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 complain about the extra cost being imposed on them via the DHA plans, and muttering about further inflationary pressures building up in Dubai. But to balk at this plan for such short-term motives seems contrary to the very spirit of the emirate.
If you take an average sized company of say 1,500 employees, the annual cost of the scheme will be in the region of Dh1 million, depending on where the final figures is set for employer contributions. This does not seem an excessive amount to ensure the health and security of your employees, and the increased productivity associated with a more contented workforce. It is a simple fact, proven time and again in labour surveys round the world – healthier and more secure employees work harder and more productively than sickly wage-slaves.
The extra stimulus given to the healthcare industry and the insurers should also be taken into account. A whole new business sector of health management will be created by the establishment of service providers to remove the administrative burden from doctors and nurses, with contracts awarded via competitive tender later this year. The insurers will have to refine their products to offer premium services to those who chose to afford them, but should see that as an opportunity to get into the high added value end of the industry.
There will be many issues to be resolved before the scheme is fully implemented in 2015. Apart from the concerns of business, the anxieties of potential patients will also have to be addressed: will there be a rush to register with the best hospitals and clinics? How will the scheme work for smaller companies and partnerships, or for the self-employed? At the other end of the scale, will large-scale employers in construction and other infrastructure be tempted to pass on the cost to already low-paid employees? Will illegals get basic healthcare, especially in emergencies or accidents, without abusing the new system? The DHA will have its work cut our to ensure the smooth introduction of its plans. But is should not be distracted from its long-term goal by the intricacies of implementation.
The DHA has set out a far-sighted and ambitious plan for Dubai's most precious resource – the health and well-being of its population, national and expatriate alike. It must now strive to ensure the vision of its strategy is implemented in full.