Urgent solution is needed to long-term patient care

The general policy of free health care for citizens is gradually changing, writes Peter Hellyer

Patients relax in the hallway of the Ajman Elderly Care Home. Razan Alzayani / The National

In recent weeks, considerable angst has been expressed about the decision by the Health Authority – Abu Dhabi (Haad) that Emiratis with Thiqa medical insurance must now pay 20 per cent of the cost of their treatment at private hospitals and clinics.

While that may seem a modest amount to expatriates, it has come as a great shock, with many citizens facing what are huge burdens. Attention has been focused on those who require long-term inpatient care which, in many cases and for a variety of reasons, is not available at government-owned hospitals. For them and their families, the 20 per cent can amount, it is suggested, to as much as Dh60,000 a month. That is beyond the reach of all but the very wealthy.

I have, thus far, read little about the impact on outpatient care. Many families, naturally, prefer, if possible, to have those in need of long-term attention or care at home. When a properly-trained nurse in attendance for only eight hours a day can cost Dh30,000 a month or more, a payment of 20 per cent would cost Dh6,000 a month. For many Emiratis, often with large families to support, that amount too would represent a heavy burden.

Private health-care providers, we hear, have been told that if they fail to collect the 20 per cent, to pass on to the insurer, or if they offer discounts to those who find it difficult to pay, they will be in breach of the contracts which govern their relations with the government-owned insurer, putting at risk their entire business.

The problems clearly need to be addressed swiftly. If there are no beds available in government hospitals and the family of a long-term inpatient cannot afford the 20 per cent, are they really expected to take the patient home, when inadequate care or possibly an earlier death may result?

Surely someone, somewhere, should have seen these issues coming. One wonders whether sufficient thought was given to the broader ramifications of what is, in essence, a government cost-cutting measure.

Perhaps a solution can be found quickly, either within the existing structure or through the establishment of a special office to which people can apply for assistance.

Beyond that, however, there is a need for a wider re-examination of the whole health-care sector.

Over the past decade or so, there has been an increasing tendency to encourage the growth of the private sector, in health care as in so much else. This applies not just to the supply of beds, doctors and nurses but also to the provision of particular types of treatment. Thus the private sector now supplies most of the long-term inpatient care facilities while government hospitals seem, currently at least, to have insufficient beds for this category.

I am not aware whether any understandings, explicit or otherwise, exist, but the private sector may well have invested in the facilities to provide this kind of treatment on the assumption that government would continue to pay for the health care of Emiratis. As a corollary, government investment in this aspect of the infrastructure of the public health care sector was saved.

The general policy of free health care for citizens is gradually changing, and perhaps rightly so. With a rapidly rising Emirati population, the policy is no longer affordable. It is reasonable that people should make some contribution, especially those who choose to use private hospitals when similar facilities are available in the government sector, although one should recognise that the quality of care is not always comparable.

At the same time, one could argue that it is the duty of government, as part of its commitment to provide for its citizens, to ensure that appropriate health care is provided for those whose needs cannot be met by themselves or their families. Until the necessary facilities are available in the government sector, the private sector should be paid, fully, to do so.

Peter Hellyer is a consultant specialising in the UAE’s history and culture