Health sector reforms remove capacity constrains

Robust population growth, lower child mortality, increased life expectancy and changing lifestyle risk factors such as chronic non-communicable diseases (NCDs) have in recent years led to increased pressure on Kuwait’s healthcare system. To their credit, the government and the ministry of health have responded by introducing several measures and reforms aimed at addressing many of the capacity constraints in the sector and improving quality of health services.

Despite relatively low oil revenues, healthcare spending has continued to be a priority for the government, with reforms to the health sector forming a key component of the state's ‘New Kuwait 2035’ development plan. The plan, which outlines the country’s long-term development priorities aimed at transforming Kuwait into a financial, cultural, and institutional leader in the region, is organized around five themes, or desired outcomes, and seven pillars, or areas of focus for investment and development.

Healthcare is one of the seven pillars that support the New Kuwait vision and is centered on several strategic programs and projects designed to have the most impact on achieving the vision. The strategic programs envision improving Kuwait’s relative ranking on the global quality of health care index from 51 percent in 2014 to 54 percent by the end of development plan in 2035.  

The projects planned or being implemented as part of the reforms are expected to improve the quality of medical services and, increase the number of healthcare facilities and hospital beds in the country. The plan also aims to develop a national cadre with the requisite capabilities to offer efficient and effective health services to the public.

Other development goals under the New Kuwait healthcare initiative are in line with the changing demographics and disease patterns in the country. These include augmenting preventive health services to reduce the rate of chronic non-communicable diseases (NCD); developing occupational health services to treat the labor force; enhancing health services aimed at students; increasing the level of exercise and sports among citizens and residents; and creating awareness of the importance of healthy lifestyle choices among all sectors of society.

Projects being implemented as part of health sector reforms are expected to bring about a sharp increase in the number of available hospital beds and provide health facilities with cutting-edge capabilities. Some of the new hospitals that form part of the reform initiative include a 780-bed Maternity Hospital, a 792-bed Children’s Hospital, a new Police Hospital with 500 beds and a Physical Medicine Hospital with over 700 beds.

Ongoing expansions to existing hospitals will also see a significant increase to their existing bed-capacities and health service capabilities. In addition, construction of the new 1,166-bed Jaber Al-Ahmad Hospital, one of the largest health facilities in the Middle-East, has been completed and is awaiting handover to the Ministry of Health. There are also three new hospitals, under the expatriate insurance program, with a total of 750 beds slated to open in the near future.

The plan to build more hospitals and expand existing ones in a bid increase the number of available hospital beds and health facilities in the country is a welcome move. But new hospitals and beds are only one part of the healthcare equation; equally important is improving the quality of medical services provided to residents.

Apparently, it is a lack of this quality quotient, or at least confidence in the available quality, which has prompted many Kuwaitis to seek specialized medical services abroad at government expense. Until recently, the government had a policy of liberally funding specialized treatment abroad for Kuwaitis requiring complex medical procedures. The funding covered all medical costs for the patient’s treatment, as well as the expenses of spouses and other family members accompanying them abroad.

But by signing on to this 'medical tourism' policy, the government had inadvertently been questioning the competency of local doctors and medical facilities to handle complicated medical procedures. Besides encouraging a rush of outbound 'medical tourists' this policy led to the government incurring huge overseas health bills that could have been better utilized to improve the quality of local healthcare. In a damning report, the State Audit Bureau pointed out that the government spent in excess of KD440 million in 2014 to fund 11,000 medical trips abroad for citizens.

Repeated annual expenditure overruns and an avalanche of citizens seeking medical treatment abroad led the government to begin reining-in this unsustainable practice. In 2015, the authorities slashed the daily allowance granted to patients and their spouses during their stay abroad. Simultaneously, the authorities made the approval process for treatment overseas more arduous, so that politicians could no longer easily peddle medical tourism jaunts abroad in exchange for votes from their electorates.

The government also initiated the opening of several specialized medical treatment facilities at local hospitals and enhanced the quality of services provided. To maintain the quality of medical services, the Ministry of Health also signed a number of agreements with prestigious global institutions to regularly train medical staff and periodically evaluate the quality of healthcare being delivered. By the end of 2016, these actions on their own had resulted in a drop by half the number of people seeking treatment abroad at government expense.

Initiatives aimed at improving quality of medical services and facilities, and policies designed to enhance the healthcare system in the country are undoubtedly necessary and welcome moves, but these policies should not come at the expense of one section of society. Segregating people on the basis of citizens and non-citizens, and apportioning the morning hours of the day for Kuwaitis and evening hours for expatriates at hospitals and clinics, is clearly a policy that the authorities have not thought through.

While this strategy might help alleviate rush during morning hours and relieve Kuwaitis from having to wait for services at public healthcare facilities, it will definitely increase the rush of expatriate patients in the evenings. The huge influx of patients and the limited work hours will in turn increase workload on doctors, nurses and other medical staff in the evening shift. The pressure is bound to add up and eventually impact negatively on the quality of services provided, besides further straining the country's healthcare system.

Similarly, the recent move to increase fees for healthcare services provided to foreigners will certainly help increase health ministry revenues, but it will also prevent many non-citizens from availing of needed health services. Most Western expatriates and others having health coverage as part of their work contract generally do not seek medical attention at government-run facilities, but there are those in the weakest sections of society who rely entirely on public healthcare to meet their health needs. The high fees now being imposed by the government will deter this group of people from seeking the medical services that they might urgently need, but can no longer afford.

The authorities may feel that segregation of patients and selective fee hike for healthcare services are necessary steps, but for a country that takes pride in its generosity and humanitarian credentials these are definitely steps in the wrong direction.