Dubai: Preventative care is probably the most important thing that stands between a woman and developing major gynecological health problems like breast cancer or cervical cancer. But for many women, that all-important care is beyond their reach.
Preventative care, including mammograms, pap smears, HPV testing and physical examinations are often not fully covered by insurance companies in the UAE, meaning that for many women they are an added cost.
Women are recommended to have mammograms once every two years after they reach the age of 40 until they are 65, and should have yearly physical exams to protect from breast cancer, says Dr. Muna Tahlak, a consultant obstetrician/gynecologist at Latifa Hospital in Dubai and the president of the Obstetrician/Gynecologist Society in the UAE. High risk women should be tested more frequently depending on their family history, she adds. In addition, pap smears and HPV tests should also be administered regularly to protect from cervical cancer.
But many insurance companies do not cover the charges, a number of doctors told Gulf News.
“[Mammograms] are not covered by insurance here at all,” said Dr. Alexandra Economacos, a breast radiologist at the City Hospital in Dubai Healthcare City, while the hospital’s consultant gynecologist Dr. Elsa DeMenezes said that insurance would not cover preventative measures unless the woman has a medical problem requiring such tests. Dr. Tahlak also confirmed that while treatment of gynecological conditions is covered by insurance companies, preventative care is not.
“When a woman comes to me for her pap smear, unless she says she has a problem they just don’t pay for it,” she said. Women then end up getting these crucial tests after its too late, “which is exactly not the ideal situation,” Dr. Tahlak pointed out.
Although some insurance companies, such as AXA Insurance, have policies that include coverage of routine physical examinations and gynecological tests, a Gulf News’ poll of 404 readers showed that 62 per cent are not covered by their insurance company for any preventative gynecological measures at all, and 14 per cent require a diagnosis before their company will agree to pay the costs of the examinations.
Arlene Fazlul, an accountant at Novelty Group, is one of the 62 per cent. Fazlul said that her insurance, which she gets from her company, covered a pap smear doctors asked her to get after she gave birth. However, her insurance does not cover regular check-ups or gynecological care, and as a result she does not get mammograms or pap smears regularly, waiting instead until she can go to her home country to do so. “I’m a little on the dangerous side, actually,” Fazlul said.
In some cases, insurance companies will cover the costs, but there’s a catch. Enaya, for example, provides coverage for preventative measures without a diagnosis – but only at public clinics and hospitals run by the Dubai Health Authority, according to Lubna Farouk, Enaya’s helpline supervisor. Additionally, because Enaya is a government insurance company, it is available only to Dubai government employees.
At Al Khazna Insurance Company, check-ups and preventative testing is covered only if there is a request by the doctor, said Beni John, the company’s underwriting assistant, but added that there are policies that include routine check-ups as a benefit. However, Al Khazna only provides group medical insurance, making its customers dependent on the type of policy chosen by the companies they work for.
In Abu Dhabi, the Health Authority Abu Dhabi has mandatory universal insurance coverage and 98 per cent of the emirate’s residents are covered, according to the most recent HAAD statement. The statement also said that Abu Dhabi makes healthcare more affordable through a standardized payments system. However, information on the costs of gynecological tests in HAAD and Ministry of Health hospitals was not immediately available.
The costs of preventative treatments vary from one hospital to another, and without insurance coverage they can be prohibitive. Although public facilities offer the tests in the Dh100-250 range, at some private hospitals prices can go up to almost Dh800 for a mammogram, meaning it can be difficult for many women to get the important procedure regularly. Pap smear costs are generally in the Dh200 range, while HPV testing and vaccinations are the most expensive, coming up to Dh900 at some hospitals. Even physical consultations can be pricey, with some hospitals charging over Dh500.
The situation here in the UAE is in stark contrast with that in other countries such as South Africa, where Dr. Economacos says women are encouraged to get preventative tests done, or in the United Kingdom where national health insurance covers the tests.
“[In the United States] at least once a year you go for your physical, everything is covered. Your physical, your pap smear, your mammogram. Everything is covered,” Dr. Tahlak said, adding that the lack of insurance coverage and high cost of tests must have an impact on women’s decisions to get checked regularly. In fact, a Gulf News’ readers’ poll of 453 women showed that 60 per cent do not go to their gynecologist for check-ups, while only 27 per cent go once a year or more.
What tests to have and when:
•The Centre conducts mammograms for women younger than 40 if they have a family history of breast cancer and they have been sent to the Centre after an abnormal clinical exam.
•Pap smears and physical examinations are not available to expats at Al Qassimi Hospital. •Prices vary across the New Medical Centre system.