Saturday, May 28, 2005

Healthcare for Expats

As you all probably know, healthcare for expats in Oman does not come for free. It has been like this for years. I know its the same in the UAE, but I'm not sure how it is in other GCC countries. Everyone has got their own point of view regarding this matter. There are supporters just as there are opposers.

This is not a new issue I'm discussing, but, it was something that came up in a phonecall I had with a very good friend of mine from Dubai. She was telling me about a young Indian lady who works in the salon she has been frequenting for years. This lady recently had a miscarriage (her third), and when she went to see the doctor, she was told she had virus in her blood and that she needed to go on some sort of medication. Because she couldn't go to a government hospital, she was forced to visit a private clinic. To see the doctor and get a consultation, she had to pay DH300. As for the medication, each pill bottle costs DH350 and is for a one month dosage only.

This woman works in a salon, making about DH1000-1050 per month exclusive of tips. Her husband is a construction worker in Dubai making slightly more than his wife. How could they be expected to pay fees like these for treatment?

Its not fair.

European or Lebanese Expats in Dubai make so much more money, to them DH350 is pocket change. How can lower class workers be expected to pay the same? Shoulnd't there be some sort of law that makes you pay for healthcare according to your income? Because that would make sense. If there is one that I haven't heard of, then I appologize for making assumptions.

What do our fellow bloggers think of this issue?


Lym said...

I think they should take into account their customers finacial background. As in , the indian cannot afford it , therefore he should be given free consultations , while a rich Lebanese should pay for it.
I don't know how can that be accomplished. But it is better than the current system.

Chanad said...

You've raised an important issue that I've thought about a lot (since I'm an expat myself).

My suggestion is that for every expat worker, an amount should be paid to the government. This could be paid by the sponsor, the employer, or the employee. The money would go to a special fund that would be used to subsidize health costs, and also to help support projects like an abused workers shelter.

Basically, this would be equivalent to insurance, or social security tax.

What do others think about this?

Mansur said...

This is such a big issue!

I have to tell you, there is something wrong with the UAE medicine market. My mom and I were out at a pharmacy. She needed to get Claritine. I bought it and it cost me about Dhs50. My mom gasped. "Mansur, this only costs SR 13 in Jeddah!!" Talking to other people, we realized that medicines here in UAE are highly over-priced. I know of people who bring in their medicines from outside, especially if they are the ones like anti-depressants, weight control, the kinds that need to be taken for a period of time.

I do not what the solution is, but there certainly needs to be monitoring of the prices of these medicines. Why is Calritine in Dubai for Dhs50, when I can get it for SR13 right next door? It's the same deal with the home rents here, of which I am going to get into!


anonymous said...

Why should a doctor charge less for services rendered and even then how is he to know which patient is rich and which isn’t? The same example could be used for all sectors. What about buying groceries from a supermarket a carrot is a carrot but I am poor so you should charge me less because I am not as rich as the next guy! The doctor is trying to make a living too.

Instead of asking a private doctor to provide patients with free healthcare why do you not blame the government for not providing these services to expats with low incomes? That way they would be able to control who comes in the government hospitals. Some countries provide free healthcare to anyone who walks in through the emergency room.

OceanDream said...

When I discussed this with Muscati he said he completely believed that it was the employer's job to provide a healthcare scheme for his employees. I agree. As Chanad mentioned above, this should be done in cooperation with the government. Each company should pay a certain sum that should be sufficient enough to cover healthcare costs for its workers. A health insurance scheme.

@Mansour: I never knew the difference in medication prices between KSA and UAE would be so great! I have a friend at work who asked me to buy a special brand of multivitamins for her baby from Dubai when I was last there because it was not available here. I bought her the bottle for DH65. A few weeks later she was at one of the hypermakets here and found that they had started selling the same brand and for RO 2.5! I was shocked. Thats half the price!

There are no laws to regulate the prices of medicine, are there? (pardon my ignorance in this field)

SoWhat, where are you?! Maybe you can help us out here :)

muscati said...

All medicine prices in Oman are set by the government. That doesn't mean they'll be cheaper here than in other countries. All it means is that we have price controls.

More later.

DevilishAngel said...

OD, just as Muscati mentioned to you, large corporations (where you would find the Lebanese/ Europeans you pinpointed) have health plans under the "benefits" they get as employees. I am going to be considered an "expat" once I start working there, and I already signed my insurance papers. As for the unfortunate Indians, and those who work in constrution, beauticians or retailers, their employers don't offer them health benefits with their services. And they make less money, as it 
The governmental health units in UAE treat GCC ppl for free, or for very reasonable prices, I am not sure why she couldn't go to a government hospital, and even if she could I am not sure if she could get treated there, but governmental services are provided for non locals, that much I know.

As for the regulation of drug prices across countries, well the same issue is raised in the States vs Canada where the drugs sold in Canada are upto 65% (I think) cheaper than the States, and the pharmaceutical industry in the states suffered so much, that they had to ban drug exports from Canada. I don’t know what they'll do about it here, I wasn’t even aware that this problem existed here till you guys mentioned it.

muscati said...

Do you know in Oman an expat won't be accepted in a government hospital unless referred there by a private doctor. Not even if it's an emergency.

The expats who work in big companies and the government get covered by health insurance or get healthcare at their employers' expense. But it's the lower paid ones who suffer.

Why do you think clinics like Lama and Badr Al Sama are growing so fast and starting to get into bigger procedures like surgery while at the same time the private hospitals like Shatti and Muscat Pirvare Hospital continue to lose money? No one wants to pay for premium healthcare and the ones who are forced to use private healthcare want it as cheap as possible.

I think the only solution is to enforce a health insurance system. Just like employers have to pay an annual fee to the Labor Dept every year for a labor permit, they should be forced to pay an annual health insurance premium for every worker. Of course this would lead to either a reluctance on companies' par to hire expats or an increase in the cost of service.

By the way DevilishAngel, the big multinational companies give health insurance benefits even to their Omani employees here in Oman. Omanis I know who work for Shell, Philip Morris, etc here in Oman all get premium benefits and never go to government hospitals.

Sowhat said...

Nice topic indeed ..

yes here in oman expat have to pay for their treatment unlike omanies .. except in emmergencies cases as i think ( but delivery for example is not considerded as emergency )

However some big companies have their own health insurance and they would pay for the worker for his medication ..

while if the patient doesnt have any health insurance and he/she doesnt have the money to pay for medication they wont treat him /her ,,as am doing surgery Rotation right now ,, we had a patient who is expat and work as maid , she escaped from her work for personal reason she refuse to tell, she doesnt have enougth money to go back to her country . she presented with a lumb in her breast which was diagnosed unfortunatly as Cancer .. the cancer was in advanced stage that need radical surgery and a medical treatment in with chemotherapy and hormonal therapy .. unfortuantly she did not recieve anything becouse she couldnt pay for it .. the hospital rule is clear and doctors could do nothing against it.. they supplied her with pain killers and some other drugs that wont treat her but would relief her symptoms ..

this case is not strage case or unique we see alot of them and we cant do anything to help them except pain killer and some other cheap medications ..

regarding the question if there is any type of control regardign drugs prices Yes there is .. there is a list of drugs ( include the drugs that are widley used ) that have fixed price maintained by the Minstry of health .. Thyroxine or Eltroxin ( the trade name for thyroxine ) -whcih is basicly a hormone replacemnet Drug - price had been reduced by the MOH becouse of the increase in the number of patient suffering from Hypothyrodism ( decrease in secretion of Thyroxine ) ..

why MOH do this , amean why it doesnt treat patients for free ??becouse they cant afford it .. Royal budget is around 24 million RO with this regualtion just imagine how much it will be if they make it for free for exapt!!

i think the only solution is health insurance that take a percentage of your salaray so it wont affect noth rich o poor ppl and every one could have the proper treatment for their diseases ..

muscati said...

When we were in Dubai last month we heard a call-in show on the radio and a guy (I think he was Syrian) called about a sudden decision by the Ministry of Health to increase the cost of cesarian section births. Apparently in the UAE they have a fixed cost system for expats. There's a list of all procedures with the cost of each available in all hospitals. The ministry announced in April that the fee of a c-section was going to be doubled starting May 1st. The guy's wife was scheduled for a c-section on May 6th. She was too late in her pregnancy for him to send him her to Syria to give birth. No airline would let her travel. And at the same time he couldn't afford the newly increased fee. He said he had prepared his budget based on the original fee. The poor guy was desperate and didn't know what to do.

iamnasra said...

Just today I was looking at this article which about increased fee for Goverment hospital...

How sad...It heartbreaking not to do that for people with law income...I just think with all the labour workers in UAE who much they will have to endure..

OceanDream said...
This comment has been removed by a blog administrator.
OceanDream said...

Like SoWhat mentioned, deliveries are not considered emergencies. A collegue of mine was in the hospital once when an Egyptian man rushed his wife in. His wife was almost 6 months pregnant and unfortunately went into labour early. She was losing her baby and they refused to admit her. He was yelling at the top of his lungs that she was due to travel to Egypt soon to deliver before this happened, but non of the staff on shift took the risk of accepting her.

I'm sure this story is not unique, its just as horrible as the story of the maid with breast cancer.

It breaks my heart to hear stories like these. I hate feeling helpless.

I just hope, pray, that someone with power stumbles upon our blog and maybe raise this issue with the decision makers in the country.

Nzingha said...

Here in KSA its the same situation. In Government hospitals non Saudis are not to be taken. It was always like this but for a time it slacked up and people were seen anyway for free care. But again they are starting to tighten up.

However, the director, or a doctor, in the hospitals can choose to take on patients even if they are non saudis.

My mother lives here, not even with an iqama but a visit visa we have been renewing for four years. (thats a whole other hassle) while here she was diagnosed with a terminal cancer. While we have medical insurance for our family, she doesn't. Nor can she afford treatments from private hospitals. It was a single dr. in the government hospital who approved her as his patient so she could recieve care. She has been going there since sept. and hasn't paid for anything.

Granted the quality of care isn't as good as a private hospital. But that drs. can approve patients for care is a big plus.

What I find amazing is that Saudi sends Millions of SR on foriegn aid. Anything ranging from food to health care in other countries. But people living right here have to be and plead if they can't afford it.

alhamdulillah we meet a good dr. who felt it was his duty as a muslim to take her in for care. But I have to wonder about all those who don't get accepted by such a dr.

A simple solution is that a an allowance of care can be had for expats who are in the lower income bracket within the government hospitals. This can be based on income and the type of medical care that is needed. Other expats need not pay for everyone elses health care simply because they make more Why should the wealthier be penalized. Nor should companies have to put out extra money for hiring expats who are manual labors for example. Not all employers can absorb such costs and you run the risk of forcing them out of buisness.

Preternatural_aL said...

I dont understand y couldnt she go to the govt. hospital.
As per visa rules she has to have a medical card.This medical card costs dhs300(or so ..not sure abt the price but def within this range.
An expat pays 20-50dhs for consultation and the rest of the treatment is free,unless she/he has to be admitted (room charges + disc.).
Basically it is way cheaper than private hospitals.
U mentioned her husband was from the "labor-class"- then he would not be able to sponsor his wife.So we can conclude that the saloon sponsors her,therefore the saloon paid the intial money for the medical card as it is a visa requirement and all visa fees are to be covered by the employer.

I didnt mean to offend anyone, just that saying it as I know it.

dervish said...

For a 100 rial fee, everyone in Qatar is entitled to health insurance. As an ex-pat, the payments for drugs and visits are a little higher than for citizens, but still very reasonable. Everyone is treated regardless of ability to pay.

I would refuse to work in a country which denied medical treatment to anyone (a large part of the reason I left the US). Denying healthcare to those who need it is un-Islamic... Does someone out there really believe that they won't have to face Allah(swt) one day?

Keefieboy said...

Hi Muscati - just discovered your fascinating blog.

The issue of medical care for expats in the UAE is one that I've covered a fair bit in my blog. I've had a fair number of (not-life-threatening) medical problems over tha last year, and it seems that the price of healthcare is rising by leaps and bounds here in the UAE.

I'm puzzled by the person in the original story not being able to use a Government facility - these are open to anyone on the planet.

And yes, the cost of medicines does strike me as being very high here. I laughed at the comment about this lady's pills being Dhs 350, and that this is mere pocket-change to a westerner. You have to be kidding! That's a lot of money (and yes, I appreciate it's an even larger amount if you have a low income).

I am currently on a course of antibiotics. They cost Dhs 100 for 20, and I have to take four of the blighters every day. Ouch!

I'm wandering a bit here, but what i want to say is that the UAE government health services are outstanding. But they have recently introduced a whole bunch of charges (locals always get stuff for almost nothing, expats have to pay through the nose) for lab tests, scans, x-rays, etc. Which makes me wonder what we get for our annual health card fee - answer, a health card. In fact if you don't have a valid health card, all fees are more than doubled.

The real killer (literally) fee that I read about recently, is for kidney dialysis. Dubai Hospital is apparently charging Dhs 800 per session. This is ridiculous. Mosrt people who need dialysis, need it three times a week, and that comes to about Dhs 10,000 per month!. That's far more than the majority of the population earns, (I certainly couldn't pay that every month).

So yes, there is a very good case for charging according to the patient's income level, and I do think the DOHMS in the UAE is facing a major financial crisis. But sometimes when I go to the Clinic I feel like I am personally funding the entire system out of my own pocket!

Having said all that, and my apologies for going on so long, I think government health services here are superior to what you get in the UK (even though as a Brit I would never ever have directly pay a penny for using the service). The UK health service is starved of resources, and has outrageously long waiting lists. At least we can get treated very quickly here.

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Anonymous said...

It's one of the major concerns when moving to israel or anywhere. You need to be aware of your health.

daniellaprice30 said...

I can't suggest a good healthcare for expats yet but I know a great Houston cosmetic dentistry that could provide superior oral health care. All the dental procedures I had in this clinic is satisfactory.

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