Executive Summary

Since gaining independence from Britain in 1971, the United Arab Emirates (UAE) have had a policy of providing free out-of-country medical care for all those whose medical conditions cannot be adequately treated by medical facilities within the UAE. Over the years since independence, the demand for this service has outstripped the country’s ability to cover the costs. In a series of regulatory and policy changes since 1972’s initial formal initiation of the program, the scope of such international medical payments has decreased steadily. A July 2009 poll indicated that the majority of UAE nationals (57%) would prefer to seek treatment outside the country if they became seriously ill (Gornall & Underwood). In December 2010, the UAE Ministry of Health faced a major budgetary crisis. While outside consultants claimed it needed approximately a 20% increase in budget for 2011 to cover essential programs and services—including the out-of-country healthcare program—the proposed 2011 ministry funding was a 5% decrease (Shaheen). This crisis has led to an analysis of the out-of-country medical care program in this report. Three alternatives are proposed: (1) to maintain the current program and eligibility; (2) to reduce the amount and types of expenses covered by the program; and (3) to reduce eligibility for the program based on economic ability to pay, but retain other essential features. Of these options, the most viable would be to retain the existing program, but to ameliorate this approach by initiating an active campaign to both improve the perception and level of domestic healthcare capabilities, and also to move to a patient-centered healthcare system.

Introduction

The United Arab Emirates (UAE) offers health care for citizens abroad when no suitable medical treatments for their conditions are available within the country. This paper analyzes the current policy for paying for such out-of-country care, in an attempt to determine if the policy is adequate, too lenient, or too strict, and presents a recommendation for how, if at all, the policy should be modified.

The UAE is a union of seven emirates, with the two most significant cities being Abu Dhabi (the capitol city), and Dubai. Matters of health policy are determined by the Ministry of Health. Standards of health in the UAE are generally high. For a total population estimated to be approximately 4.5 million in 2005, the UAE spent $436 million in healthcare from 1996 to 2003, spending just under $500 per person or approximately 2.9% of the country’s GDP (LoC-FRD 7).

The extent of the country’s growth in medical resources and facilities can be seen by comparing the 7 hospitals in the country in 1970 to the 40 public hospitals in the country in 2007 (Ibid.). In addition, the Ministry of Health is actively expanding the number of medical facilities in the country, including hospitals, medical centers, and a trauma center, with an eye toward making Abu Dhabi and Dubai destinations for “medical tourists” (Ibid.,; Gornall & Underwood). Dubai in particular has created a “Dubai Healthcare City” which is a “health care free zone” (similar to a “trade free zone”) that offers “international-standard advanced private health care and provide an academic medical training center” (LoC-FRD 7).

Brief Background of the Issue

Until 1982, the UAE offered free medical care to all residents. However, the rising costs, decreased revenues from oil fields, and cultural change in the approach to foreigners resulted in a change of policy. At that point, free medical care was rescinded to noncitizens except for emergency care, maternity care, and children (EMRO).  Beginning in the 1970s, and with technical assistance from Egypt, there was a significant expansion of in-country medical services. By the mid-1980s, nearly all medical personnel were still foreigners, but by the 1990s, the UAE’s medical system was modern and staffed largely by nationals (Ibid.).  While most of the medical facilities are in either Abu Dhabi or Dubai, most of the population has access to clinics or other basic medical facilities (Ibid.).

Only 20% of the resident population of the UAE (as of 2009) are UAE citizens; the 80% majority are foreign nationals. Most of the foreign nationals (an additional 60% of the population) are from South and Southeast Asia, with much of the remaining foreign nationals from various other Arab-speaking countries (LoC-FRD 5).

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