Health Challenges in the UAE - Case Study Example

Healthcare Building Blocks and Outcomes of Introduction Countries and international organisations such as the World Health Organisation (WHO) often conduct health systems analysis and ranking of countries and health organisations. These analyses are often based on the certain key performance indicators. The indicators on which health systems are analysed and ranked are health inequalities within a population, overall level of population health and level of health system responsiveness relating to patient satisfaction. The others are the proper operations of health systems and distribution of responsiveness within the population and the distribution of the health systems financial burden within a population (World Health Organization, 2000). According to the WHO report on health analysis in 2000, the core message was that the health and well-being of the world population relies heavily on the performance of health systems. Nonetheless, wide variations exist in the performance of countries’ health systems, even for countries with same health expenditure and income levels. This study compares the health systems in the UK and the UAE using the comparative policy analysis methodology. The aim of this comparison is to identify to the UAE health system and its key decision-makers, the reasons underlying these variations to improve the health of the UAE’s populace. Health Challenges in the UAE The main challenges facing the UAE health sector are as outlined. First, the UAE health ministry appears to place more emphasis on public sector, at the expense of the often larger private sector health care. Secondly, in the UAE, as is the case in many other countries, most health care workers such as physicians work concurrently for the public sector and engage in private practice (Health Authority Abu Dhabi, 2011). The implication of this trend is use of public sector resources to subsidize unofficial private practice. . The UAE health systems have also been undermined by low pay for workers compared to the UK. The UAE government has also not been able to effectively address the problem of black market in the health sector. Consequently, corruption, moonlighting and other crimes thrive in the sector, at expense of health care delivery. The health ministry in the UAE has also failed to a greater extent than the UK’s in the enforcement of health regulations (Health Authority Abu Dhabi, 2011). In 2014, the UAE’s Federal National Council (FNC) became concerned of the deteriorating status of the health care system in the country. The council thus called for system reform to reinstate the health care to international standards. At the same time, the Dubai Health Authority (DHA) developed a strategy to establish a price regulation model to regulate health care prices and premiums (Loney et al., 2012). The easily identifiable weaknesses of the UAE health system, according to the FNC were; lack of medical professional staff, shortage of hospital beds and the increasing number of chronic diseases patients (Health Authority Abu Dhabi, 2011). Notably, because of the poor status of UAE’s health system, many UAE citizens seek treatment abroad, especially in the UK, which has a better performing health system. Disparities in Cost On the issue of disparity in cost of medical care, UAE lacks uniformity in health-care cost, especially in Dubai where doctors’ consultation fees vary among the various clinics and hospitals (Saberi, 2014). There is also disparity in treatment costs. The UAE lacks guidelines that may inform patients on the cost of treatment in facilities of different levels. Moreover, the cost of health care in the UAE is generally growing, implying some patients simply cannot afford health care and would rather they put off treatment. Patients also complain that doctors ask for quite many tests, just to get higher commission (Loney et al., 2014). This practice increases the cost of health care. The cost of medicine is also exorbitant in the UAE. There are also long waiting lines for patients intending to see a doctor, leading to stress, frustrations and even death of patients (Loney et al., 2014). Health Risks Awareness The other challenge facing the UAE health system is lack of awareness on health risk by the public. Notwithstanding wealth and a good medical system, UAE people are not enjoying a full and healthy life because they are not aware of health risk factors. The table below summarises the statistics of the health system of the UAE (Retrieved from http://www.who.int/countries/are/en/) Statistics Total population (2012) 9,206,000 Gross national income per capita (PPP international $, 2011) 41,550 Life expectancy at birth m/f (years, 2012) 76/78 Probability of dying under five (per 1 000 live births, 0) not available Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012) 85/60 Total expenditure on health per capita (Intl $, 2012) 1,355 Total expenditure on health as % of GDP (2012) 2.8 Diabetes and Heart Diseases In a study analysing the health status of the UAE, Loney et al (2014) established that cardiovascular disease accounted for over 25% of deaths in the UAE in 2010. The study also projected that by 2020, incidences of cancers will have doubled in the UAE (GLOBOCAN, 2010). The study also established that respiratory disorders ranked second among non-fatal condition in 2010. Currently, the UAE is ranked second world-wide in diabetes while about 37% of Emiratis suffer from hypertension, translating into increased cases of heart conditions (Loney et al., 2014). The big population suffering from diabetes and heart complications have increased the burden on the government exchequer because these patients have to be treated for the various complications related with the deadly diseases (Saberi, 2014). The table below summarizes the key health indicators for the UAE (Health Authority Abu Dhabi, 2011). Health Indicator Status Fertility 4.4 to 2.4 children per woman (1990-2010) Life expectancy 2009 report: 77 years (males) and 79 years (females) Death rates 308.9 Per 100,000 for males and 203.9 per 100,000 for females. Ratio of physicians 1.5 Ratio of nurses 2.7 Beds per population 1.1 (lowest in the GCC region) Status of UK’s Health System Unlike the UAE health system, the UK health system is ranked among the best in the world, ostensibly because of the NHS, which also happens to be among the best in the world. In a commonwealth-funded study, the NHS ranks highest, based on certain measures of performance. The first measure is the way in which the health system deals with patients of chronic and serious illnesses such as cancer and diabetes (Colliers International, 2013). The study also established that the UK health system is not only well-coordinated but is also more easily accessible by patients compared to the UAE health system. The UK health system also suffers the least number of medical errors among the high-income countries such as Sweden, Norway, France, Germany, the Netherlands, the US, Canada, Switzerland, Australia and New Zealand. UK patients report more positive health care experiences compared to patients in the UAE and other countries. In addition, UK patients are more likely to get next-day appointment whenever they fall ill and have easier access to after-hours care compared to the UAE patients. UK patients are also less likely to encounter uncoordinated care than their UAE counterparts. Health outcomes in the UK improved between 1990 and 2010 but not to the same level as 18 other similarly developed countries. Comparative to the other developed countries, UK’s performance was worse on most measures of healthy life expectancy in more than two decades. Statistics Total population (2012) 62,783,000 Gross national income per capita (PPP international $, 2012) 37,340 Life expectancy at birth m/f (years, 2012) 79/83 Probability of dying under five (per 1 000 live births, 0) not available Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012) 90/56 Total expenditure on health per capita (Intl $, 2012) 3,495 Total expenditure on health as % of GDP (2012) 9.4 The graphs below compare the mortality rate in England and Wales between 1963 and 2013 International Comparisons Compared to healthcare systems of Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA), UK’s is the most impressive, based on the Commonwealth Funded study in 2014. UK’s system was rated the best system on indicators such as efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related issues. On equity, UK was ranked second. However, it fared less well on healthy lives. Health expenditure in the UK stood at 9.27% of GDP in 2012 compared to 16.9% in the USA, 11.77% in the Netherlands, 11.61% in France, 11.27% in Germany, 10.98% in Denmark, 10.93% in Canada and 9.19% in Italy. The study also showed that UK health system had 2.8 physicians per 1,000 people in 2012, compared to 4.0 in Germany, 3.9 in Italy, 3.8 in Spain, 3.3 in France, 3.3 in Australia, 2.7 in New Zealand and 2.5 in Canada. The UK health system had 2.8 hospital beds per 1,000 people in 2012, compared to 8.3 in Germany, 6.3 in France, 3.4 in Italy, 3.0 in Spain and 2.8 in New Zealand. In the UK health system, the average length of stay for all conditions was 7 days in 2012 compared to 9.2 in Germany, 8.2 in New Zealand, 7.7 in Italy, 7.4 in Canada, 6.7 in Spain, 5.6 in France and 5.2 in the Netherlands.       Conclusion and Recommendations For the UAE health system to perform at par with that of the UK, the following recommendations should be implemented. First, more resources should be invested in research. The research should investigate the connection between lifestyle and personal health risks for conditions that are prevalent in the UAE. These risk factors are harmful dietary practices, smoking, obesity, physical immobility, vitamin D deficiency, and parental consanguinity. This type of research would really help lower the prevalence and the development of chronic disease such as diabetes, cardiovascular disease and cancer (GLOBOCAN, 2010). The UAE authorities should also invest in the training, education, and federal legislation. It should have a sufficient number of professionally trained health care providers that would address the current shortages, thus improving the health status of the population. The professionals that ought to be trained and hired should be in the disciplines of histopathology, oncology, occupational medicine, and infectious diseases, which lack in the UAE health system. There should be more effort to achieve increased professionalism through training in universities and health organisations for clinical and public health specialists in the UAE (Colliers International, 2013). Other indirect professionals such as engineers and other specialists should also be trained as they help in activities such as occupational and environmental hazards, health education and health promotion. In education, more emphasis ought to be directed at improving population health via primary prevention. Primary prevention requires health education and awareness programs such as inclusion of health education activities that target the reduction or cessation of tobacco use, promotion of safe driving and compliance with safe systems at workplace. On legislation, the UAE authorities should review and revise its standards and legislations regularly. An example of a regulation that should be reviewed periodically is the requirement that new workers in the UAE be screened (Loney et al., 2012). This regulation should be reviewed to ensure it is constantly in tandem with the current international standards and concerns. According to Colliers International (2013), the key insight areas for the UAE health authorities are shortage of health care facilities, high population growth, the size and growth of the private sector, public-private disparity, medical insurance, regulatory environment, quality professionals and funding options. References Colliers International (2013) “Accelerating Success.” Retrieved on January 7, 2015 from www.colliers.com/en-gb/unitedarabemirates/services/healthcare Health Authority Abu Dhabi (2011) “Abu Dhabi Health Statistics, 2011.” Retrieved on January 7, 2015 from from: http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=JY0sMXQXrOU%3d&tabid=1243 International Agency of Research on Cancer, GLOBOCAN (2010). Incidence and mortality date for the United Arab Emirates. Retrieved on January 7, 2015 from from: http://globocan.iarc.fr/ Loney T, Sharif, A. A., Thomsen, J. et al (2012) “The Legal Framework and Initiatives for Promoting Safety in the United Arab Emirates.” International Journal of Continuous Safety Promotion, 2012; 19:278. Loney, T., Tar-Ching, A., Handysides, D. G., Ali, R., Blair, I., Grivna, M., Shah, S. M., Sheek-Hussein, M., El-Sadig, M., Sharif, A. A., and El-Obaid, Y. (2014) “An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues.” Retrieved on January 7, 2015 from www.cmhsweb.uaeu.ac.ae/home.asp?msheekhussein Saberi, M. (2014) “How robust is Dubai health care system?” Retrieved on January 7, 2015 from http://gulfnews.com/news/gulf/uae/health/how-robust-is-dubai-health-care-system-1.1316924 World Health Organization (2000) “Assesses the Worlds Health Systems.” Retrieved on January 7, 2015 from http://www.who.int/whr/2000/media_centre/press_release/en/ Background The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. Read More