Dose of reality

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Business, heal thyself

Among healthcare providers, much has been made of the funding mechanism behind the insurance scheme. Physicians have talked anxiously about how and when they will be paid, and how much. So far, DHA has resisted nailing its colours to the mast - the exact sum primary care clinics will receive per patient will be revealed in October.

What is clear, however, is that primary care has been cast as the lynchpin of the new system. Medically and economically, argues Hodges, it makes more sense. In a reflection of Britain's health system, patients will now be referred to specialists via their family physician.

What is also clear is that quality of care will now come first. Eventually physicians, clinics and hospitals will be measured on the standard of care they deliver and rewarded accordingly.

"Licensing for all facilities, public and private, will be linked to performance," says Dr Haider Al Yousef, DHA transition director. "Preventive care, for example, will become a key performance indicator for clinics, and we may have incentives built into the system to encourage this."

This vision is, however, dependent on private sector clinics choosing to sign up to the scheme. Alone, the public sector does not have nearly enough primary care doctors to meet the anticipated rise in demand. Much will depend on the allocated budget per patient, and how the health scheme is sold to physicians.

For Hodges, the clinical and monetary benefits are transparent. "By the time the system is rolled out in 2012, around 85-90% of healthcare spending in the emirate will be passing through it. To opt out of 90% of an industry's expenditure is quite a brave move."

Not only that, but many physicians will have a better relationship with their patients as they are signed to a specific clinic, he adds. "You'll be able to plan an improved life for that patient...and we can say, with absolute certainty, that you will receive an income."

Ready to operate

The abiding question is, can Dubai's industry deliver? In all honesty, DHA does not know. Alongside funding, the key lever it will use to drive health reform is a solid information system. Currently, the Authority is operating blindly and it desperately needs performance data to shape its decisions. That DHA has deep-seated doubts about the health industry's ability to modernise is clear - it has roped in professional help.

Clinics signing up to the scheme will be obliged to tie-up with a healthcare management company for three years; the first year paid by the government. The move is intended to help level the playing field between public and private units, providing a corporate skill set to spur competition.

As DHA sells it, both sectors will be sparring for patients, creating a lean, mean healthcare machine where rivalry trims away inefficiency. In reality, of course, quality improvement has victims. Some clinics, services, even hospitals won't survive.

These changes will be painful, even when stretched over a seven-year plan. Still, regardless of the sloganised rhetoric behind all healthcare policy, it is not about philanthropy. Mandatory health insurance is a means to rein in costs and boost productivity for the greater good of Dubai's economy.

Price, admits Hodges, will dictate the course now and in the future. "We need a healthcare service that will attract people into the economy, but not at such a high price that it makes other activities uneconomic. We'll never get a perfect answer to health...because it's uneconomical.

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