In April 2016, the Dubai Health Authority launched the world’s first medical tourism website, establishing a goal to attract 1.3 million medical tourists to the city by 2021. Since the boom of oil wealth in the 1980’s, The United Arab Emirates, and other member states of the Gulf Cooperation Council (GCC) has observed great change and investment into human resources including regional universal free healthcare for their citizens, a paradigm shift when considering the state of healthcare in Gulf countries just a few decades ago. White the Emirate of Dubai’s ambitions to transform the city into a hub for both leisure and medical tourism appears symbolic to the quality of care and human infrastructure in the region, the actuality of both state and private healthcare in the Gulf is rife with inequality, fundamental inaccessibility, and a lack of public funding.
Despite the commitment of free healthcare to their people, GCC governments and healthcare sectors have noticed a spark in the local reliance of medical tourism. Wealthier Arab patients frequently seek medical treatment in cities like Boston, Munich, and London, while less affluent patients flock to Chennai, Bangkok, and Bangalore. While medical tourism is a path typically taken for more severe illness, such as cancer or diabetes, it hints at a more systemic problem with regional healthcare systems, despite being free. Firstly, the reliance on medical tourism is an indication of the illusion of universal free healthcare – a term that usually denotes a reality of collective healthcare accessibility of a basic standard – nevertheless, a reality that Gulf healthcare fails to meet. Secondly, medical tourism acts as a medium to perpetuate elitism and disparity within basic human rights, widening existing gaps in wealth that plague the GCC region. Finally, the lack of regulation of medical centers in countries like India and Thailand often mean that less affluent medical tourists are provided questionable treatment plans and are often left with little health agency as a result of their failing national healthcare sectors. These three issues in the flows and relationships of medical tourism manifest into a long term obstacle for the Gulf’s sustainable development within human infrastructure.
Universal healthcare is a concept often deemed an obligation of a government to its people; however, it exists intentionally independent of the broader systemic public health issues that create morbidity and mortality in peninsular states. In this, Gulf universal healthcare is relegated to a symbol. Universal free healthcare in the Gulf may be considered illusionary, as despite its presence, systems are unable to cater towards growing numbers of patients with longer life expectancies, the proliferation in occurrence of non-communicable diseases, and the lack of public funding for new centers and treatment methods. Increased rural-urban migration, steady population increases, and generally increasing usage of public hospitals by locals are being blamed for overcrowding in state hospitals, with doctor to patient ratios significantly unbalanced. State hospitals have now shifted from a resource for public good to public nuisance, becoming a driving force to seek medical care in expensive local private hospitals or in clinics and sanatoriums in South Asia and Europe. This is especially the case when it comes to the growing issue of non-communicable ‘first world’ diseases, like diabetes and specific cancers. Factors like westernization of diet and high tobacco usage have been attributed to a spike in diabetes cases in the Gulf.
According to the International Diabetes Federation, the GCC region contains six of the ten most diabetes prevalent countries in the world, with Saudi Arabia struggling to deal with a prevalence of 20.5%. Non-communicable diseases like diabetes require intensive treatment that is often expensive and temporally difficult to deal with for state healthcare sectors that are built on the basis of ‘third world’ endemic short term treatment communicable diseases, forcing patients to turn to alternative sources of healthcare. In short, universal healthcare is illusionary simply because it is a status – inconsequential to the growing and ever-mutating public health crises that face the Gulf. The illusionary of universal healthcare holds great implications in the long term for the Gulf. When looking at historical models of countries like South Korea and Singapore, investment into both healthcare and education are essential for long term development in almost any context, nevertheless, Gulf healthcare (and education) is increasingly lacking, pushing emphasis on unsustainable medical tourism.
Without long term development planning, universal healthcare is hence rendered short term. The future of healthcare in the Gulf is not only unsustainable but also unpredictable. These traits manifest in characteristics such as health sector reliance on expatriate workers. The Gulf significantly lacks local doctors, and instead relies on doctors from countries like Egypt, India, and Iraq. Expatriates skilled workers are both expensive and short term, expatriate doctors tend to live in GCC countries for a few years before moving on to other countries or returning to their home country with wages and remittances collected in the Gulf. This flow of expatriate workers is not continuous, however, the Gulf has failed to divert appropriate resources into training local doctors. While most GCC countries have programs and scholarships to train locals abroad in the UK and USA, this in itself is unsustainable to support entire healthcare sectors. In addition, the disparity between locals and expatriates becomes problematic in regards to healthcare delivery, as different standards of medical education, clinical competence, and ethnic variances interface in doctor-patient relationships. In the UAE, only 3% of nurses are Emirati, yet public healthcare mostly provides for Emiratis themselves. The Gulf must look to develop their higher education systems to be more inclusive of medical training of locals to standards that universal health care demand, as well as making longer termed contracts with expatriate health workers that are filtered through a standard expectation of clinical competence.
Continuously, the modes of treatment for illnesses like cancer differ immensely depending on the background of the status of a Gulf local. Inequality of Gulf state run hospitals systems originates in local ideologies of class, ethnicity, and homeland. Regionally, domestic socioeconomic disparities have been demonstrated to affect childhood development and long-term health. These inequalities constitute factors such as maternal and child’s level of education, per capita income, and area of residence, which in the Gulf, renowned for extreme wealth, are factors that meet disparate extremes. These disparities compound to create forces that transform healthcare from universal to inaccessible. One of the primary issues regarding accessibility is the allocation of human resources by GCC governments. Gulf development is primarily focused on urban development, with most human resources in small GCC countries invested into cities like Dubai, Doha, and Abu Dhabi. While these centers have a diverse array of different standards within city hospitals, the focus on urban development creates a development vacuum for rural populations. Rural populations hence become disenfranchised through their accessibility to urban healthcare, as they face poor rural infrastructure and small scale clinics for treatment of serious illnesses. In Oman, the two largest public hospitals are both located in Muscat, the capital, which at its furthest can be a multiple days travel for isolated rural communities. Considering the expense of accommodation and travel as well as the quality of care once arrived – universal healthcare effectively isolates the citizens it supposedly cares for.
To summarize, the rise of medical tourism in the Gulf is indicative of a broader failing of regional healthcare systems. To secure sustainable development, the Gulf must look to invest in rural healthcare infrastructure, encourage local medical higher education, and restructure universal healthcare to be flexible in changing nature of ailments and healthcare demands.
Photo: Image via Nelson Ebelt (Flickr)