Shock at insurance coverage cuts for ‘most vulnerable’ Emirati patients

Changes in health insurance that require users to cover 20 per cent of their treatment leave families and care providers in a tough position because many long-term patients will never leave hospital and have no means to pay.

Ali Hashemi, Amana Healthcare director, said making long-term patients pay was unnecessary. Christopher Pike / The National

ABU DHABI // The families of hundreds of Emiratis in long-term private care are facing bills of up to Dh60,000 a month after a change to their health insurance.

Most cannot afford to pay and fear they will be forced to bring their loved ones home – where, without expert care and treatment, a patient’s condition will deteriorate and many may die.

Until June 30, treatment at private hospitals was fully covered for UAE nationals under Thiqa health insurance plans. The Health Authority Abu Dhabi then announced, without warning, that from July 1 patients would have to pay 20 per cent of the cost.

Families reacted with shock and disbelief.

Ahmed Mohammed’s brother Abdulla, 70, is in a coma and on life support at a long-term care centre after suffering a stroke. “I can’t pay to keep him here, so shall I just take him home to die? There is no other option,” he said.

› How the changes in insurance coverage in Abu Dhabi will affect you

Ali Hashemi, executive director of Amana Healthcare, the country’s only operator of long-term care and rehabilitation facilities accredited by the international non-profit Commission on Accreditation of Rehabilitation Facilities, said making long-term patients pay some of the cost of their care was unusual.

“It just doesn’t make sense. I can’t think of a single example worldwide where such a significant financial burden is placed on a vulnerable population,” he said. “Long-term patients are the most vulnerable. In some cases, they are here for the rest of their lives.”

Some families have been advised by health authorities to discharge their loved ones from long-term care centres and wait until they are reassessed. If a medical report states that no treatment is available, they have been promised that the authorities would then waive the 20 per cent charge.

Mr Hashemi described this proposal as “unnecessary, and extraordinarily dangerous”.

He said patients in long-term care had already been assessed by Seha, the Abu Dhabi Health Services Company that operates the Emirate’s public hospitals and clinics.

“These are incredibly ill patients. They are all critically ill and on life support. If you take them out of this environment you are introducing them to huge, unnecessary risks.”

Both Amana Healthcare and Cambridge Medical and Rehabilitation Centre, the other long-term care provider in Abu Dhabi, were continuing to look after their patients, despite families having told them they could not afford the 20 per cent levy.

“We are monitoring this situation on behalf of our patients and their families. We are continuing to seek additional clarification,” said Dr Howard Podolsky, Cambridge chief executive.

Michael Davis, chief executive of ProVita International Medical Centres, which has branches in Al Ain and Abu Dhabi, said many long-term patients would be considered a lower priority at acute care ICUs.

“Half of their patients suffer from progressive, irreversible congenital, degenerative and neuromuscular disorders, he said. “Our patients, half of which are paediatric patients, will need institutionalised care for the remainder of their lives.”

At ProVita, the treatment involves reintegrating patients into society by sending them to school, mosques, family gatherings and other therapeutic activities “that cannot be done in the government hospitals”. “It’s unusual in western countries for long-term care patients to bear the burden of a co-pay for an indefinite period of time,” Mr Davis said.

Mr Hashemi said in principle he supported the new insurance scheme – which, for the first time, required a percentage payment for all medical services that were previously free. He hoped an exception could be made for patients in long-term care.

“I am expecting a simple clarification and have confidence that the decision makers know that this is untenable,” he said.

“For 99 per cent of healthcare services, it makes sense to require a part payment. But there are certain areas where you can’t apply it. Usually outliers are exempted. It’s too much of a burden on the families.”

All of Amana’s patients have been referred by the Government “one way or another”, he said. Such patients in general hospitals were “callously referred to as ‘bed blockers’”.

“These are people who did not choose to be here,” Mr Hashemi said. “Some are almost compelled to be here because government hospitals are full.”

Even if beds were available, government hospitals were not equipped or designed to deal with long-term patients who were too sick to go home, he said. Hospitals such as Sheikh Khalifa Medical City and Mafraq in Abu Dhabi were for acute care, not long-term care.

“If you go to any physician, manager or chief executive at an acute-care hospital and tell them, ‘please accept a long-term patient’, they will look at you like you are crazy because they are not designed to do that. It is an ineffective use of their resources,” said Mr Hashemi.

“The system is designed to work in this way. We built Amana because we were encouraged by the Government to do so. We worked with the Government to improve healthcare standards and to improve clinical guidance.”

Most patients at Amana, which has 160 beds, and Cambridge, which has 180, are UAE nationals.

“Our patients are the most vulnerable in society, many of them were forgotten. They were stuck in an ICU in an acute-care hospital not because of neglect or poor-quality care, but because it was the right environment to deliver the best care or the best family cohesion, “Mr Hashemi said.

He described asking long-term patients to pay part of the cost as “double punishment”.

“It is a legitimate and effective tool when a patient is making a choice, but not when a patient has no choice, such as anything that is catastrophic – cancer care, oncology, chemotherapy.

“If a patient has to cover 20 per cent of the cost of chemotherapy you are punishing them twice – once for getting the disease, and then making them pay for it. The whole point of insurance, the whole point of a government- safety programme, is to protect the most vulnerable.”

Mr Hashemi was confident the Government would find a solution to benefit long-term patients. “I have confidence in the UAE and I know that they want to continue the immense progress that has been made.”

Thiqa, the Government’s health programme for Emiratis, is managed by Daman, who referred requests for comment on the 20 per cent payment rule to the Health Authority Abu Dhabi.

On Tuesday, Haad said it required 48 hours to prepare a response. As of Thursday it had not yet done so.