Ethical Issues in Healthcare system in the UAE - Research Paper Example

Zayed University, Abu Dhabi College of Sustainability Sciences and Humanities Executive Masters in Public Administration EMPA 506:APPLIED RESEARCH METHODS IN PUBLIC POLICY AND ADMINISTRATION DR.SUZANNE JOSEPH Personal Loans & Consumerism Habits among UAE Nationals Research Paper January 2013 Done By: Samah Al Hajeri – M80001822 Abstract PURPOSE: This research paper aims at identifying the main causes that drive nationals to request personal loans from banks and to find out if a major factor is consumerism. Therefore the primary research question was “Is there a correlation between consumerism and nationals obtainment of personal loans from banks?” DESIGN/METHODOLGY/APPROACH: A survey was designed and distributed to 93 respondents that included the team’s family, friends and colleagues in Abu Dhabi city. The team used the method of snowball sampling given that it was the most appropriate and convenient method given the sensitivity of the topic and the time limitation. RESULTS: The results have shown that nationals do have some saving habits in place by setting a specific saving account in their banks. However, there are some consumerism habits. Nationals have a tendancy to enjoy buying new products before everyone else and enjoy feeling more stylish wearing designer apparel. The study also revealed that nationals tend to take personal loans mainly for the objective of purchasing a car. In addition, results have shown that. KEYWORDS: United Arab Emirates, Abu Dhabi, Consumerism, Personal Loans, Nationals’ Debt Introduction Why are personal loans among nationals a significant area to study? Ethical issues are presents whenever policy makers and decision makers assess the performance of the healthcare systems. Most of the countries worldwide have identified laws and regulations that covers most of the ethical issues in the healthcare system. The ethical issues is considered crucial that it is associated with individuals and communities welfare and the legislature and authorities is working hard to provide a quality healthcare system without affecting the rights of the indivisuals. There are four main ethical principals in the healthcare system which represents concepts and values that can set the general ethical character and approach for healthcare. (loewe); these four key principals are Autonomy1; The rights of individuals to self-determination, Beneficence2; Actions that serve the best interests of patientsm non- maleficence3; do no harm and justice4 which is Obligation to be fair. From these four principles comes many other ethical issues such equity, transparency, conflict of interests, informed consent, and confidentiality. The expectation of such principals is that, in practice, ethical principles will assist in taking the decision through tough and unclear moral issues and in defending subsequent decisions. Advocates of such principles entitle that these principals play an important role in resolving ethical dilemmas and be given in justification of our actions. In the UAE there was no clear law addressing the ethical issues in the healthcare system until the First written code of conduct in MOH , 2001 and on 16th December 2008 the Medical responsibility in the UAE was published. Yet the earliest law addressing healthcare issues in the Healthcare system is No. (7) of 1975, concerning the Practicing of the Human Medical Profession. The healthcare system in the United Arab Emirates consists of three healthcare regulators two of them are local Authorities serving its own emirate; Health Authority In Abu Dhabi (HAAD), and Heath authority of Dubai (DHA) and the third one is Ministry of health (MOH) which is a federal body covering all the other Northern Emirates (Sharjah, Ajman, Umm Al Quween, Ras Al Khaima and Fujairah). The Ministry of Health and Emirates Health authority was established accordingly by the Federal Law of 1972, main function was to; License Institutions and doctors tasked with healthcare provision, Construct and Oversee Management of healthcare facilities, regulate the different healthcare sectors. However, through the Cabinet Resolution No.10 of 2008, the Ministry was given the following functions; provide health care to the UAE citizens, establish and supervise health facilities, formulate health regulatory and training programs and arrange for the training of health care vocation (Latham& Watkins, 2013). The Ministry officially delivers different healthcare laws concerning ethical issues of healthcare department in the UAE. The first law, the Federal Law No.5 of 1984 controls licensing and registration of all medical practitioners in both public and private sectors, secondly the Federal Laws No.7 of 1975 and No. 2 of 1996 outline the critical requirements for establishing and licensing of both private and public medical institutions. Lastly is the Federal Law No. 4 of 1983 conducts the affairs of pharmaceutical professions and importation, production and supply of medical products (Latham& Watkins, 2013). The Healthcare Authority of Abu Dhabi was established by the General Authority of Health Services in 2007 (whose function was to manage all public healthcare institutions in the Emirate of Abu Dhabi) through the Abu Dhabi Law No.1 of 2007 as a public authority not controlled by the government (Latham& Watkins, 2013). The law stated that HAAD’s role is to provide the best medical and health insurance coverage to the citizens through checking and regulating the activities of the healthcare industry and upgrading the hospitals and clinics to improve the health sector in Abu Dhabi to be at par with international standards (Matthews, 2009). These functions enable HAAD to formulate courses of action to address ethical issues in the health department; these policies outline requirements for licensing, authorization, and regulations of operations and physical requirements of different medical sectors. Abu Dhabi Health Service Company (SEHA)was established from GAAS through Abu Dhabi Amiri Decree No. 10 of 2007 and it is a public joint company owned by the government. This decree gives SEHA authority to own and supervise the public health facilities and in addition to put into effect the policies, schemes and long-term plans sanctioned by the HAAD aimed at developing the healthcare industry of the Abu Dhabi Emirate (Latham& Watkins, 2013). The Dubai Health Authority was reacted in June 2007 by an issuer of law His Highness Sheikh Mohammed bin Rashid Al Maktoum who is also the ruler of Dubai. DHA was mandated with the role of planning and promoting healthcare investment in Dubai. In addition to his, the body is also supposed to improve health care quality through raising the quality of information and communication standards. Regulation of healthcare services in Dubai is also an essential role played by this body. DHA is also mandated by the process of ensuring comprehensive compensation through healthcare insurance and funding , public health promotion in addition to facilitating proper medical and research facilities in Dubai. In summary, Law No. 13 issued by his Highness Sheikh Mohammed bin Rashid Al Maktoum authorizes DHA to regulate all health care services in Dubai including those found in free zones (Latham& Watkins, 2013). The healthcare system in Abu Dhabi is an insurance based system in both public and private hospitals while in Northen Emirates public healthcare is funded by the hospitals while the health insurance is used for treatment in the private hospitals. It is evident that the three different bodies DHA, HAAD, and MOH play different roles of providing health care services to citizens of the UAE. It is also evident that these bodies are mandated to perform regulations such as licensing of health care facilities like hospitals, surgical centers, ambulatory centers and diagnostic centers separately within the UAE. The different bodies are also responsible for training and hiring of medical personnel separately. THE SUPREME COUNCIL The following research study focuses on the ethical issues in the healthcare system in the United Arab Emirates. The primary aim of this study is to identifying the effects of having multi healthcare regulators in the same country on the UAE citizens and expats who belong to different emirates and the ethical issues arises from such healthcare structure. The following paper provides a detailed overview about the research approach, its results, key findings and barriers faced during the preparation of the research paper. The paper concludes with high-level recommendations that could help mitigate some ethical issues in the UAE healthcare system by providing tangible solutions that allow the United Arab Emirates citizens and expats to enjoy fair and equal healthcare services. LITERATURE REVIEW What does the current literature findings signify? The United Arab Emirates has undergone massive economic developments in the last few decades as a result of its oil revenues and government policies. The UAE is considered as one of the fastest growing economies in the world and the second largest Gulf Arab economy. Significantly, it has set human development as one of the main pillars for economic prosperity. In 2012, the government allocated from its federal budget, billions of funds for social services including health care, education and housing. The UAE’s GDP per capita has also witnessed an increase from AED 100,000 in 1975 to AED 174,000 in 2011 (Mehmood-Ul-Hassan, 2012), Specifically (for the purpose of this study) Abu Dhabi currently possesses one of the highest GDP per capita in the world which is equal to AED 380,000 in 2011 (Statistics Centre – Abu Dhabi, 2012). Moreover, according to the most updated official statistics in 2008, the labor structure for nationals in Abu Dhabi indicates that most of the citizens are employed in the government sector representing 55,000 of the total labor force (Abu Dhabi Council for Economic Development, 2012). The UAE was able to develop its urban landscape with modern buildings and shopping malls within a short period of time, these massive developments led to an estimated 80 percent of Fortune 500 companies having regional hubs in the UAE. Thus these shopping malls assisted in changing the purchasing and spending patterns of the citizens by accommodating the increasing demands for foreighn goods and services. In fact, the UAE was ranked number 16 in among the most attractive 30 emerging countries for retail investment (Ali and Wisniesk, 2010). According to another report by property adviser CB Richard Ellis (CBRE), it has become the world's second most international retail market after the United Kingdom (Kan, 2012). Indicating the level of prosperity UAE’s retail market achieved within a short period. A study conducted in 2010 by students from Indiana University of Pennsylvania in two universities in the UAE, purpose being to investigate consumerism and consumer ethics and the relationship between the two concepts indicated that there is a positive correlation between consumerism and consumer ethics. The study also showed that religion does play a role in shaping consumers’ orientations and attitudes. Based on the fast developments in the UAE and exposure to global trends, high consumption habits and consumerism behaviors have emerged in the society. Therefore this research paper, defines consumerism as individuals’ tendency to have high spending habits on leisure, entertainment, high-end products and any other products or services that are not considered necessities. The study also indicated that this tendency is associated with the spread of retail outlets, shopping malls and the widespread of consumerist values into societies. An intensive review of current literature done by researchers has revealed that “consumerism is viewed as a phenomena associated with globalization and by necessity is a capitalistic ideology which underscores the necessity of conspicuous consumption, overspending, and ‘shop till you drop’ attitudes” (Ali and Wisniesk, 2010). Consumerism is also evident in neighboring countries in the Gulf such as the Kingdom of Saudi Arabia.A research paper done by King Abdulaziz University regarding “The rise of consumerism in Saudi Arabian society”, shows that by the 1960s the consumer society had expanded from the USA to Western Europe and Japan, It also defined the spread of consumerism as “a cultural orientation that perceives the possession and use of a variety of goods and services as the path to personal happiness, social status, and success”. The paper also points out that based on its literature review, consumerism has spread to Arab countries and specifically the Gulf countries,and that the lower middle-income class within Arab societies is following the upper and middle-income class lifestyles in terms of consumption behavior. The results showed that globalization components such as commercial television, the Internet, intensive marketing strategies and advertising, urbanization, and proliferation of shopping malls are all major contributors to promoting the western consumerism lifestyle within the Gulf region. Other key factors that have enabled the transformation of the region into a consumer society is; the availability of government subsidies, absence of income taxes, public sector job availability, emerging middle class, liberal import policies, increased female participation in family purchase decisions, a burgeoning youth market, and increased per capita income (Soraya, 2007). These components and factors can also be found in the United Arab Emirates due to its open-economy and similar economic dependence on its oil revenues. An international consultancy firm (Bain & Company) has indicated that the Middle East is a key region for growth. According to a survey compiled by Altagamma in partnership with Bain, the luxury sector is forecasted to grow by 8.5% in the Middle East throughout 2012, compared to 3.75% in Europe or 6% in North America. In addition, EC Harris another consultancy firm agrees by stating, “Quick wins can be made for retailers looking to make early international moves in the Middle East, particularly at the luxury end” (Kan, 2012). According to a study conducted in 2005, the UAE currently offers low or middle income earners in the ountries granted lands to help them build their houses. Nationals earning less than AED 120,000 per year are entitled to a grant of AED 500,000 that can be used for the house design and construction. However due to the rising construction costs, some people have preferred to ask for personal loans from banks to add on the grants from the government. Given that there is no provision for mortgaging of property, any loans that are used to finance housing construction or improvement are recorded as personal loans by the banks in the UAE. Leading to relatively high figures for outstanding personal loans in the bank’s portfolio (Boleat, 2005). Up until now there is no existing literature that researches intensively into the reasons behind the acquisition of personal loans by Emirati citizens or studies the possible links between these loans and consumerism among the national population. This study is an attempt to fill this knowledge gap and create a starting base for further research in regards to this topic. Methodology What was the approach and methods use to carry out this research? In the proposed research paper, the following combination of research methods has been chosen to collect data and information about the research topic “Ethical Issues in the Healthcare system in the United Arab Emirates”: Data sources Primary sources Primary research will be carried out to answer specific questions and address specific areas of focus for the research paper such as the Health insurance system in Abu Dhabi and Dubai. The advantages of this method are that it provides conclusive outcomes and updated data about the subject being under research. Data Collection In the proposed research paper, the primary source of data collection will be through Qualitative research; includes interviews which will assist in getting answers and information for specific concerns or questions (not to make predictions). Interviews The research paper proposes to gather data through in-depth interviews with a doctor working in one of the hospitals related to the healthcare system in the United Arab Emirates as well as a Human Resource Manager who, works in the Ministry of Health, responsible for employees’ recruitment and compensation. The interview will be standardized and less-structured in order to assist in controlling the interview. The interview questions will be open-ended questions in standardized structure, using un-coded questions which will allow going in depth and investigating the full range of responses gotten before short listing the responses by categorizing them. Secondary sources The secondary research sources will be mainly done through desktop research. Hence, the search will be conducted on available articles, publications, reports and news related to health care system in the United Arab Emirates and the ethical issues faced. In addition, federal and local laws that cover ethical and equity aspects in regards to health care system will also be looked at. Using secondary research to collect data will help to understand the subject history and its different perspectives. Hence, this will assist in providing applicable recommendations for further development of the healthcare system in the United Arab Emirates. Results and findings What are the key findings from this applied research? Summary of major key findings After compiling the data from desktop reviewe as well as the interviewees’ responses, the information was analyzed in-depth in order to provide an executive summary of the key findings that could help with an understanding of the results at the high-level. This below list provides a comprehensive snapshot about the results: Decision making for incompetent patients Children Psychiatric or neurological conditions Temporarily unconscious or comatose Beginning-of-life issues (BOL) Contraception Assisted reproduction Prenatal genetic screening Abortion Severely compromised neonates End-of-life issues (EOL) Euthanasia Assistance in suicide Discussion What were the main conclusions drawn from the applied research Confidentiality As per , the World Medical Association (WMA) announced the WMA Declaration as follows: • All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death. Exceptionally, the descendants may have a right of access to information that would inform them of their health risks. • Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law. Information can be disclosed to other healthcare providers only on a strictly "need to know" basis unless the patient has given explicit consent. • All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage. Human substances from which identifiable data can be derived must be likewise protected. (Julie K. Taitsman, 2013) Ms. Fareeda Al Hosani, Manager Communicable Diseases at HAAD as stated that by law that infectious diseases must be reported in all the healthcare sector including private and public hospitals and clinic. (Gulf). Such regulation by HAAD is implemented for the safety and welfare of the community. Moreover, the three health regulators in the united Arab Emirates are using electronic medical systems which is used as a databases for all patients private information and records. The information available on the system about the patients can be accessed from all the hospitals and clinics relatedelated to the health regulator network by any healthcare professional. According to James McCarthy patient confidentiality “at risk” under Dubai healthcare scheme that as per” the new system introduced health care professionals must submit full details of any treatment received by patients as well as the patient’s name and one form official identification such as a passport or labour card number”. Healthcare professionals who fail to provide the information may face the risk of losing their professional license. (Svorny, 2008). Stating the regulation of reporting pacient disease as well as systemizing the healthcare finction rasies an ethical issue of breeching confidientiality of patients. Because patients might not want other people to know about their private information which can be accessed by any health professional in the healthcare regulator network. Such information might be personal, private or related to diseases like AIDS or any psychiatric diseases. Since health insurance is implemented in some of the healthcare system in the UAE, one of the requirements to get treated through the insurance system is to submit patients information to the insurance company which can be considered againt patients confediencality. Such issues are questionable when it comes to the ethical procipal of patients’ autonomy where patients have the right for self determine. Conflicts of interest As mentioned above,health insurance system is applied public and pricate healthcare system in Abu Dhabi while in Northen Emirates it is applied in the private healthcare services. Insurance companies may increase their premium rate when the patient is diagnosed with a chronic or an infectious disease in order to cover the cost of such burden on the company or they might implement restictions on the patient insurance plan such as not covering the chronic disease or the prevention. This is raising the ethical issue of conflict of intreast which is questionable in the thical principal of justice and benifience. The issue of conflict of intrest also may arise because some of the private sectors aim for marketing and income; by prescriping more medicince and urging patients to do unnecessary invistigations and tests which can be considered as an ethical dilemma. Informed Consent Fully informed and understand the potential benefits and risks. To understand NOT to accept Patient's refusal for lifesaving procedures Operations or procedures Language Culture Females The informed consent1used in the healthcare regulators in the UAE only comes in two languages Arabic and English. There are over 200 nationalities live in the UAE (citation), therefore an interpreter or translator should be available in the informed consent counseling. Yet, the interpret is not always available in the counseling session. (citation). The language barrier is related to the autonomy ethical principal that some of the nationalities especially from labours will be signing the consent without getting the full information and explanation if the interpret was not available. Although he chose to sign but he didn’t get the full information Also, reference to HAAD consent policy issued 2007, which states that “Consent for those less than 18 years of age should be signed by the father, legal guardian, or Substitute Consent Giver” (citation). Forexample, to consider a competent person who is 17 and 11 months years old decided to have a surgery yet his gadian didn’t approvefor him to go through the surgery. This is questionable as patient’s autonomy because the patient couldnt decide for himself although he is . so he is ethically competemnt for his deciosion but legally he is not. Yet, It is the duty of the healthcare professionals to fully explain to patients and give them sufficient information. Information should be given not only to obtain consent, but also to enable the patient to come to a decision with an adequate knowledge of the risks associated with accepting, rejecting or postponing genetic testing. The information given should reflect what a reasonable person in the patient’s circumstances need to know and also he has the right to know his genetic prognosis. The healthcare professionals should explain the procedure, benefits, expected outcomes and how to manage them as well as the risk of false- positive, false negative results and the uncertainty implications. Also, the uncertainties, limitations of the test and the psychological as well as the social implications should be explained. In addition, the healthcare professional should be fully trained and experienced in the genetic testing field. Another area of concern is obtaining the newborn and children informed consent. Newborn genetic testing is optional all over the UAE. For parents who reject such testing may face liability under child protection law, but to expose a child to such invasive testing can be considered as a parental abuse. Some of the tests will not necessarily benefit the child, but it might have psychological implication on the parents and family. In Abu Dhabi and Dubai local governments, for any person under 18 years old, the decision of doing the genetic testing is totally depends on the parent’s choice. However, in the federal government it is age versus competency which means that any person under 18 years old can decide whether to do the genetic testing depending on his competency level without his parent’s choice which lessens the ethical issue. Nevertheless, from ethical point of view, if the result of the test is positive, is it going to change the pathway of the disease or allow the establishment of a treatment or preventive measures earlier? What if no treatment is available? Is it better to live and enjoy the child’s childhood with no far future worries than to live forever in anxiety for something that might occur in 40 years’ time, if not more. If the answer to the first question is yes and the second is no, the parents should have the right and the full support to test their kids. If the answer is no to the first question and yes to the second, then let the children and parents live peacefully with no worries. This dilemma is further addressed by Norrgard (2008): The decision to undergo genetic testing can only be made by the individual at risk for a disorder. Once a test has been conducted and the results are known, however, a new, family-related ethical dilemma is born: Should a carrier of a known genetic risk be obligated to tell his or her relatives (Forrest et al., 2007; Gaff et al., 2007)? This very question has begun to challenge the well-established medico legal principles of confidentiality and privacy. Although some people feel that an individual who is found to carry a dominant gene for Huntington's disease has an ethical obligation to disclose that fact to his or her siblings, there currently is no legal requirement to do so. In fact, requiring someone to communicate his or her own genetic risk to family members who are therefore also at risk is considered by many to be ethically dubious. So, then, should a medical professional get involved if he or she becomes aware that communication within a family has failed or is blocked? A professional's actions in such situations depend in part upon the nature of the information available (e.g., do the test results only estimate risk levels, or are they definitive?), as well as the implications of the condition. For instance, a greater imperative to breach confidentiality may be felt when preventative treatment options are available or when reproductive choices are at stake. Respect and Equal Treatment the United Nations has developed the Universal Declaration of Human Rights in 1948. It states that all human beings are born free and equal in dignity and rights.(cite) Moreover, as per the UAE strategy 2011-2013, The UAE Government aims to ensure access of all citizens and residents to primary health care, and to improve the quality of healthcare services provided in the country to global standards. (cite) In the healthcare sector, the uae nationals can get free access to all healthcare services in all healthcare regulators public facilities. This is provided either by direct government payment or indirect through insurance companies which are fully paid by the government for uae citizins, while for non locals, they have to pay for healthcare service or they should have a health care insurance plan either directly purchased by them or by their work. This is raising the issue of equity and justice because the healthcare services are not delivered to everyone equally. Furthermore, even between the UAE nationals there is a difference in the healthcare plan provided by the governemtn through the healthcare insurance. Abu Dhabi citizens they are covered for all public and pricate hospitals all over the UAE. While, UAE nationals who are not from Abu Dhabi, they are only covered for public hospitals in the UAE. Limitations Since the issue of personal loans and nationals debt is relatively new as it has significantly in the last couple of years, there was a lack in prior research studies related to the topic as well as limited available relevant peer-reviewed publications that focus on personal loans and nationals’ debt. This limitation affected the decision to perform both an explanatory and descriptive study of the issue. Moreover, the snowball sample used may not accurately represent the general population. For example, the sample did not include low income individuals. However, with the limited time and resources, snowball sampling is the only available option. The given factors also affected the sample size as a larger sample size would be better for an accurate quantitative research. Recommendations After conducting a comprehensive analysis of the data gathered in this study, the following recommendations are hereby made: Such declaration should be utilized in the UAE in general and specifically in the genetic testing field. Patients won’t suffer from confidentiality issues that the instructions and rights are clear to all relevant parties. (recommendation) Therefore, the government should provide funds to sponsor the genetic testing expenses. Strengthen the role of the credit bureau. Although a credit bureau has already been founded with a chosen board of directors, it has not effectively functioned yet (Salem & Hunter, 2013). Banks in the UAE are not yet obliged to share clients’ credit information in order to regulate granting loans and collect information on customers’ borrowing behavior from all banks involved. Furthermore, the UAE government had set several regulations to protect borrowers from credit risks and prevent banks from luring individuals into taking out personal loans, but an independent credit bureau is a necessity for the enforcement of these laws and regulations. Organize public awareness campaigns and financial literacy workshops. UAE nationals should be targeted with financial awareness campaigns through mass media and social media organized in collaboration with the concerned government entities (Ministry of Presidential Affairs, Family Development Foundation, Marriage Fund, Abu Dhabi Vocational Education and Training Institute, etc.) as well as private sector organizations (banks, insurance companies, stock brokers) in order to raise public awareness regarding credit risks and personal finance and to develop sufficient financial literacy. For the same reasons, free of charge, effective workshops should be offered for different groups of the Emirati society. These workshops should look at UAE case studies and include discussions which fit the UAE’s context. The goal is to create a financially-knowledgeable society where people are better able to manage their finances and protect their income and to help develop saving habits among Emirati citizens. References Abu Dhabi Council for Economic Development (2012). 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