x Abu Dhabi, UAETuesday 23 January 2018

Honest diagnosis first step to UAE health care reform

As Abu Dhabi sets out to become the world leader in many fields, compromise will be critical. Nowhere is this more important than when it comes to health care.

A city and country of world class medicine, including vast research facilities with skilled scientists leading the world in discovery. A centre for training the young doctors who will heal the region's sickest people. New and modern hospitals to attract patients from all over the world for the latest treatments of complex health conditions.

This may sound like a health care utopia in the United States or Britain. But in fact, it is what political and business leaders are growing in Abu Dhabi, a topic I'll discuss tonight as part of NYUAbu Dhabi's lecture series on public health at the Al Mamoura Auditorium.

As the United Arab Emirates modernises, an exploding population will push the demand for health care services - in the capital and beyond - to new heights. Over the next decade, Abu Dhabi alone is projected to need an additional 25,000 doctors and nurses to treat an increasingly ageing population. Tough decisions lie ahead, for the public and their leaders.

While offering health care options that rival those in the West is laudable, filling medical facilities with highly trained doctors offering the latest treatments using the newest and best technologies is going to place an increasing burden on all government resources.

This leads to the fundamental questions at the basis of developing a modern health care infrastructure: where does a government balance the burden between the public and private sector? How much money should be allocated? And how good is good enough?

Abu Dhabi has grand plans for its health care sector, and the government should be applauded for making the necessary investments for the future of the Emirates.

But like the United States, there are limits to what can be provided. As health care is heavily subsidised in both countries, there remains a big disconnect between what health care costs to provide, and what we pay for the service. That missing link creates an artificial market with unlimited demand. New treatments and technologies do not come cheap. In fact, they become more expensive every day with each new discovery.

There is no limit to what will be needed in the future to meet this insatiable demand.

In this regard, the experience of the US has lessons for the UAE.

What is missing in the United States is an honest dialogue about what the issues are and how the system works. We spend huge sums of money on drugs and treatments with marginal benefits, yet we are unwilling to ask ourselves whether spending $100,000 (Dh367,000) per year on a treatment for one person that extends a life for four months is even worth the effort. The US health care programme for the elderly, Medicare, allots 30 per cent of its entire annual budget on end of life care, yet the life expectancy in the US is lower than many countries where far less is spent.

The UAE faces a different set of challenges. As in most countries, there is disparity in the level of health care provided in the country. While world class institutions such as the Cleveland Clinic are expanding into the UAE, there remains a great divide on how health care can be provided to everyone. There are stories of health care being denied and surgical operations gone wrong. While this happens in the United States, developing nations confront these issues on a much larger scale.

As Abu Dhabi sets out to build the best health care system in the region, there are immediate challenges that need to be addressed, all while the constant pressure of adequate funding remains front and centre.

How much money should be spent, and what are the limits, needs to be understood before it is too late. Equally important are issues over how to provide access to adequate levels of care for a population that includes all classes of residents, from wealthy citizens to labourers struggling to make ends meet.

While there are no right answers to many of these questions, American health care reform suggests that an important first step is establishing a viable dialogue between providers, patients and government regulators. The recent release of the US budget plan, which radically restructures Medicare, illustrates the difficulty in educating the public on the challenges facing the delivery system.

As Abu Dhabi sets out to become the world leader in many fields, compromise will be critical. Nowhere is this more important than when it comes to health care. The foundation of success will lie in the willingness to address these difficult questions early on. The more people who understand the difficult choices and challenges, the more willing they will be to embrace a system that requires sacrifice and compromise.

No matter how well run and modern, health care delivery is, by its very nature, flawed. So many of us want to live as long as we can and we want the best resources available to us to keep us healthy and enjoying our time on this planet. But there are limits, no matter how wealthy a country, and Abu Dhabi has the chance to lead the way. Ultimately, the government and the people will have to make the hard decisions on how much to invest and how much is enough.

The more spent, the better the health care system will become for everyone. Yet the trade-offs are clear. Just like the United States, the more spent on health care, the less will be spent on everything else like schools, infrastructure, housing and whatever else is needed to build a modern country.


Andrew Rubin is the vice president for medical centre clinical affairs and affiliates at the NYU Langone Medical Center.