Dose of reality

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Now the dust has settled around Dubai Health Authority's radical plans, MT gets the measure of the emirate's new-look funding system.

Dubai's mandatory health insurance scheme is proving an exercise in hype. In the weeks since its launch, the plan has attracted much fuss and delivered little information. Press headlines have declared ‘healthcare for all' and ‘universal access'.

For hostile employers who will bear the brunt of any health tax and medical facilities braced for a treadmill-style national service, this is a new breed of health scare. Ask Simon Hodges, a senior adviser on the project, about the coverage and he appears bemused.

"Everyone has latched on to the aspirational picture and expects it to be kicking in on 1 January 2009", he says. "In fact, very little is going to change. We're looking at a seven-year roll out."

Dubai's current healthcare system has been hampered by years of underfunding. The United Arab Emirates (UAE) spends only 2.5% of its GDP on healthcare, less than a third of the spend of high-income western countries and half that of its poorer neighbours Egypt and Jordan.

Hodges' response sums up the reality of the situation - any reform of the health sector won't happen overnight.

Supply, demand and politics

The crux of Dubai's health policy breaks down into two parts: 1) how to force people or employers who can afford medical care to pay out; 2) how to fund adequate medical care for everyone, regardless of their means, without the government footing the bill.

The majority of white-collar Dubaiites don't stand to gain or lose. For most, their employers will pay their annual health contributions and they will continue to visit the same doctors they always have. For this demographic, admits Hodges, the fee is more a health tax; "Which we are balancing by explaining the benefits of controlling healthcare spending."

In fact, Dubai Health Authority (DHA) itself is banking on minimal uptake of its health services. The plan offers only modest benefits to patients in its first year - an X-ray and some lab tests - offset by a co-pay to dissuade overuse. It is aimed at, DHA is keen to stress, those for whom money is so tight they skip the doctor in favour of their local pharmacy.

"The benefits we provide are certainly better than nothing, but it isn't designed for the white collar workers," says Hodges. "We want those people to stay where they are. The patients you see in 2008, you will be seeing in 2009."

In principle the plan works. DHA has sidestepped a common mistake, which is to pour money into so-called "vertical" health programmes that address specific diseases such as diabetes or obesity, instead opting for a delivery model grounded in basic healthcare.

By 2012, Dubai should have a broad - largely employer-funded - "horizontal" health system, capable of tackling all forms of ill health. On the flipside, the government may eventually find it has scored an own goal. Evidence from Germany, France and Australia - where much of the inspiration for the Dubai plan is drawn from - showed higher private healthcare spending didn't cut the demands on public-sector funds.

In fact, it is often associated with increased public spending, potentially due to the competitive dynamic between the two sectors. Still, Hodges is philosophical. "We want to create a health system that allows competition to do what competition does best - improve the system."

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