A lack of confidence in the UAE's healthcare system, exposed by a survey on behalf of The National, is rooted in a variety of factors, according to experts. They include out-of-date perceptions, the relative immaturity of the medical regulatory system and the absence of a widespread "gatekeeper" system for general practitioners, which prevents patients and doctors developing trusting relationships.
"The gatekeeper system plays a huge role," said David Hadley, director of The City Hospital in Dubai Healthcare City. The hospital is partnered with Medi-Clinic, a private group that operates about 70 hospitals around the world. "Because a GP is seen as a low-level doctor in Dubai, which they are not, patients would rather see a specialist," said Mr Hadley. "They may go to see an orthopaedic surgeon because their stomach is sore, when in fact they may need to see a gastroenterologist - here a GP would have prevented an unnecessary confusion.
"What happens elsewhere is you go to see your GP who knows your medical and family history. They are able to direct you. They know you and you trust them to give you the best advice and care." Lack of trust was also a "historical thing", Mr Hadley said. "In many other places in the world doctors must accumulate continuing education points to keep their skills. This has only come into play here relatively recently."
There had, he said, been a number of recent developments in the UAE to build trust in the healthcare system. Dubai Healthcare City, for example, had been created to encourage high-profile international groups to set up in the country. "The idea started by looking at certain countries that have proper registry bodies for doctors and only allowing these to come here," he said. "This boosted the qualifications of practising professionals here. The problem is that trust in healthcare is going to take a few years to develop. People still have reference to what it was all like before."
Dr Fatma Abdulla, a fellow at the Dubai School of Government, put the absence of trust down to the quality of healthcare workers rather than the standard of facilities. She said expatriate healthcare professionals were frequently no different to the other expatriates attracted to the UAE by the lifestyle and the chance to earn good money. Good healthcare, however, demanded more than this, she said. "It is more of a calling. You really have to want to do it. It's about more than economic reward."
The UAE had invested in some of the most advanced medical technology in the world, Dr Abdulla said, so there should be no reason for anyone to travel abroad for treatment. "It is not about the facilities or technologies," said Dr Abdulla. "We surpass the developed countries, let alone the developing ones, on this. "The major problem is the issue of confidence in relation to healthcare workers. They are the people that provide care and it doesn't matter how good your facility and your equipment is."
YouGov's survey of 876 UAE residents found a disturbingly high rate of dissatisfaction with both private and public arms of the nation's healthcare system. Lumulal Mullassery, 34, an Indian civil engineer who lives in Abu Dhabi, said: "In India, we normally go to a general practitioner who refers us to a specialist. Here, when I ask to see a GP, the receptionist asks me why I'm sick and refers me directly to a specialist."
Mr Mullassery said patients were not referred to the same doctor who had previously seen them. Both Mr Hadley and Dr Abdulla pointed to the healthcare insurance system in the UAE, which effectively allowed patients to self-diagnose and make an appointment with any specialist they chose, whether appropriate or not. This, taken with the absence of GP gatekeepers to guide people to the right treatment, contributed to the lack of confidence, said Dr Abdulla, who is also managing director of Global Consulting Associates, a healthcare consultancy.
"Because of the lack of personal care, people base big decisions about their treatment, such as where to go to treat a serious condition, on little bits of experiences. They are unlikely to have built up a relationship with someone in healthcare and therefore do not have confidence," she said. firstname.lastname@example.org