First published in ITIJ 106, November 2009
As one of the world’s most up and coming tourist destinations, the UAE boasts major progress in its healthcare facilities. Peter Hogg takes a closer look at the provisions provided for tourists
The United Arab Emirates (UAE) is a federation of seven emirates, each of which has its own government and a fair degree of independence from the federal government based in its capital, Abu Dhabi. In recent years there have been some signs of the federal government becoming more powerful but in many areas, including healthcare, this is yet to happen and recent trends have produced totally separate healthcare reforms in Abu Dhabi, Dubai and the rest of the emirates – often labelled the Northern Emirates. The UAE is made up of Abu Dhabi (including the City of Al Ain); Dubai; Sharjah; Ajman; Umm Al Quwain; Ras Al Khaimah; and Fujeirah.
In recent years the government of Dubai has had considerable success in boosting the UAE’s image as a tourist destination and, as a result, a number of luxury resort hotels have been developed. In 2008, there were around seven million foreign tourists to the UAE, including business visitors, those visiting family and expatriate residents and those living in the UAE on a tourist visa. Currently, around 3.5 million of the UAE’s population of five million are expatriates of different nationalities. However, the number of medical tourists visiting the UAE is not great and most of these arrive from neighbouring countries such as Qatar, Kuwait and Yemen.
Tourist activity continues to grow, with more resorts planned and further expansion of the infrastructure that will support tourism, especially golf courses and Dubai Land, a massive development with several theme parks and other tourist facilities due to open in the next few years. A large airport is also being built at Jebel Ali, around 35 kilometres from the centre of Dubai, and work continues with developing and upgrading Dubai’s existing airport. The recent economic downturn, although exaggerated in the British and American press, is generally viewed as being good for Dubai in the long-term, as it has brought an element of sanity back to the market. There is no doubt, though, that Dubai is already recovering its poise and will get back on course in the near future.
Most of the current hotels in Dubai are situated on the coast in an area generally called Jumeirah Beach – this is also the name of one of the emirate’s leading hotels. There are also developments taking place on the Palm Jumeirah, including the Atlantis Hotel and future developments are planned for the Palm Jebel Ali. One can expect more tourism developments to happen around Dubai Land, as well as the hotels located outside of the city in the desert or mountains. Business hotels tend to be situated in the centre of Dubai, although many business visitors stay in the beach hotels, especially if they are doing business in what is generally called ‘New Dubai’.
"government hospitals are, therefore, best avoided in favour of the better private hospitals, other than in emergency situations"
Following the success of Dubai’s development, the other emirates are, to a greater or lesser extent, trying to move in a similar direction. Abu Dhabi has recently embarked on some spectacular new projects that will complete over the next two or three years, including some located deep in the Empty Quarter towards the Saudi Arabian border. Currently, there are few tourist hotels in Abu Dhabi. All its main hotels are located near to the city centre with only one or two smaller ones outside this area although, as mentioned above, there are increasing developments around the Liwa area in the Empty Quarter. Al Ain, in the emirate of Abu Dhabi also boasts several five-star hotels, all of which are located around the city.
Ajman and Umm Al Quwain have not developed much at present, although there is a Kempinski Hotel in Ajman. Sharjah is, in fact, the second largest emirate, but it lacks the tourism and business infrastructure of the other emirates partly due to its stricter laws, which include the banning of alcohol. Sharjah is geographically very spread out and parts of the east coast are in Sharjah; this can cause problems as it surrounds and splits the more liberal emirate of Fujeirah in two. Ras Al Khaimah and Fujeirah have also recently begun to develop a reasonable tourist infrastructure. Fujeirah currently has more facilities and the main hotels there are on their own, located away from any major city. The developments in Ras Al Khaimah are much nearer to the city and are mostly under development.
Throughout the UAE there are both government and private hospitals and clinics. There are currently no university hospitals of any note in the UAE, although there is one being built in Healthcare City. In many cases, private clinics are run as fairly aggressive businesses and are not prone to giving charity to visitors, so travellers should be prepared for expensive treatment costs throughout the UAE, except in real emergencies. People will often visit clinics for primary treatment and then transfer to the hospital for any necessary surgical procedures as clinics are outpatient only. Hospitals, however, do have their own outpatient facilities.
In emergency cases, government hospitals tend to treat patients until such time as they are considered stable and out of danger, at which point they will bill the patient – again, these charges are in line with the private hospitals. Standards in the government hospitals vary and tend to be more basic, particularly with regard to ‘luxuries’ and are often crowded and busy. Some of the government hospitals in Abu Dhabi, though, such as the Khalifa Hospital, are well regarded but in general, other than in trauma cases, most foreign visitors will end up in the private sector. Government hospitals are, therefore, best avoided in favour of the better private hospitals, other than in emergency situations. Having said that, the authorities are working hard to improve overall standards and government hospitals located in Abu Dhabi generally hold a better reputation than those in the other emirates. The trauma unit at the Rashid Hospital in Dubai, for example, has been upgraded and is now well equipped to handle accident and emergencies.
Again, one needs to examine the different emirates to get an idea of what medical treatment is available starting, as before, with Dubai, where there is a wide range of private and government facilities which provide reasonably good healthcare. Dubai has also been developing Healthcare City, a government initiative that will eventually be run as a private facility designed to provide a much higher standard of healthcare and, hopefully, attract health tourism to Dubai. The plans for Healthcare City are expansive although there has been ta slow down in activity due to current economic conditions. A second, bigger site near to the first will concentrate more on rehabilitation and similar types of facility. To date, the main facility to be opened in Healthcare City is the city hospital as well as some clinics. The new city hospital, in fact, has begun to challenge the American hospitals at the top end of the market and future plans include significant new facilities such as a large university training hospital. There are also branches of some well known international hospitals operating in Healthcare City, such as Moorfields Eye Hospital and Mayo Clinic.
Outside of Healthcare City, the Dubai Health Authority is in the process of bringing in new regulations that will generally apply across all types of hospital. Proposals include tightening up on the qualifications of medical practitioners practicing in the UAE, as well as emphasis on the whole financing of the system and through this, additional reporting requirements are being created. The process is not moving as quickly as expected and some changes to the plans are likely. The new regulations will begin to match the standards imposed by Healthcare City. There are several good quality private hospitals in Dubai that offer a range of services and facilities – most of these are around the centre of town near to Healthcare City, although there are now a couple in the suburb of Qusais and one in Jebel Ali. There are also two more under construction near to the beach hotels in a suburb called Al Barsha.
In general, government hospitals in Abu Dhabi have been a more established part of the healthcare provision than in Dubai, with the Khalifa Hospital, in particular, having a very good reputation. As a result, the private hospitals have been slower to develop, but there are, however, several good quality private and government hospitals and clinics in Abu Dhabi. In Al Ain there is also a well respected missionary hospital – The Oasis Hospital. In the northern emirates there are private hospitals in Sharjah, Ajman, and Fujeirah and a new hospital, which is gaining a good reputation in Ras Al Khaimah.
Throughout the UAE, there is now a fairly efficient ambulance service; this has improved in Dubai, in particular, over recent years. In the past, ambulances were ill equipped and seemed unable to get through traffic but nowadays they are much better equipped and are frequently seen passing heavy traffic with sirens blaring. In addition to this, it is not uncommon for helicopters to be sent to particularly serious accidents especially if they are away from the city centres. These helicopters are either run by the police or by the ruler’s private air fleet, but in each case are effectively government controlled. These services, together with the initial emergency treatment, will be provided free of charge – the charges will only start once the patient is stabilised and considered to be out of danger. Additionally, for less serious incidents, the major private hospitals have their own emergency rooms and some run their own ambulances. Here patients will be treated a lot more personally and be placed in a private room should they need inpatient treatment, as well as access the better medical facilities provided by these hospitals. They will, however, charge patients at their standard rates and the bill could be considerable. To date, the only assistance company based in the UAE is ISOS, which has an office in Dubai; other companies are due to open offices at some point in the future. There are four third party administrators that currently provide services to international insurers and assistance companies – Neuron, for example, works with around three or four assistance companies, allowing them to have access to their providers and discounts.
Regulations concerning short-term visitors.
If you are visit the UAE from a country that doesn’t require you to obtain a visa prior to departure then there is no compulsory requirement for medical expenses cover, although travellers are taking a major risk to visit the UAE without it. If a traveller is involved in any major incident or illness the medical costs could be considerable and there is a requirement to pay up before being allowed to leave the country. If, however, you are coming from a country where a visa is required in advance then you will have to purchase basic inpatient-only coverage from the appointed insurer in the UAE you are obtaining the visa from. Any other insurance you purchase will not be admissibly for the purpose of entering the country, but it is still advisable to purchase travel insurance from your own country before departing.
It is also essential to check whether you are bringing any medicine with that is banned in the UAE; if this is the case, it is essential to make sure that the paperwork from your doctor is in order and conforms to the relevant regulations. Advice on this is obtainable from the UAE Embassy in your home country and there is also advice on the British Embassy’s website for the UAE.
Regulations concerning residents and anyone obtaining a work permit
Yet again, regulations vary from emirate to emirate and are in a state of some flux. There are new regulations being considered in Dubai at the moment and there are various rumours as to whether these are likely to be implemented or not; the latest appears to confirm that they will be starting some time in 2010. Healthcare for the local and indigenous population is currently free of charge but this is beginning to change. In the meantime, anybody coming to work and live in Dubai will need to have either a medical card issued by the government or certain private hospitals, or have evidence of having purchased an admitted insurance policy in order to obtain their residence visa. This is asked for at the time of the compulsory medical test for all expatriates on entering the country and on each visa renewal – which occurs every three years. This test is not a pleasant experience with long queues at state-run hospitals with, at times, rather basic hygiene standards but equally, for most Western expats, there are priority queues and minimal testing – mostly for AIDs.
"in emergency cases, government hospitals tend to treat patients until such time as they are considered stable and out of danger, at which point they will bill the patient"
Most employers nowadays offer reasonable levels of medical insurance to those at manager level and above, but it should be something that anyone accepting a job in the UAE takes advice on. There is a wide range of insurers and products in the market – everything from very broad international products with high limits and global scope, to very restricted local policies with inadequate limits and tight networks. Some large companies, particularly in the government sector operate ‘self-insured schemes’. In general, these can be very generous to senior employees although it is worth seeking advice on the table of benefits being offered.
In the construction sector, there is a tendency to provide either onsite healthcare or to utilise the services of clinics. However, this tends only to be for outpatient services and government services will be utilised on an emergency basis, with the probability of anyone needing non-emergency inpatient treatment sent back to their home country. It is compulsory for the indigenous population, outside the labouring community, to have private health insurance.
The new plans being put forward by the Dubai Health Authority are designed to ensure better healthcare for the labouring population in particular (all of which are foreign) but will apply to all residents, expatriate and indigenous, with a contribution made by a sponsor – either an employer if you are in work, or your spouse or parent if you are not. For several years, at least, this will not really provide much cover and so the need for health insurance will still be there and, to some extent, always will be.
Abu Dhabi has already introduced a very strictly interpreted health insurance scheme, which all expatriates have to have before living or working in the emirate. This is administered by the health authority of Abu Dhabi, which insists on the policy being issued by an insurer who is licensed with them, with the insurance broker and any administration company also needing to be registered. This defines minimum levels of coverage that are, in fact, quite generous, but only apply to facilities within Abu Dhabi. Policies offering better terms than this are allowed, so long as they have been registered with the authority. It is unlikely anyone operating in Abu Dhabi will be looking to circumvent these rules but it is, as in the case of Dubai, still sensible to ensure that the policy is registered and legal.
"around 3.5 million of the UAE’s population of five million are expatriates of different nationalities"
The Northern Emirates have not announced any plans for change so the comments on the current situation in Dubai still apply. It is likely, though, that anyone accepting a position in the Northern Emirates will find that the coverage offered is more regional and at a lower level than many are now offering in Dubai.
In common with other areas of government in the UAE, healthcare is a priority issue and it is clear that officials want to raise standards to position themselves amongst the best countries in the world in the provision of healthcare. Currently, overall spending on healthcare is comparatively low in relation to the West, but this needs to be viewed in context due to the comparatively young age of most residents and the lack of older people from the majority expatriate community, many of whom will return to their home country for medical treatment. Considerable effort by both the federal as well as the governments of Abu Dhabi and Dubai has been made in this regard. This is partly to address criticism of the plight of certain segments of the labouring population but also fits in with their plans to build their cities into world-class places where people want to live, work, and play.