewed the financing and provision of healthcare and observed that the share of public spending of the total health expenditure was substantially lower than most industrialised nations. The top 20 World Health Organisation (WHO) ranked countries typically spend around 8-12 per cent of GDP on healthcare, while UAE spends about four per cent. It was also observed that the infrastructural development had slowed down from 3.2 beds per 1,000 population in 1991to 2.3 beds per 1,000 in 2002.

“There was a need to undertake public policy initiatives and mobilise additional resources,” explains Dr Nagpal.

“Therefore, the government decided to introduce mandatory social insurance in the same time period.”

“Establishment of HAAD and Daman are two major accomplishments of this initiative. Today, nearly 1.5 million low-income expatriate workers and their families insured by Daman enjoy the benefits of mandatory health insurance,” estimates Dr Nagpal.

The private sector, on the other hand, feels much has to be done before the system is rolled out. Dr Kassem Al Om, Managing Director of the privately-owned Al Noor Hospital in Abu Dhabi apprehends that the supply is expected to override the demand.

“The current system has seen a limited number of patients reach out for medical help since they have to bear the costs. Compulsory insurance will ensure that everyone has access, but a lot in terms of infrastructure and manpower needs to be done before the entire system is in place,” Dr. Kassem says.

He adds that the widely prevalent idea of free healthcare for all in the UAE has to change.

Looking at the global trends, Dr Kassem feels that in the future individuals may not be able to pay for their own well-being at all.

“The concept of mandatory insurance is appreciable, and much more so if someone else is paying for you,” he points out.

“Encouraging the private sector to invest heavily can help overcome expected shortage, but this can be done only when regulations are eased.”

Likewise, feeling that healthcare spending is spinning out of range for common man in the UAE, Pakistani national Mohammed Azeem, 47, believes that compulsory insurance would rein it to a certain extent.

Spelling relief for Azeem, who survived a heart attack, the scheme is expected to cover provision of prescription drugs.

“If I buy medicine from the UAE, I have to spend Dh1,000 per month but I get the same drug from Pakistan for Rs2,000 (Dh105) since it is manufactured there. But, to me it does not matter. Instead, itmeans huge savings, so why should I spend extra?” he questions. The success or failure of the scheme can only be gauged once the system is fully in place by 2015.

Till then, residents say they would prefer to keep their fingers crossed.

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