Healthcare workers and residents are calling for mandatory health insurance to be extended across the northern emirates without delay to ensure families are no longer saddled with unmanageable medical costs.
From a simple visit to the doctors to complex surgeries, residents must pay their own way, unlike in Abu Dhabi and Dubai where mandatory health insurance has been implemented.
The Ministry of Finance have said they are pursuing mandatory cover and a draft law will be raised with the UAE Cabinet, but have not specified an expected date of implementation.
“I wish that they will implement the insurance law quickly, so that all people can get treatment, every single person,” said Mohammed Rashed, the deputy director of RAK Medical District.
At government hospitals in the northern emirates, emergency treatment is provided by the government and chronic cases are supported by donations and government.
“With money or without money, regardless of nationality, we treat people,” said Dr Yousef Altair, the director of the Ibrahim Obaidallah Hospital, a government hospital in Ras Al Khaimah.
“We are dealing with humans. We can’t say no. The issue is when a patient is discharged we have to we have to ask them about this money,” he said.
Costs are often absorbed by the government, said Dr Mohammed Abdullah, director of Fujairah Medical District. “If he has money he will pay, if he doesn’t have money government will pay. But if is organised by medical insurance, I think it will reduce some of the government’s costs.”
It will also raise the level of healthcare, he said. “The situation needs to be organised.”
Individuals and companies are reluctant to buy insurance when it’s not legally required, said Dr Altair. “Some people are not convinced about buying insurance. They say they won’t be sick all year, that they’ll pay Dh4,000 and not even make one visit to the hospital. I say that’s wrong, that anything can happen.”
Others simply cannot afford insurance, said the hospital’s social worker Maryam Al Manai. “Insurance is important for those who have money but our patients don’t have money. How will they pay for it? Most of them don’t have work. Insurance requires money and when people come to the hospital they don’t have one dirham.”
When Reham, a resident of Ras Al Khaimah, gets sick all she can do is call her mother in Egypt and ask for home remedies. Reham is a newlywed, six-months pregnant, unemployed and one of the thousands living in the northern emirates without insurance.
Recently, Reham and her husband borrowed Dh1,500 to cover blood tests and ultrasounds.
They had little choice. Their monthly income is Dh5,000.
“I can’t complain as it's not mandatory for our employer to provide us with medical insurance and when I accepted the job offer I didn’t know how important it was to have an insurance card,” said Reham’s husband, 33, who asked not to be identified. “I didn’t know that without a card we would pay a fortune.”
Recently, it was announced that all Ministry of Health employees in the northern emirates would receive full insurance but this does not extend to dependents.
Hospital staff said the number of uninsured patients requesting financial assistance had dropped significantly in the last five years, from a few people a day to a few per week.
Ms Al Manai said the hospital receives people “every other day”.
“We see maybe three or four people a week.”
Many are receiving long term treatment, like dialysis.
The hospital follows up on these cases every month and every three months for psychiatric cases.
Of course there are many who simply do not approach the hospital at all or until their pain is unmanageable.
Mr Hemdan, who worked as a director of operations four hospitals in Abu Dhabi, said low income workers would be in acute or terminal stages of illness before coming to the hospital. He said he remembers patients standing outside the hospital, asking for medication for the pain. Many had kidney stones.
“It’s is one of the most excruciating pains,” said Mr Hemdan, who now works as director of operations at Medeor Hospital in Dubai.
“You can pick out the guy with it easily. He’s the guy who is bent over, who cannot sleep and who cannot stand. You can imagine how it was for people who couldn’t afford access to the doctors or access to painkillers. It doesn’t need a professor to treat it but without an insurance card they did not have access to this simple service. So of course it makes a difference in these people’s daily life and these people’s daily confidence,” he said.
The northern emirates can look to the success of Dubai’s Health Insurance Law, which passed in 2013 and made health insurance mandatory for all workers and their dependents.
Mandatory health insurance was first introduced in Abu Dhabi in 2006. An estimated 98 per cent of the population was insured within five years.
It has taken time for universal coverage to be extended across the country but this has taken time; a federal law requiring mandatory insurance for workers across the country was drafted in 2013, after similar draft laws were considered in 2004 and 2007.
“In Abu Dhabi it was a success story, there is no doubt,” said Mr Hemdan.
Dr Altair added, “They tested it in Abu Dhabi and Dubai and it can fit here in Ras Al Khaimah. Insurance is important for everybody, everywhere in the world.”
The Ministry of Finance is now studying implementation costs before raising it with the UAE Cabinet.
“The draft law on health insurance was prepared alongside the Ministry of Health and Prevention, and the draft law will be raised to the Technical Committee for Legislation,” said Younis Al Khoori, the undersecretary of the Ministry of Finance.
“There have been no delays,” he said. “The Ministry of Finance is currently in the process of studying the financial costs of implementing the law, and the next step would be to raise it to the UAE Cabinet.”
For Reham, every day without insurance is a struggle. Her child is due in January. Her husband is seeking employment that provides medical insurance.
“The plan now is to send my wife to give birth in Egypt and keep her there for around three months after birth as newborn babies needs medical care in the first few months and we won’t be able to cover it here,” he said. “If I found another job with insurance before December my wife can give birth here and I will have the chance to attend my first childbirth.”