Where has money gone in Dubai health sector?

The Dubai Health Authority (DHA) announced the findings of the first health accounts report for the emirate at a press conference held today at the last day of Arab Health 2014.

The findings provide an overview of all expenditure flows within the public and private healthcare sector, answering questions such as where health funds came from, where health funds went, what health services were purchased and who benefited from these services.                            

Referring to the accounts fo the year 2012, the total amount spent on healthcare was Dh10 billion, with a public-private funding ratio of 32:68. This ratio matches Dubai’s strategic goal ratio of 30:70, said the DHA.

In a more detailed breakdown of the fund sources, the 68 per cent of private funding was divided between 45 per cent originating from employers and corporations and 22 per cent from households.

Commenting on these numbers, Altijani Hussin, Health Economics Consultant at the DHA said: "We would like to see more involvement of the employer."

The share of the employer was only in 36 per cent of the cases funded through prepayment amounts, which is not sustainable, according to the DHA. "When various health financial sources pool money into a common collection, it reduces individual risks and increases efficient distribution as per patient needs," read the document.

In other words, a funding system more reliant on insurance schemes is desirable, which will be realised once the mandatory insurance scheme is in place. This will allow for more variety in health funding resources and better management of these sources, argued the DHA.

Noteworthy were also the findings regarding the services purchased, as they showed that only 6 per cent of these funds were dedicated to preventive health care, while 55 per cent went to curative care, 20 per cent to drugs and other medical goods and 15 per cent to services provided outside Dubai.

"This is an important finding. Based on these figures we know that we should invest more in preventive health care," commented Hussin.

Part of the problem, is that insurance companies are reluctant to invest in preventive programmes since the majority of the population in Dubai is transient, argues the report. "Employers and health insurance companies should be guided, trained and communicated on preventive care," it read.

The relatively high rate of services provided outside Dubai is telling too, added Hussin. Although these services are funded by sources in Dubai and stringently evaluated by the DHA, it would be better if these funds contribute to the local economy. Services that are frequently provided outside Dubai deserve the attention within the health care sector of Dubai, he argued.

The report read that these services were most commonly oncology, neurosurgery, and cardiac surgery, which were largely sought in Germany, Thailand, and the UK.

Statistics showing where health funds went indicated that the majority of health care is purchases in hospitals. While 48 per cent of the funds went to hospitals, 22 per cent went to clinics and polyclinics, and 15 per cent to the mentioned services outside Dubai. The government share of hospitals was even higher, with 54 per cent.

According the DHA the hospital share of funds in Dubai is higher than international standards, and undesirable phenomenon as it places a great burden on the hospitals.

The new Health Law is based on a primary care model, where primary centres should be better utilised. "A more balanced distribution of where the money is spent will ensure better value for money spent on services," read the report.

In terms of the people who beneficiates from health care spending, a healthy model was presented. Although 53 per cent of the funds were spent on the male population and 47 per cent on the female population, these figures are perfectly in line with biographical data; 76 per cent is male and 24 per cent is female, and females traditionally spent more on health.

The report is the first Health Accounts of the Emirate report produced and will continue to appear on an annual basis. The timing of the report is crucial, as Dubai is undergoing major developments based on the recent Health Insurance Law, noted  Essa Al Maidoor, Director-General of the DHA.

He stressed that the decision to implement the Health Accounts System of Dubai (HASD) was based on three pillars: firstly, HASD allows measuring the financial dimensions of the health care system in the public and private sectors, which shows the efficiency of the allocation of the health funds.

Secondly, HASD enables monitoring changes in the distribution of the available financial resources, comparing Dubai to other regional and international health systems. These changes give the Government and the investors the information necessary to measure the investments size.

Thirdly, HASD allows the support and implementation of the health insurance system through monitoring the health spending.

“HASD measures the dimension of health spending before the scheme as a baseline. These indicators will be used then to monitor changes overtime, with each wave of beneficiaries joining the health insurance, till universal coverage in 2016. Then, DHA will compare the situation post the implementation against the desired results, and will take the necessary measures in case of any deviation from these planned stages”, said Haidar Saeed Al-Yousuf, Director of Health Funding Department.

As the findings will be made available to the public in a matter of days, all parties involved will benefit from the findings, argued the DHA.

Al-Yousuf explained that the DHA will hold a workshop to disseminate the results and details of the report, in order to raise awareness of these financial results and ways to use them in planning the future investments for the health sector.

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