Identifier
Created
Classification
Origin
03ABUDHABI3553
2003-07-30 12:13:00
UNCLASSIFIED
Embassy Abu Dhabi
Cable title:
ESCALATING HEALTH CARE COSTS IN THE UAE
null Diana T Fritz 03/21/2007 12:10:20 PM From DB/Inbox: Search Results Cable Text: UNCLASSIFIED SIPDIS TELEGRAM July 30, 2003 To: No Action Addressee Action: Unknown From: AMEMBASSY ABU DHABI (ABU DHABI 3553 - ROUTINE) TAGS: ABUD, AMGT, APER Captions: None Subject: ESCALATING HEALTH CARE COSTS IN THE UAE DICTATE FUNDING FOR FSN HEALTH INSURANCE Ref: None _________________________________________________________________ UNCLAS ABU DHABI 03553 SIPDIS CXABU: ACTION: DCM INFO: ECON POL AMB ADM Laser1: INFO: PER DISSEMINATION: DCM CHARGE: ICAS APPROVED: AMB:MWAHBA DRAFTED: ECON:CCRUMPLER CLEARED: A/DCM:VDVATE; MGT:BARKLEY; ECON:JOHN; POL:MENARD; HRO:GAFFNEY VZCZCADI799 RR RUEHC RUEHDI DE RUEHAD #3553/01 2111213 ZNR UUUUU ZZH R 301213Z JUL 03 FM AMEMBASSY ABU DHABI TO RUEHC/SECSTATE WASHDC 1103 INFO RUEHDI/AMCONSUL DUBAI 3312
UNCLAS SECTION 01 OF 02 ABU DHABI 003553
SIPDIS
FOR NEA/SA/EX KATHLEEN AUSTIN-FERGUSON, STEVE HARTWELL,
MICHELLE ESPERDY
E.O. 12958: N/A
TAGS: ABUD AMGT APER
SUBJECT: ESCALATING HEALTH CARE COSTS IN THE UAE
DICTATE FUNDING FOR FSN HEALTH INSURANCE
REFS: A) BOOTH-BARKLEY E-MAIL DTD. 6/30/03
B) MARSHALL-BARKLEY MEMO DTD. 6/30/03
C) BARKLEY-KEITH E-MAIL DTD. 6/23/03
D) STATE 170942
E) ABU DHABI-FRANK MEMO DTD. 4/23/03
F) STATE 97917
G) ABU DHABI 1728
H) 02 ABU DHABI 2829
I) 02 ABU DHABI 1502
UNCLAS SECTION 01 OF 02 ABU DHABI 003553
SIPDIS
FOR NEA/SA/EX KATHLEEN AUSTIN-FERGUSON, STEVE HARTWELL,
MICHELLE ESPERDY
E.O. 12958: N/A
TAGS: ABUD AMGT APER
SUBJECT: ESCALATING HEALTH CARE COSTS IN THE UAE
DICTATE FUNDING FOR FSN HEALTH INSURANCE
REFS: A) BOOTH-BARKLEY E-MAIL DTD. 6/30/03
B) MARSHALL-BARKLEY MEMO DTD. 6/30/03
C) BARKLEY-KEITH E-MAIL DTD. 6/23/03
D) STATE 170942
E) ABU DHABI-FRANK MEMO DTD. 4/23/03
F) STATE 97917
G) ABU DHABI 1728
H) 02 ABU DHABI 2829
I) 02 ABU DHABI 1502
1. SUMMARY AND ACTION REQUEST: IN THE LAST TWO YEARS,
THERE HAS BEEN A DRAMATIC EROSION IN THE PREVIOUSLY
GENEROUS HEALTH BENEFITS PROVIDED BY THE UAEG TO NON-
CITIZEN RESIDENTS. THE HIGHEST HEALTHCARE COSTS IN THE
GULF REGION, COMBINED WITH DECREASING GOVERNMENT
SUBSIDIES IN RECENT YEARS, HAVE FORCED THE UAEG TO
CHARGE EXPATRIATES FOR NEARLY ALL HEALTH SERVICES.
SINCE 1996, THE UAEG HAS REQUIRED EXPATRIATES TO HOLD A
HEALTH CARD -- ISSUED BY THE MINISTRY OF HEALTH, A LOCAL
HOSPITAL, OR A PRIVATE HEALTH INSURANCE COMPANY -- AS A
PREREQUISITE FOR A RESIDENCY PERMIT. THE UAE MINISTER
OF HEALTH RECENTLY ADMITTED TO LOCAL REPORTERS, HOWEVER,
THAT THE HEALTH CARD SCHEME HAS NOT WORKED, AND
EXPATRIATES IN REALITY PAY FOR MOST OF THEIR MEDICAL
TREATMENT. MANY PEOPLE ARE UNABLE FINANCIALLY TO COVER
THEIR OWN HEALTH CARE COSTS, AND THEREFORE DELAY
TREATMENT AND ENDANGER THEIR HEALTH.
2. SUMMARY AND ACTION REQUEST CONTINUED: IN SPRING
2001, THE UAEG ANNOUNCED A PLAN TO MAKE IT COMPULSORY
FOR EMPLOYERS TO PROVIDE PRIVATE MEDICAL INSURANCE FOR
EXPATRIATE WORKERS. PROGRESS ON CODIFICATION OF THIS
LEGISLATION HAS BEEN SLOW, HOWEVER, DUE TO THE
COMPLICATED CONSENSUS-BASED DECISION-MAKING PROCESS OF
THE UAE BUREAUCRACY. COMPARATOR COMPANIES AND
COUNTERPART DIPLOMATIC MISSIONS DETERMINED IN 2001 THAT
INSURING THEIR EMPLOYEES WAS A DE FACTO REQUIREMENT,
DESPITE THE ABSENCE OF A LAW. POST REITERATES ITS
REQUEST TO WASHINGTON TO BUDGET FOR FSN HEALTH INSURANCE
IN FY04. END SUMMARY AND ACTION REQUEST.
--------------
HEALTH CARE SYSTEM IN THE UAE IS BROKEN
--------------
3. THE CURRENT HEALTH CARE SYSTEM IN THE UAE
DISCRIMINATES AGAINST EXPATRIATE WORKERS -- WHO COMPRISE
MORE THAN 85 PERCENT OF THE COUNTRY'S POPULATION AND 98
PERCENT OF PRIVATE SECTOR WORKERS. UAE NATIONALS PAY
BETWEEN 25 DIRHAMS (US $6.80) AND 100 DIRHAMS (US
$27.23) FOR A HEALTH CARD THAT ENTITLES THEM TO LARGELY
FREE HEALTH CARE FOR FOUR YEARS. EXPATRIATES, ON THE
OTHER HAND, ARE CHARGED BETWEEN 100 DIRHAMS (US $27.23)
AND 300 DIRHAMS (US $81.68) FOR A HEALTH CARD FOR ONE
YEAR, WITH ADDITIONAL FEES FOR ROUTINE HEALTHCARE
SERVICES -- 50 DIRHAMS (YS $13.61) FOR EACH X-RAY OR
ULTRASOUND, 75 DIRHAMS (US $20.45) FOR AN INTRAVENOUS
PYELOGRAM, OR 100 DIRHAMS (US $27.23) FOR A CT SCAN.
SINCE 2001, EXPATRIATES HAVE PAID FOR ALL MEDICATIONS.
SUCH CHARGES CAN BE A HUGE FINANCIAL BURDEN ON OUR FSNS.
4. PRICES FOR PHARMACEUTICALS AND SOME MEDICAL TESTS IN
THE UAE ARE NOW 20-30 PERCENT HIGHER THAN IN THE REST OF
THE GULF, AND MORE THAN 50 PERCENT HIGHER THAN PRICES OF
SIMILAR PRODUCTS IN THE INDIAN SUBCONTINENT. THIS IS AN
UNEXPECTED CONSEQUENCE OF POST'S EFFORTS TO ENSURE UAE
COMPLIANCE WITH ITS WTO PATENT PROTECTION OBLIGATIONS.
AS THE RESULT OF WASHINGTON'S AGGRESSIVE CAMPAIGN TO RID
THE UAE MARKET OF CHEAP ILLEGAL COPIES OF PATENT-
PROTECTED MEDICINES, THE UAE HEALTH SECTOR NOW IS
LARGELY DEPENDENT ON DRUGS FROM EUROPE AND THE UNITED
STATES -- IN TURN PUSHING UP PRICES OF BASIC MEDICINES.
-------------- --------------
COMPULSORY PRIVATE HEALTH INSURANCE IS THE SOLUTION
-------------- --------------
5. THE QUASI-PARLIAMENTARY FEDERAL NATIONAL COUNCIL
FIRST RAISED MANDATORY EMPLOYER-PROVIDED PRIVATE HEALTH
INSURANCE IN 1999. THE PROPOSITION WAS RECOGNITION BY
THE UAEG THAT ITS CURRENT HEALTH CARD SCHEME FALLS SHORT
OF PROVIDING BASIC HEALTH SERVICES TO THE UAE'S MORE
THAN 3 MILLION EXPATRIATE WORKERS. THE UAEG, HOWEVER,
MAY NEVER SIGN THE PLAN INTO LAW. THE UAE'S CONFEDERAL
STRUCTURE REQUIRES THAT THE RULERS OF ALL SEVEN EMIRATES
RATIFY LEGISLATION, THE PRESIDENT GIVES HIS FINAL
APPROVAL, AND THE LAW IS PUBLISHED AS OFFICIAL -- A
LENGTHY AND DIFFICULT PROCESS THAT HAS MIRED MANY GOOD
PROPOSITIONS IN THE BUREAUCRACY FOR YEARS. POLITICAL
SENSITIVITIES AND SECURITY CONCERNS ALSO HINDER THE
PROVISION OF CODIFIED RIGHTS AND PRIVILEGES FOR THE
UAE'S MASSIVE FOREIGN POPULATION.
-------------- --
PREVAILING PRACTICE: MANDATORY HEALTH INSURANCE
-------------- --
6. PROPOSITIONS, SUCH AS MANDATORY HEALTH INSURANCE,
OFTEN ARE THE PREVAILING PRACTICE WITHOUT EVER BECOMING
OFFICIAL LEGISLATION. AS PART AND PARCEL OF THEIR
EFFORTS TO PROVIDE A SAFE WORKING ENVIRONMENT AND
ACCEPTABLE LIVING STANDARDS FOR THEIR EMPLOYEES, OUR
COMPARATORS AND MANY OTHER LOCAL EMPLOYERS ARE PROVIDING
PRIVATE HEALTH INSURANCE TO STAFF. COUNTERPART
DIPLOMATIC MISSIONS (AUSTRALIA AND UNITED KINGDOM)
DETERMINED IN 2001 THAT IT WAS NECESSARY TO PROVIDE
HEALTH INSURANCE FOR THEIR STAFF. THE UAE'S MONOPOLY
TELECOM PROVIDER AND LARGEST EMPLOYER RECENTLY
CONTRACTED A NATIONAL INSURANCE COMPANY TO PROVIDE
PRIVATE HEALTH INSURANCE FOR ITS MORE THAN 20,000 STAFF
COUNTRYWIDE.
-------------- --------------
DELAY OF FSN HEALTH INSURANCE HAS TRAGIC CONSEQUENCES
-------------- --------------
7. ALTHOUGH NO ONE CAN PREDICT WHETHER A TRAGIC DEATH COULD
HAVE BEEN AVOIDED BY THE PROVISION OF BETTER HEALTH CARE, OUR
EMBASSY FAMILY HAS SUFFERED RECENT LOSSES THAT COULD HAVE BEEN
AVOIDED BY BETTER HEALTH CARE. FOR EXAMPLE, IN MAY 2003, AN
EMBASSY DRIVER WHO WAS ONLY ONE WEEK AWAY FROM RETIREMENT
SUDDENLY DIED FROM A PROBABLE HEART ATTACK. HE PREVIOUSLY HAD
SOUGHT TREATMENT FOR CHEST PAINS AT THE EMBASSY HEALTH UNIT, BU
TOLD HIS SUPERVISOR THAT HE WAS DELAYING THE RECOMMENDED FOLLOW
UP CARE UNTIL HE RETURNED TO INDIA -- WHERE HE COULD AFFORD
TREATMENT. ALTHOUGH POST'S HEALTH UNIT HAS IMPLEMENTED A PROGR
OF REGULAR MEDICAL REVIEWS OF DRIVERS AND OTHER FSN EMPLOYEES,
THE LACK OF HEALTH INSURANCE CONTINUES TO DISSUADE OUR EMPLOYEE
FROM SEEKING FOLLOW-UP CARE AT LOCAL HEALTH FACILITIES.
8. CONCLUSION/ACTION REQUEST: WHILE THE UAEG HAS YET TO PASS
LEGISLATION (AND MAY NEVER DO SO) FOR MANDATORY EMPLOYER-PROVID
HEALTH INSURANCE, THEY ARE RELYING ON THE FACTS ON THE GROUND T
SOLVE THE PROBLEM. AS MENTIONED IN PARA 6, MOST INSTITUTIONS A
NOW PROVIDING HEALTH INSURANCE AND WE STRONGLY BELIEVE THE U.S.
MISSION SHOULD AS WELL. POST REQUESTS BUDGET ALLOCATION TO FUN
FSN HEALTH INSURANCE AS OF SEPTEMBER 21, 2003.
WAHBA
SIPDIS
FOR NEA/SA/EX KATHLEEN AUSTIN-FERGUSON, STEVE HARTWELL,
MICHELLE ESPERDY
E.O. 12958: N/A
TAGS: ABUD AMGT APER
SUBJECT: ESCALATING HEALTH CARE COSTS IN THE UAE
DICTATE FUNDING FOR FSN HEALTH INSURANCE
REFS: A) BOOTH-BARKLEY E-MAIL DTD. 6/30/03
B) MARSHALL-BARKLEY MEMO DTD. 6/30/03
C) BARKLEY-KEITH E-MAIL DTD. 6/23/03
D) STATE 170942
E) ABU DHABI-FRANK MEMO DTD. 4/23/03
F) STATE 97917
G) ABU DHABI 1728
H) 02 ABU DHABI 2829
I) 02 ABU DHABI 1502
1. SUMMARY AND ACTION REQUEST: IN THE LAST TWO YEARS,
THERE HAS BEEN A DRAMATIC EROSION IN THE PREVIOUSLY
GENEROUS HEALTH BENEFITS PROVIDED BY THE UAEG TO NON-
CITIZEN RESIDENTS. THE HIGHEST HEALTHCARE COSTS IN THE
GULF REGION, COMBINED WITH DECREASING GOVERNMENT
SUBSIDIES IN RECENT YEARS, HAVE FORCED THE UAEG TO
CHARGE EXPATRIATES FOR NEARLY ALL HEALTH SERVICES.
SINCE 1996, THE UAEG HAS REQUIRED EXPATRIATES TO HOLD A
HEALTH CARD -- ISSUED BY THE MINISTRY OF HEALTH, A LOCAL
HOSPITAL, OR A PRIVATE HEALTH INSURANCE COMPANY -- AS A
PREREQUISITE FOR A RESIDENCY PERMIT. THE UAE MINISTER
OF HEALTH RECENTLY ADMITTED TO LOCAL REPORTERS, HOWEVER,
THAT THE HEALTH CARD SCHEME HAS NOT WORKED, AND
EXPATRIATES IN REALITY PAY FOR MOST OF THEIR MEDICAL
TREATMENT. MANY PEOPLE ARE UNABLE FINANCIALLY TO COVER
THEIR OWN HEALTH CARE COSTS, AND THEREFORE DELAY
TREATMENT AND ENDANGER THEIR HEALTH.
2. SUMMARY AND ACTION REQUEST CONTINUED: IN SPRING
2001, THE UAEG ANNOUNCED A PLAN TO MAKE IT COMPULSORY
FOR EMPLOYERS TO PROVIDE PRIVATE MEDICAL INSURANCE FOR
EXPATRIATE WORKERS. PROGRESS ON CODIFICATION OF THIS
LEGISLATION HAS BEEN SLOW, HOWEVER, DUE TO THE
COMPLICATED CONSENSUS-BASED DECISION-MAKING PROCESS OF
THE UAE BUREAUCRACY. COMPARATOR COMPANIES AND
COUNTERPART DIPLOMATIC MISSIONS DETERMINED IN 2001 THAT
INSURING THEIR EMPLOYEES WAS A DE FACTO REQUIREMENT,
DESPITE THE ABSENCE OF A LAW. POST REITERATES ITS
REQUEST TO WASHINGTON TO BUDGET FOR FSN HEALTH INSURANCE
IN FY04. END SUMMARY AND ACTION REQUEST.
--------------
HEALTH CARE SYSTEM IN THE UAE IS BROKEN
--------------
3. THE CURRENT HEALTH CARE SYSTEM IN THE UAE
DISCRIMINATES AGAINST EXPATRIATE WORKERS -- WHO COMPRISE
MORE THAN 85 PERCENT OF THE COUNTRY'S POPULATION AND 98
PERCENT OF PRIVATE SECTOR WORKERS. UAE NATIONALS PAY
BETWEEN 25 DIRHAMS (US $6.80) AND 100 DIRHAMS (US
$27.23) FOR A HEALTH CARD THAT ENTITLES THEM TO LARGELY
FREE HEALTH CARE FOR FOUR YEARS. EXPATRIATES, ON THE
OTHER HAND, ARE CHARGED BETWEEN 100 DIRHAMS (US $27.23)
AND 300 DIRHAMS (US $81.68) FOR A HEALTH CARD FOR ONE
YEAR, WITH ADDITIONAL FEES FOR ROUTINE HEALTHCARE
SERVICES -- 50 DIRHAMS (YS $13.61) FOR EACH X-RAY OR
ULTRASOUND, 75 DIRHAMS (US $20.45) FOR AN INTRAVENOUS
PYELOGRAM, OR 100 DIRHAMS (US $27.23) FOR A CT SCAN.
SINCE 2001, EXPATRIATES HAVE PAID FOR ALL MEDICATIONS.
SUCH CHARGES CAN BE A HUGE FINANCIAL BURDEN ON OUR FSNS.
4. PRICES FOR PHARMACEUTICALS AND SOME MEDICAL TESTS IN
THE UAE ARE NOW 20-30 PERCENT HIGHER THAN IN THE REST OF
THE GULF, AND MORE THAN 50 PERCENT HIGHER THAN PRICES OF
SIMILAR PRODUCTS IN THE INDIAN SUBCONTINENT. THIS IS AN
UNEXPECTED CONSEQUENCE OF POST'S EFFORTS TO ENSURE UAE
COMPLIANCE WITH ITS WTO PATENT PROTECTION OBLIGATIONS.
AS THE RESULT OF WASHINGTON'S AGGRESSIVE CAMPAIGN TO RID
THE UAE MARKET OF CHEAP ILLEGAL COPIES OF PATENT-
PROTECTED MEDICINES, THE UAE HEALTH SECTOR NOW IS
LARGELY DEPENDENT ON DRUGS FROM EUROPE AND THE UNITED
STATES -- IN TURN PUSHING UP PRICES OF BASIC MEDICINES.
-------------- --------------
COMPULSORY PRIVATE HEALTH INSURANCE IS THE SOLUTION
-------------- --------------
5. THE QUASI-PARLIAMENTARY FEDERAL NATIONAL COUNCIL
FIRST RAISED MANDATORY EMPLOYER-PROVIDED PRIVATE HEALTH
INSURANCE IN 1999. THE PROPOSITION WAS RECOGNITION BY
THE UAEG THAT ITS CURRENT HEALTH CARD SCHEME FALLS SHORT
OF PROVIDING BASIC HEALTH SERVICES TO THE UAE'S MORE
THAN 3 MILLION EXPATRIATE WORKERS. THE UAEG, HOWEVER,
MAY NEVER SIGN THE PLAN INTO LAW. THE UAE'S CONFEDERAL
STRUCTURE REQUIRES THAT THE RULERS OF ALL SEVEN EMIRATES
RATIFY LEGISLATION, THE PRESIDENT GIVES HIS FINAL
APPROVAL, AND THE LAW IS PUBLISHED AS OFFICIAL -- A
LENGTHY AND DIFFICULT PROCESS THAT HAS MIRED MANY GOOD
PROPOSITIONS IN THE BUREAUCRACY FOR YEARS. POLITICAL
SENSITIVITIES AND SECURITY CONCERNS ALSO HINDER THE
PROVISION OF CODIFIED RIGHTS AND PRIVILEGES FOR THE
UAE'S MASSIVE FOREIGN POPULATION.
-------------- --
PREVAILING PRACTICE: MANDATORY HEALTH INSURANCE
-------------- --
6. PROPOSITIONS, SUCH AS MANDATORY HEALTH INSURANCE,
OFTEN ARE THE PREVAILING PRACTICE WITHOUT EVER BECOMING
OFFICIAL LEGISLATION. AS PART AND PARCEL OF THEIR
EFFORTS TO PROVIDE A SAFE WORKING ENVIRONMENT AND
ACCEPTABLE LIVING STANDARDS FOR THEIR EMPLOYEES, OUR
COMPARATORS AND MANY OTHER LOCAL EMPLOYERS ARE PROVIDING
PRIVATE HEALTH INSURANCE TO STAFF. COUNTERPART
DIPLOMATIC MISSIONS (AUSTRALIA AND UNITED KINGDOM)
DETERMINED IN 2001 THAT IT WAS NECESSARY TO PROVIDE
HEALTH INSURANCE FOR THEIR STAFF. THE UAE'S MONOPOLY
TELECOM PROVIDER AND LARGEST EMPLOYER RECENTLY
CONTRACTED A NATIONAL INSURANCE COMPANY TO PROVIDE
PRIVATE HEALTH INSURANCE FOR ITS MORE THAN 20,000 STAFF
COUNTRYWIDE.
-------------- --------------
DELAY OF FSN HEALTH INSURANCE HAS TRAGIC CONSEQUENCES
-------------- --------------
7. ALTHOUGH NO ONE CAN PREDICT WHETHER A TRAGIC DEATH COULD
HAVE BEEN AVOIDED BY THE PROVISION OF BETTER HEALTH CARE, OUR
EMBASSY FAMILY HAS SUFFERED RECENT LOSSES THAT COULD HAVE BEEN
AVOIDED BY BETTER HEALTH CARE. FOR EXAMPLE, IN MAY 2003, AN
EMBASSY DRIVER WHO WAS ONLY ONE WEEK AWAY FROM RETIREMENT
SUDDENLY DIED FROM A PROBABLE HEART ATTACK. HE PREVIOUSLY HAD
SOUGHT TREATMENT FOR CHEST PAINS AT THE EMBASSY HEALTH UNIT, BU
TOLD HIS SUPERVISOR THAT HE WAS DELAYING THE RECOMMENDED FOLLOW
UP CARE UNTIL HE RETURNED TO INDIA -- WHERE HE COULD AFFORD
TREATMENT. ALTHOUGH POST'S HEALTH UNIT HAS IMPLEMENTED A PROGR
OF REGULAR MEDICAL REVIEWS OF DRIVERS AND OTHER FSN EMPLOYEES,
THE LACK OF HEALTH INSURANCE CONTINUES TO DISSUADE OUR EMPLOYEE
FROM SEEKING FOLLOW-UP CARE AT LOCAL HEALTH FACILITIES.
8. CONCLUSION/ACTION REQUEST: WHILE THE UAEG HAS YET TO PASS
LEGISLATION (AND MAY NEVER DO SO) FOR MANDATORY EMPLOYER-PROVID
HEALTH INSURANCE, THEY ARE RELYING ON THE FACTS ON THE GROUND T
SOLVE THE PROBLEM. AS MENTIONED IN PARA 6, MOST INSTITUTIONS A
NOW PROVIDING HEALTH INSURANCE AND WE STRONGLY BELIEVE THE U.S.
MISSION SHOULD AS WELL. POST REQUESTS BUDGET ALLOCATION TO FUN
FSN HEALTH INSURANCE AS OF SEPTEMBER 21, 2003.
WAHBA