Posted on May 03, 2011 by Sergio Ulloa
In Dubai, public healthcare costs are rising at a significant rate, which has become a major concern for expatriates, especially those without private health insurance.
Dubai residents can apply for health cards that are supposed to grant them access to public health facilities at a discounted rate. However, with the rising costs of treatment, those health cards essentially offer no discounts now. Treatment costs in government hospitals are now about the same as those of private hospitals, with a consultation costing around 250 Dhs to 400 Dhs (US$ 75 to US$ 120), and a one night stay in the Intensive Care Unit costing around 3100 Dhs (US$ 845).
There has been discussion of passing a legislation that would make health insurance mandatory for all expatriate employees that would be paid for partially by their employers. Abu Dhabi currently already has a similar law in place, which has led to around 98 percent of workers being insured. However, after years of talks in Dubai, expat residents are still waiting to see whether a mandatory health insurance scheme materializes.
To exacerbate the situation, the Dubai Health Authority (DHA) has recently announced that they will start charging expatriate patients for chemotherapy sessions. This announcement was made 2 weeks ago, and is due to be in effect in 1 week.
A staff from the Oncology Department of Dubai Hospital announced, "From May 3rd
, patients will have to pay for their chemotherapy injections, the cost of which will depend on the medications."
The vast majority of expat residents will not be able to afford these costs out-of-pocket. One session of chemotherapy can cost around 8000 Dhs (US$ 2,177), and around 14 - 16 treatments are needed in one year.
Many physicians, authorities, and patients have criticized the DHA for the short notice that it gave patients, and the lack of consideration for patients who have already begun a course of treatment and cannot afford to stop.
For many expat patients, they cannot wait to go back to their home country to seek treatment because it may take a while for the paperwork to be processed before they can start receiving treatment. The delay in treatment can drastically change the outcome of their recovery. It is also too late for these expat cancer patients to apply for and get private health insurance because no private insurer will agree to cover cancer treatment costs once the patient already has cancer.
Other costs, aside from chemotherapy, are also on the rise. Expats, B. Joseph and his wife, had a baby in Dubai in 2000, said, "We paid just Dh 100 for the delivery then. The health card is of no use now" Eleven years later, they have to pay 12,000 Dhs (US$ 3,266) for the same delivery package.
A DHA representative stated, "The card has no specific benefits. It only gives you access to government hospitals and clinics."
Currently, treatment is still free for Emirati nationals. Emergency treatment for expats is also free until the patient's condition stabilizes. At that point, they will be billed for all other treatment received outside of the emergency ward.
For example, an Arab woman, who was stabbed during a robbery, was billed 285,000 Dhs (US$ 77,589) for her treatment costs after her situation stabilized. She cannot afford the bill, and felt that the burden of the bill should not be on her. She complained to the Dubai Police Chief Lieutenant General Dahi Khalfan Tamin, and has started a discussion in the Emirate about who should be responsible for treatment costs for crime and traffic accident victims.
The DHA has responded to criticisms of cost cutting measures and rising costs by saying, "As a vital service provider, we take into account ethical and moral requirements. We are always aware that the field involves the life and death of patients and keep in mind the oath all doctors have taken - to treat all patients no matter what race, religion, or social standing - leading to the fact that all patients coming to the hospitals, especially emergency cases, need to be treated immediately regardless of their capability of paying or not. However, taking into account the rapid increase in the population of Dubai and the spiraling costs in running health organizations, there should be a mechanism in place to at least cover the costs of such services."
He goes on to add, "We believe that most of the issues, if not all, will be resolved with the introduction of a universal mandatory health insurance scheme, whereby every resident of Dubai is covered for certain health services. Dubai is moving forward in that direction."
However, many Dubai expat residents are skeptical about whether the scheme will ever come into effect. The DHA has said in the past that the scheme was originally to be introduced in January 2009.
According to a month-long Dubai Household Health Survey performed by the DHA, 75 percent of workers in Dubai have no health insurance. This creates a chain of consequences that results in reduced interest and investment in Dubai healthcare services as well as escalating bills.
Dr. Haider Al Yousuf, Director of Health Funding at the DHA said, "Limited access reduces utilization; this does not provide enough volume to maintain a high quality of services provided, allow specialized centers of excellence nor promote medical tourism."
Ram Lachhan Raj, a laundry worker, ran up a bill of 44,000 Dhs (US$ 11,978) in one week after he was diagnosed with leukemia and renal failure. Neither him nor his employer can afford the costs.
"As good residents, we would like to pay, but just cannot afford it," said Somsun S, a small business owner, who is left with a bill of 45,000 Dhs (US$ 12,250), after an employee was paralyzed after a fall.
In the past, hospitals have been understanding and have waived the bills for many people. NGOs and other organizations have contributed to treatment costs, but this solution is no longer sustainable as the amounts involved have become much too high.
Patients and hospitals are also trying to organize charity drives by holding garage sales and markets to raise money for patients who cannot afford the costs, but many experts believe that the only permanent solution is mandatory insurance.
Others have pointed out that it is not as simple as passing a law that makes health insurance mandatory. Albert Rodrigues, the Managing Director of Millenium Insurance Brokers noted, "It is not easy. The challenge for the health authorities is to find the right formula that would satisfy all the stakeholders - medical providers, employers, insurance companies, and the general public who include both Emiratis and expatriates. Most employers do not have the margins to cater to the new equipment"
Deteriorating economic conditions are another contributing factor to the delay in implementing the mandatory health insurance scheme. Sanjay Tolani, Director of Goodwill Insurance Brokers expressed, "After the financial crisis, some multinationals have sized down employee covers, while others have begun to share premium costs with the employees." Tolani also said that to compromise, many large employers have opted for Health Management Offices (HMOS), where employees can have discounts at a network of predetermined clinics and doctors.
Until employers, health authorities, and insurance companies reach a deal, the situation continues to worsen with hospital bills continuing to escalate.
According to the World Health Organization (WHO), the UAE expenditure on health per capita is 3,607 Dhs (US$ 982). Comparatively, this is much lower than many Western countries. However, since the UAE is a tax-free country, medical care costs are becoming more difficult for the government to carry entirely on their own.