Landmark health insurance plan

How a society serves the health needs of its people is one of the basic criteria of political and economic development. Indeed it is one of the essential hallmarks of "civilisation". So I regard news that the Dubai Government is to introduce a comprehensive and equable system of healthcare provision as a landmark on the emirate's path to modernity. What I especially like about the strategy – unveiled yesterday by the head of the Dubai Health Authority (DHA) Qadi Saeed Al Murooshid – is that it borrows the best of the various global models for healthcare, while avoiding the prescriptive elements that other societies have felt forced to include in their healthcare systems, often for ideological reasons. The DHA scheme mixes pragmatism and altruism in a way that is unique, certainly in the Middle East, and probably in the rest of the world. Let me explain. When the world was dominated by the confrontation between capitalism and communism, your view on healthcare was determined by your choice of ideology. In (capitalist) America, it was every man, woman and child for himself. If you were wealthy enough in the US, you had access to the best medical treatment in the world. In (communist) Russia, healthcare was every citizen's entitlement as one of the obligations of an egalitarian state. In theory, the president of the Central Committee used the same hospitals as the humblest peasant. In practice, there were vast aberrations in each system. The American insurance industry soon found a lucrative niche for its business, which made access to good healthcare affordable to many more people. And the US Government was forced to provide at least a basic minimum, in the form of Medicare. In Russia, access to superior medical facilities became one of the privileges of political rank; and – despite the enormous cost of providing universal free healthcare – wealthier or better connected Russians often preferred to go abroad for private medical treatment. In Europe, a hybrid system evolved whereby private and state-funded systems existed side-by-side, but this caused its own tensions. For example, in Britain, which once boasted the "best health service in the world", the financial strains of providing healthcare-for-all led to the imposition of increasingly savage compulsory contributions from employers and employees alike. When these became unsustainable, the private sector grew to take up the slack. This brought its own social and political problems, which Britain is now struggling to control. In Islamic societies, medical facilities have been mainly provided free by governments or by wealthy individuals and foundations, as a extension of the Muslim belief in the value of charitable actions, especially regarding the poor and the sick. The DHA plan – which has been under detailed consideration for many months and involved many hours of consultation – has obviously looked at all those precedents and come up with an eclectic formula that takes the best from each, tailored to the complex needs of life in Dubai in the early 21st century. Under the scheme, healthcare for Emirati nationals remains free and universal, which is entirely equable and consistent with the socio-economic thrust of government policy. To provide for the vast majority of the population – the expatriates who chose Dubai as their home and workplace for a substantial part of their lives – healthcare will be funded by an annual levy on employers of between Dh500 and Dh800 (the exact figure will probably be set by autumn) which will go into a central pool, to be administered by a central clearing body under the auspices of the DHA. It will – as far as possible – balance contributions with costs and ensure the long-term financial viability of the scheme. This kind of central supervisory responsibility is essential if the plan is to avoid the financial pitfalls and inequalities of the present British and US systems. Employees will be required to register with a recognised clinic or hospital, which will then be funded by the central body according to the number of patients it has, equalising supply and demand of quality healthcare providers. The DHA recognises that there are elements of medical care that can never be fully factored in to these equations – major epidemics and casualties from catastrophic events, for example. These will be partly taken care of by a "capital fund" within the central pool, with the ultimate responsibility of the state as funder of last resort. In the long-term, the idea is to make the scheme as close to self-funding as is possible. The starting point is equal access to medical services. The chief executive will have access to exactly the same basic level of health care as the construction worker. But the plan also allows for individual freedom of choice by allowing, even encouraging, "top-up" services via private insurers. If you want more and can afford it, you are free to buy it. There will be some in the private sector who will com