Healthcare in the Emirates: Oasis Hospital Case Study
I have recently come back from a client trip to Al Ain in the Abu Dhabi emirate. Al Ain is a sleepy oasis town tucked away two hours south of the glitz and glam of Dubai and a similar distance from the richest city on the planet, Abu Dhabi.
In the late 1990s, the Emirates began privatizing healthcare, largely to increase access for expatriates, which make up 85% of the population (70% in Al AIn). Two years ago, the emirate of Abu Dhabi launched a bold program to insure universal insurance coverage for all residents: expatriates would have mandated employer coverage and nationals would have government-paid insurance. My client has seen their inpatient insurance coverage rates hike up from 29% in January 2008 to 96% by August. The government is hoping that the widespread insurance market will do three main things:
- Increase competition between public and private hospitals. Until very recently, nationals would only go to public hospitals (if they wanted free care) and expats would only visit private hospitals (unless they had a life-threatening situation which expanded access to the secondary and tertiary public hospitals).
- Reduce costs. Increased competition, it is believed, will expand the network of services and drive down costs.
- Raise quality. The advent of insurance introduces coding rigor, which leads to the compilation of claims data that can be analyzed for medical efficacy, among other things.
In addition to insurance reform, the UAE has begun to revamp its care policies which have led to the nearly $2B per year expenditure in medical tourism. Moral hazard has run amok as nationals have gone abroad for care, often for services which are offered domestically. Perverse financial incentives (such as $10,000 per diem discretionary spending budgets for patients’ families) have been a chief driver of these costs.
An Inter-Faith Oasis
Oasis was the first hospital in the entire country. It started at the behest of the ruler of the nation, Sheikh Zayed bin Al Nahyan, fifty years ago when infant mortality rates were 50% and maternal mortality rates were 35%. Today, Sheikh Mohammad, his son acknowledges that, “We were dying as a people before [Oasis Hospital] came.” The population of the city at the time was 1800: now it is over 600,000. The Mission of the hospital can be recited by any employee: To provide an international standard of quality healthcare and services to the communities in which we serve by representing the love and compassion of Jesus Christ. A colleague of mine from the States thought that it was incredibly odd (and foolish) to advise a Christian hospital in the midst of a majority Muslim Arab landscape, but ten years ago I had the pleasure of working for the YMCA of East Jerusalem in a very similar Christian-Muslim backdrop. I have been quite humbled by both experiences. Today, Oasis Hospital is a very trusted member of the community with burqa-clad women coming all the way from Oman to deliver there because their mothers and their grandmothers delivered there. My work is to help them think through the operational implications of growth and added competition and the investments in people, technology, and teaching that they will need to make to expand from a largely women and children’s hospital to something much more substantial in heft.
Oasis is a part of CURE International whose missionary hospitals spread across nearly a dozen countries.