Right prescription for health care

Decades of medical advances have extended and improved lives around the world. Preventive medicine, diagnostic tools, medications, surgical techniques, medical devices - all have progressed, so that people in almost every country expect to live longer, fuller lives than their ancestors.

But paying for all that health care is a growing concern; the public in every country seems to have an insatiable appetite for medical attention. The details of the debate vary from country to country, but the clamour for more health care money knows no boundaries.

In the UAE, the issue has flared again this month. The medical insurance industry has grown rapidly in the last decade, especially since medical cover was made mandatory in Abu Dhabi in 2008 (Dubai is preparing for a similar requirement).

Intense competition among insurance providers took the form of reductions in premiums paid by employers and individuals. When low premiums meet rising costs, the prognosis is bad: last week, Mediclinic Middle East notified insurance firms that it must raise charges at its 10 clinics and hospitals in Dubai by 6 per cent, to meet higher costs. Some insurers agreed, others baulked; people covered by those firms will, from February 1, have to pay for care directly, and then seek reimbursement - possibly less than 100 per cent - from their insurers.

The Mediclinic case is just one symptom of a malady afflicting the whole medical-insurance economy. For companies and employers, the easy solution would be to pass costs to employee/clients, by trimming the list of services provided or by imposing (or raising) per-visit fees.

But this should be the last resort, not the first. There are efficiency savings to be made throughout the system: problems such as over-prescribing, too-easy access to specialists, physicians' disdain for generic medications, the prevalence of preventable "lifestyle" ailments and outright fraud should all be tackled before premiums go up.

Insurers understand this: for example, a key purpose of Abu Dhabi's new Pharmacy Benefits Management service is to control claim costs.

Competition brings any industry healthy growing pains. The challenge here - for medical professionals, accountants and policymakers - is to make the process more efficient while minimising cost and complexity for patients.