Dubai: Recently, the members of the UAE’s Federal National Council (FNC) expressed concern about the situation of the health-care system in the country.
They called for reforms in the system that would help bring back health care to international standards.
The FNC members were particularly critical of the shortage of hospital beds in the country, lack of medical professional staff and the rise in the number of people suffering from chronic diseases.
The Council members noted that the situation is bleak, with many UAE nationals seeking medical treatment abroad. The number of people suffering from chronic diseases was especially startling. The UAE is ranked second world-wide in diabetes. Nearly 37 per cent of Emiratis suffer from hypertension that goes on to take a toll on the heart.
The situation among expatriates is equally of concern. A large segment of the population, especially from the subcontinent, suffer from heart disease and diabetes and are also putting a huge burden on the government exchequer as they have be treated for the various complications of these deadly diseases.
How is Dubai planning to cope with these major health-care issues as the population continues to grow and age and develop various age-related illnesses?
Gulf News looked into some areas of concern in the health-care industry and approached all stakeholders to present their point of view.
Here are the issues and the responses.
1) Issue: Disparity in costs of medical care
There is no uniform health-care cost in Dubai and doctors’ consultation fees vary among the various clinics and hospitals. There is a also a huge disparity in treatment costs and there are no guidelines for patients to inform them of cost of treatment at a particular facility and what type of treatment a patient can expect.
a) Consumer’s viewpoint: “I know this is a free market and the doctor’s fees cannot be controlled. But at least let me know what the charges are at different clinics. For example, if I go to a particular clinic in Karama, what would it charge? This information will be helpful to many who do not yet have health insurance.” - Preeti (not her real name)
b) DHA’s response : Dr Haider Al Yousuf, Director of Health Funding at the Dubai Health Authority (DHA), says:
“In the next few months, DHA will establish a price regulation model, which will include regulation of prices and premiums. Facilities have been requested to submit their existing price list and consult with DHA before increasing their prices. Every facility has its own business model so we are not looking at price setting; rather, we are looking at regulation.
“The aim is to ensure that there is no monopoly of services and other such issues that can be addressed through price regulation. Having said that, facilities have their own business models and we respect that. Our aim is to ensure that the same service is available across various hospitals and health facilities so that people have access to health care and choice.”
c) What the health-care industry says:
David Hadley, CEO, Mediclinic Middle East:
“You cannot have the same price everywhere. It would be difficult to implement an unified cost across the board. Some people would want VIP treatment, a higher level of quality service. If you take the comparison with the hotel industry, a 5-star hotel cannot charge the same fee as a 2-star hotel. It is the same with health care, but on a more complex scale. The government has taken a bold step in announcing new rules and regulations which will help people know what they are being charged for. It is an ethical move.”
Dr Azad Moopen, Chairman, DM Healthcare
“We have cut out the frills and are providing basic health care through our clinics (that cater to the lower income group. The treatment is the same in all our clinics, but the charges are different because of the ambience. If you rent an apartment in Karama, it will be at least one-fifth of the cost of an apartment in Jumeirah. Same thing when you travel by First Class or by Economy Class to Delhi. The destination is the same, but you will be charged for the ambience [in the aircraft cabin]. We have to bear in mind the cost of running a clinic in the various areas of the city. Even the nationality of the staff makes a difference. That has an impact on the cost.”
2) Issue: Growing cost of medical care
This is a common grouse of people living in Dubai. There are many reports in newspapers of patients caught in a bind due to not being able to pay exorbitant hospital fees.
a) Consumer’s viewpoint: “I try to put off any treatment that is not urgent till the time I go home for my vacation. The price of treatment is sometimes too high.” - Sunil
b) What the health-care industry says:
David Hadley, CEO, Mediclinic Middle East
“The biggest driver in health-care costs is salaries of the medical professionals, not to mention the cost of equipment or the cost of drugs. The salaries are dependent on the cost of living. The per capita GDP here is Dh180,000 compared to less than Dh1,800 in India or Thailand. You can hire an excellent doctor there at one tenth the price here. Unless the GDP here drops [which we hope it will not], we will never be able to compete with those countries in price.” (Per Capita GDP is considered an indicator of the standard of living).
Dr Azad Moopen, Chairman, DM Healthcare
“If you look at the cost of health care as compared to other developing countries, it is high here. It is the reflection of the overall cost of living. If you take the salary of a doctor here, as compared to a doctor in India, it is very high. Then there is the cost of the accommodation of the doctor, or the rental of a clinic. We cannot provide the same rate as in India. But there is definitely scope for doing things in an economical way.”
3) Issue: Lack of adequate hospital beds
Patients are sometimes turned away because of a shortage of beds, especially in the government hospitals. Dubai has 21 private hospitals and four public hospitals, with an additional 2,229 medical facilities and 1,200 private polyclinics. But that does not seem to be enough to cater to the growing population.
a) Consumer’s viewpoint: “My friend, who was pregnant, was told she cannot be admitted because there was no bed space. We had to rush her to another hospital. The situation was not good for her or for us, her friends.” - Marcela.
b) DHA:
“Plans are to open 18 new hospitals in Dubai soon. These will include two public hospitals and will add 800 more beds.”
c) Health-care industry:
David Hadley, CEO, Mediclinic Middle East:
“There is an urgent need for additional hospitals, especially in the new developments in Dubai. We are looking at adding another hospital there. We are adding 80 beds to the North Wing Project of the City Hospital in Dubai Healthcare City. We will also be adding capacity to the Welcare Mediclinic Hospital and redesigning it to add more beds.”
Dr Azad Moopen, Chairman, DM Healthcare
“WHO (World Health Organisation) prescribes four beds to every 1,000 population. We are much lower than that in Dubai and the UAE. The paradox of Dubai is that the population is healthy and is between the ages of 22 years and 55 years. The majority of them are expatriates in this age group. The government plans a significant increase in capacity and will build large hospitals in various areas of Dubai. We are planning to build a 100-bed hospital in Dubai; a 275-bed women and children’s hospital. Besides these, we plan a 50-bed hospital in Abu Dhabi and a 100-bed hospital in Sharjah. In all, we will be adding 450 beds in the UAE with a total investment of Dh1 billion in the next three years.”
4) Issue: Doctors order too many tests
Many patients are of the view that the increasing number of tests being ordered by the doctor are because they get a commission.
Consumer’s viewpoint: “I think they [do this] as they have to pay for the new machines the clinic has ordered. Why should I get an MRI done when I got one done only last year.” - Ramesh.
DHA: “Every patient has a right to complain if they are not satisfied with the service provided and can file a complaint against a hospital or the medical practitioner. A doctor can also file a complaint against the hospital or clinic where he or she is working.”
To file complaints, visit the Clinical Governance Office, Business Village, Building B, 3rd Floor, Offices 332-335, near the Clock Tower in Deira.
For more information, contact regulation@dha.gov.ae or call 800 DHA (342).
What the health-care industry says:
David Hadley, CEO, Mediclinic Middle East
“Last year was a big year for Dubai health care, with the focus on the new regulations that are coming into play, including the mandatory health insurance coverage. It is a big, bold step in gathering data that the public do not really understand yet. It will help us understand and extrapolate data on the “health” of Dubai. This information will help implement better ethical controls. The focus on e-claims and other electronic initiatives will give the government more information to analyse and make better policy.
“The government understands what’s happening in the market. People do not understand the difference between a clinic that charges Dh500 and the one that charges Dh700. The one that charges less may send patients for all kinds of lab tests, radiology, etc. The data being gathered [by the DHA] will be analysed and give patients assurance that they are being serviced correctly. Patients can be assured of better governance and the type of treatment they are getting. If you go in for earache and the doctor prescribes medicine for knee pain, the system will see that the medication and diagnosis do not match. This will be comforting for the public as it will provide ethical medicine and that is the way forward.
“For serious players like us, it is good news as it will differentiate those that provide good health care and those who do not. The growth of Dubai depends on serious players [in the medical sector].”
Dr Azad Moopen, Chairman, DM Healthcare
“There are some who misuse the system and do not follow an ethical approach to medicine. We are long-term players and we are very careful about this. All the staff is instructed that they are here for the benefit of the patients. That is why the insurance companies are very considerate to us. The good thing is that in the next there years, the DHA has made health insurance coverage mandatory. All the records will be transmitted to them, the system will be very transparent. There will be an audit and, if something is ordered for a disease which does not indicate it is needed, it will be noted. Insurance companies will also have access to these records.”
5) Issue: High cost of medicines
A significant number of expatriates in Dubai suffer from heart diseases and other lifestyle ailments and find that drugs for their treatment are expensive.
Consumer’s viewpoint: “I have high cholesterol and every time my doctor prescribes a statin, I have to wait at the pharmacy as the pharmacist has to first check with the insurance company [to see whether they will pick up the tab]. And if they don’t, it’s my expense. These medicines are very expensive. I know that many people ask their friends to buy their medications for them from back home during their visit home.” - Ben
Ministry of Health:
“We have reduced prices of 152 drugs for chronic diseases by 60 per cent after negotiations with international pharmaceutical companies. The price drop will range from 10 per cent to 60 per cent, said Dr Ameen Al Ameri, Assistant Undersecretary at the ministry. “This will help patients who need to take these medications on a long-term basis.”
According to him, there are 7,500 pharmaceutical products in the UAE. “Other countries force them [drug companies] to bring down the cost, but we have negotiated with them to reduce the prices,” he said.
The price reduction went into effect from January 1 this year. There is no move to reduce the prices of generic drugs. “It depends on the pharmacies to set the price,” the official said. A generic drug is a branded drug that uses a different name.
What the health-care industry says:
Dr Azad Moopen, Chairman, DM Healthcare
“We have been trying since the last 10 years to bring down the cost of medicines, but it was not possible till the Ministry of Health made a last revision [of cost]. This has significantly brought down the cost of medicines, especially for chronic diseases, which people wanted for a long time. We have noticed [the drop in cost] by way of increased sales in our pharmacies. The per-patient bill has come down. There is still scope for further reduction in some areas also.”
6) Issue: Long waiting time in clinics to see the doctor
A common sight in many clinics in Dubai is the long waiting period for patients after they have taken an appointment. In many instances this leads to stress and frustration for the people waiting their turn. Sometimes, even after the having booked a time, patients need to wait for an hour or more.
Doctor’s viewpoint: “Many patients do not come on time for their appointment. Even a 10-minute delay has a knock-on effect. If a patient is late, I see the next one in line. No, we do not see more than the prescribed number of patients a day.”
What the health-care industry says:
David Hadley, CEO, Mediclinic Middle East
“There is a significant growth in Dubai’s population and it is ageing. There was a perception earlier that you came here to work for three years and went home. Not any more. People are living here for longer periods. The ageing population, unfortunately, gets sicker and, in turn, puts a demand on health care. There is not enough professional staff to handle that demand.”
Dr Azad Moopen, Chairman, DM Healthcare
“We are trying to cut down the congestion at clinics and build more capacity so that people can conveniently access our facilities and not be cramped.
The long waiting time does occur and once a level has been crossed, say a doctor is seeing more than 20 patients, we bring in another doctor [to attend to the growing number of patients].
“We have also extended the timings of our clinics. Earlier, there was an afternoon break, now our clinics start from 7am or 8am and work till 10pm, with no break. This way we can accommodate more patients.”
7) Issue: UAE society is not sufficiently aware about health risk factors
The statistics of lifestyle diseases in the country is on the rise. Despite affluence and a good medical system, people are not enjoying a healthy life due to a lack of awareness of health risk factors. Most of the lifestyle diseases can be easily prevented.
Consumer’s viewpoint: “The diabetes marathons or health awareness campaigns are mostly annual calender events. Once they are done with, people go back to the old routine. The number of diabetics and breast cancer patients is increasing in the UAE. The message of prevention is not getting through to people.” - Linda
What the health-care industry says:
David Hadley, CEO, Mediclinic Middle East
“It is not just the health-care providers, but it is the responsibility of everyone, for your children and for ourselves, to take care of our health. You do not have to visit a doctor or a nutritionist on how to eat correctly and exercise. There is so much information available. We just have to be more disciplined in our lives and not eat fast food always.
“The government has been very proactive over this. Seven years ago, trauma on the roads was a big killer. Now there are speed cameras every two kilometres. There is more awareness [in the society] on diabetes and obesity. In the US, I found that fast food places have information on the amount of calories in each meal. It would be a fantastic initiative to see that here, to get that alert. Dubai always supports a free market and competitiveness and it will not over-regulate. But creating awareness would be good. Unfortunately, people want fast food, to live life quickly.”
Dr Azad Moopen, Chairman, DM Healthcare
“Lifestyle diseases are due to a problem of plenty. Earlier, there was a problem of scarcity, starvation and infectious diseases. There needs to more self-control and people need proper education and awareness.
“The number of people smoking is going down in most populations across the world because of a focused programme and constant education. Children should be taught how important it is to have a proper BMR (Basal Metabolic Rate that tells you the number of calories burned when at rest). What you do at a young age will have an impact later on in life.
“If people can park their car a little distance away from their office and walk, or if they climb the stairs instead of taking the lift, this will have a significant impact on their health. These are very basic things, and can be easily practised. People should take this seriously. The cost of ill health in western countries is high. Most of the deaths there occur due to cardiac problems.
“I believe in heavily taxing cigarettes. Make it ten times more expensive. Charge more for fizzy drinks, that will reduce the consumption.”
8) Issue: How will health cover for all help?
Now that the health cover has been made mandatory for all in Dubai, residents are happy. Yet, they are also concerned about the scope of this scheme. For example, will it be possible to address most of their needs with what seems a modest amount for basic cover?
Consumer’s viewpoint: “I am not sure the basic package for Dh600 will give me much coverage. Can I go to any hospital or clinic?” - Sana
DHA
Dr Haider Al Yousuf, Director of Health Funding at the Dubai Health Authority (DHA), says:
“With the implementation of the mandatory health insurance system, all stakeholders will benefit, as insurance provides a dynamic environment for growth of the health sector. Every person in the emirate will have access to essential services that covers several services, including maternity and surgery. For employers, covering the cost of health care will not be a burden because the essential package only amounts to 1.5 per cent of the employee’s salary and it covers a host of medical services.
“The roll-out of the scheme will take place in phases until mid-2016, by which time every person in Dubai will have access to essential health services.”
What the health-care Industry says:
David Hadley, CEO, Mediclinic Middle East
“This is a fantastic initiative. People will have access to facilities for serious health-care needs. Now that the health costs will be subsidised, it will increase the cost base for many organisations. Say, for a company with 10,000 employees, the costs will increase. It will have to recoup those costs and will pass it on to us consumers. It is a conundrum as inflation will go up. But it is a right step and Dubai will be competing on the global stage [in the health-care sector]. Next is to clamp down on unethical behaviour. This will push other operators to provide ethical health care.”
Dr Azad Moopen, Chairman, DM Healthcare
“There is a very positive outlook about the health-care sector, both from patients’ point of view and from providers, as insurance cover gets rolled out. This is significant as many people were earlier not able to access quality health care. That is going to change. Insurers will get a significant share of the business and we, as health providers, have a great responsibility and we getting ready for that.
“We are already increasing the number of units in Dubai. There will be a huge requirement for primary health-care facilities. We will significantly increase the number of pharmacies to 30.
“As Dubai begins to attract medical tourists, I believe there should be more centres of excellence established and Dubai Healthcare City (DHCC) is looking into that. There will be a huge requirement of professional staff but we are not producing doctors and nurses as we should. Hopefully, 25 years down the line, UAE nationals will study at local medical colleges that will also attract people to come here and study and fill positions in the medical institutions here.”
