Qatar rolls out universal healthcare plan

Jenifer Fenton, Financial Times, August 13, 2012

Doha - When Qatar opened its first hospital in 1957, few could have imagined the surging demand that would be placed on the country’s fledgling healthcare system in the coming decades.

More than half a century later, Qatar is now rolling out an even more ambitious first: a scheme to introduce a universal healthcare system, driven by private insurance providers, by 2014.

The new national strategy mandates insurance coverage as compulsory for all Qatari citizens, expatriates and even tourists visiting the country. Insurance plans will be valid at any service provider in Qatar, including the private facilities that represent more than 65 per cent of all the country’s healthcare providers.

“The government is trying to control the costs by having this insurance scheme,” says Khalid al-Mughesib, a Qatari national who helped establish and manage Al Koot, an insurance company owned by Qatar Petroleum. “It was an open cost before.”

Qatar’s health expenditure of just more than 12bn Qatari riyals ($3.3bn) last year was up by 27 per cent over 2010, according to figures released in June by the country’s Supreme Council of Health. Almost 85 per cent of that increase in spending was paid for by the government.

The burden of healthcare costs under the new system will shift from the government to mainly private hands. It is expected that the state will cover the cost of premiums for its citizens, with employers to be responsible for expatriate employees, who outnumber nationals by roughly six to one. Observers say the shift will be reflected in the cost of doing business for the expat-dependent private sector, particularly in companies employing large numbers of low-wage workers.

But the overall affect for such employers may be limited. “The construction business has an unimaginable profit margin in the [Gulf] region because of the cheap labour,” says Jad Bitar, a health principal at the consultancy Booz and Company. “Adding a couple of hundred dollars a year ... to give [labourers] basic rights, I don’t think it is a big cost or major impact.”

A big winner in the system is expected to be the country’s private health insurance market, which is relatively young but predicted to grow significantly as the planned reforms, which include mandatory insurance, are implemented.

The number of residents in Qatar who have medical insurance is very low, says Mr Mughesib, who launched the private insurance company. He estimates only 10-20 per cent of those in the country are insured, a figure Booz & Company’s Mr Bitar says is probably accurate. “Imagine if 100 per cent are insured,” Mr Mughesib says. “Even for Qatar, which is small country ... insurance companies will be making good money.”

According to Mr Bitar, “demand is going to spike up because you’ve introduced insurance and we know that the supply is not there.”

Al Khaleej Takaful Group Co, a private insurance company, has grown by some 30 to 40 per cent in the last year, according to Rolando Calixtro, the head of it’s medical department. The company is currently developing private group insurance plans primarily to cover blue-collar workers, with a focus on the construction industry. Per-person annual costs will run between 700-900 Qatari riyals, depending on the plan purchased.

But Qatar should be wary of the dangers of introducing mandatory private medical insurance plans with very limited capability for regulatory oversight, Mr Bitar says. The country runs the risk of introducing a “vicious cycle of interaction between the insurance and the provider, where providers try to scam the insurance and insurance [companies] are always trying to underpay the provider,” he says. “That is a dynamic that does not exist in a public system.”

The country’s 2011 healthcare expenditure breaks down to just more than 7,000 riyals per person, according to government numbers. If the numbers are adjusted to reflect Qatar’s unique demographics – a population that skews towards young, expatriate and male – that average exceeds many high-income western countries, the government figures claim.

Expatriate men tend to be healthy, due in part to mandatory health screenings required to gain residency. Low-paid labourers, excluding domestic workers, account for roughly half of the people living in Qatar, and they rarely use healthcare services, according to the Supreme Council for Health. Demand for old-age care is almost non-existent, as expatriates travel home when they reach retirement age and most Qatari families provide the care for their kin.

But before the government can fully implement its insurance scheme, it will need to unify its regulatory framework, create national standards for medical professionals, introduce patient billing systems, build a database of pricing plans and hire a workforce to handle the claims.

Mr Bitar does not think Qatar can pull off a compulsory health insurance plan in such a short time. “Introducing it gradually is a smart idea,” he says, “but 2014 is a couple of years, it is not going to happen.” Gulf neighbours, including Saudi Arabia and Dubai, have struggled for years with their respective insurance plans, he adds.

A more pressing need than insurance reform remains the staffing of qualified healthcare professionals. As much as 95 per cent of the healthcare workforce is made up of expatriates, who come from countries with differing regulatory and educational standards, resulting in an inconsistent quality of care. Turnover is high, with healthcare workers staying only a few years.

Rebecca Lee, a British citizen who was not provided with health insurance, knows this all too well. She visited a Qatari government health centre with a swollen abdomen, fairly severe pain and slight vaginal bleeding. The doctor there failed to spot an emergency situation and advised her to come back next week.

Mrs Lee went to a private hospital instead. “I was three months pregnant, the [fallopian] tube had ruptured and I had quite severe internal bleeding, I’d lost approximately a litre of blood,” she says.

The care at the private facility was excellent, but far too expensive for her budget. “I just didn’t have that sort of money, not even on our credit cards,” she says. Under the proposed insurance scheme, Mrs Lee should have been covered.

Copyright The Financial Times Limited 2012.