Expatriates to be banned from public healthcare?

Kuwait intends to prevent the local expatriate population of 3 million from accessing public healthcare services. Static oil revenues mean the government has to cut back economic plans and look at ways to save money.

Cash strapped Kuwait, suffering from low oil prices aims to prevent the local expatriate population of 3 million from accessing public healthcare services. The latest attempt may or may not have been rebuffed.

There are many contradictory statements coming out of Kuwait as different organisations and politicians disagree how to provide future healthcare for expatriates.

The bottom line is that with oil revenue static and now not likely to rise for some years, the government has had to cut back economic plans and look at ways to save money,

In a state where locals are outnumbered by expatriates who are vital to the economy, expatriates are seen as second class citizens by some factions who argue that cuts should affect them but not local Kuwaitis.

Doctors have rejected the proposal of the Economics Committee in the Supreme Council for Planning and Development to lift the health insurance subsidy granted to expatriates, cancel their privilege to undergo treatment in state hospitals and clinics, and refer them to private hospitals. The proposal came as part of a report prepared by the committee on lifting subsidies that negatively affect the national budget. But the council is ploughing on anyway.

Doctors argue that it is nor workable due to technical, strategic, administrative and moral considerations. The private sector only has 16 hospitals and the total capacity of these hospitals is 1,230 beds, with an expatriate population of three million. Hence, it is difficult to apply the proposal, especially in terms of admitting patients, complicated cases and surgery. Doctors fear that private hospitals will receive expatriates in their outpatient units, with crowded receptions and long waiting periods for a patient to get help.

The Private Health Professions Union says that the private hospitals cannot accommodate the huge number of expatriates, while the renovation of private hospitals takes time, let alone equipping, furnishing and providing the required manpower as well as the bureaucratic procedures in government departments.

Doctors point out that bureaucracy and lack of cash already means projects are way overdue, such as the plan to bring in health insurance. The Supreme Council for Planning and Development is criticised for making decisions and announcements without consultation with doctors or private hospitals.

Despite the opposition the Supreme Council for Planning and Development is moving forward as it listed five benefits of lifting the expatriates’ health insurance subsidy:

• It will help determine the actual cost of foreign manpower and narrow the gap between foreign manpower and national manpower.
• It will create a competitive and strong insurance market that is considered an important part of the financial sector.
• It will create a private health service industry that could develop into an industry that attracts medical tourists regionally.
• It will contribute to reducing pressure on public health services and lessen the need for huge health investments; thereby, reducing the general cost.
• It will generate new job opportunities for Kuwaiti youths in a highly specialized and competitive environment.
• In the longer term it could generate medical tourism revenue

The council wants to start with expatriates working in the government sector, followed by those in the private sector, and finally domestic workers. 2 million work in the private sector and one million expatriates work in the public sector, while legal and illegal domestic servant numbers are not known.

The report calls for imitating an example followed in the 1990’s when the Kuwaiti government scrapped free education for expatriates in Kuwait, thus banning foreigners from studying at public and forcing them to enrol in private schools. The action led to a boom in the private sector and skyrocketing of private school tuition fees. The same could happen in private healthcare and health insurance if the government’s proposals are adopted.

The council argue that insurance companies can refer their clients to government hospitals if the private hospitals lack beds during the transitional period or allow people companies cannot insure to continue receiving treatment in government hospitals, and then later, the Health Ministry may rent out or sell its extra facilities to the private sector similar to what its education counterpart has done.

The council wants the government to transfer the major part of public health services private companies.

The scrapping of access to public health services would leave expatriates with no option but to pay for private health insurance.

Last year Kuwait established a shareholding company through the public-private-partnership system, to service expatriates health needs. The company intends to build three 700-bed hospitals that provide integrated medical services to foreigners in Kuwait. The company also sells health insurance policies inside and outside Kuwait.

Unless there are enough private hospitals, it is impossible to make expatriates buy health insurance from one state or private insurer or competing insurers. For it to work the government would have to sell most state hospitals to private