US embassy cable - 03ABUDHABI3553

UNCLAS SECTION 01 OF 02 ABU DHABI 003553 
 
SIPDIS 
 
FOR NEA/SA/EX KATHLEEN AUSTIN-FERGUSON, STEVE HARTWELL, 
MICHELLE ESPERDY 
 
E.O. 12958: N/A 
TAGS:  ABUD, AMGT, APER 
SUBJECT:  ESCALATING HEALTH CARE COSTS IN THE UAE 
DICTATE FUNDING FOR FSN HEALTH INSURANCE 
 
REFS: A) BOOTH-BARKLEY E-MAIL DTD. 6/30/03 
      B) MARSHALL-BARKLEY MEMO DTD. 6/30/03 
      C) BARKLEY-KEITH E-MAIL DTD. 6/23/03 
      D) STATE 170942 
      E) ABU DHABI-FRANK MEMO DTD. 4/23/03 
      F) STATE 97917 
      G) ABU DHABI 1728 
      H) 02 ABU DHABI 2829 
      I) 02 ABU DHABI 1502 
 
1.  SUMMARY AND ACTION REQUEST: IN THE LAST TWO YEARS, 
THERE HAS BEEN A DRAMATIC EROSION IN THE PREVIOUSLY 
GENEROUS HEALTH BENEFITS PROVIDED BY THE UAEG TO NON- 
CITIZEN RESIDENTS.  THE HIGHEST HEALTHCARE COSTS IN THE 
GULF REGION, COMBINED WITH DECREASING GOVERNMENT 
SUBSIDIES IN RECENT YEARS, HAVE FORCED THE UAEG TO 
CHARGE EXPATRIATES FOR NEARLY ALL HEALTH SERVICES. 
SINCE 1996, THE UAEG HAS REQUIRED EXPATRIATES TO HOLD A 
HEALTH CARD -- ISSUED BY THE MINISTRY OF HEALTH, A LOCAL 
HOSPITAL, OR A PRIVATE HEALTH INSURANCE COMPANY -- AS A 
PREREQUISITE FOR A RESIDENCY PERMIT.  THE UAE MINISTER 
OF HEALTH RECENTLY ADMITTED TO LOCAL REPORTERS, HOWEVER, 
THAT THE HEALTH CARD SCHEME HAS NOT WORKED, AND 
EXPATRIATES IN REALITY PAY FOR MOST OF THEIR MEDICAL 
TREATMENT.  MANY PEOPLE ARE UNABLE FINANCIALLY TO COVER 
THEIR OWN HEALTH CARE COSTS, AND THEREFORE DELAY 
TREATMENT AND ENDANGER THEIR HEALTH. 
 
2.  SUMMARY AND ACTION REQUEST CONTINUED:  IN SPRING 
2001, THE UAEG ANNOUNCED A PLAN TO MAKE IT COMPULSORY 
FOR EMPLOYERS TO PROVIDE PRIVATE MEDICAL INSURANCE FOR 
EXPATRIATE WORKERS.  PROGRESS ON CODIFICATION OF THIS 
LEGISLATION HAS BEEN SLOW, HOWEVER, DUE TO THE 
COMPLICATED CONSENSUS-BASED DECISION-MAKING PROCESS OF 
THE UAE BUREAUCRACY.  COMPARATOR COMPANIES AND 
COUNTERPART DIPLOMATIC MISSIONS DETERMINED IN 2001 THAT 
INSURING THEIR EMPLOYEES WAS A DE FACTO REQUIREMENT, 
DESPITE THE ABSENCE OF A LAW.  POST REITERATES ITS 
REQUEST TO WASHINGTON TO BUDGET FOR FSN HEALTH INSURANCE 
IN FY04.  END SUMMARY AND ACTION REQUEST. 
 
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HEALTH CARE SYSTEM IN THE UAE IS BROKEN 
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3.  THE CURRENT HEALTH CARE SYSTEM IN THE UAE 
DISCRIMINATES AGAINST EXPATRIATE WORKERS -- WHO COMPRISE 
MORE THAN 85 PERCENT OF THE COUNTRY'S POPULATION AND 98 
PERCENT OF PRIVATE SECTOR WORKERS.  UAE NATIONALS PAY 
BETWEEN 25 DIRHAMS (US $6.80) AND 100 DIRHAMS (US 
$27.23) FOR A HEALTH CARD THAT ENTITLES THEM TO LARGELY 
FREE HEALTH CARE FOR FOUR YEARS.  EXPATRIATES, ON THE 
OTHER HAND, ARE CHARGED BETWEEN 100 DIRHAMS (US $27.23) 
AND 300 DIRHAMS (US $81.68) FOR A HEALTH CARD FOR ONE 
YEAR, WITH ADDITIONAL FEES FOR ROUTINE HEALTHCARE 
SERVICES -- 50 DIRHAMS (YS $13.61) FOR EACH X-RAY OR 
ULTRASOUND, 75 DIRHAMS (US $20.45) FOR AN INTRAVENOUS 
PYELOGRAM, OR 100 DIRHAMS (US $27.23) FOR A CT SCAN. 
SINCE 2001, EXPATRIATES HAVE PAID FOR ALL MEDICATIONS. 
SUCH CHARGES CAN BE A HUGE FINANCIAL BURDEN ON OUR FSNS. 
 
4.  PRICES FOR PHARMACEUTICALS AND SOME MEDICAL TESTS IN 
THE UAE ARE NOW 20-30 PERCENT HIGHER THAN IN THE REST OF 
THE GULF, AND MORE THAN 50 PERCENT HIGHER THAN PRICES OF 
SIMILAR PRODUCTS IN THE INDIAN SUBCONTINENT.  THIS IS AN 
UNEXPECTED CONSEQUENCE OF POST'S EFFORTS TO ENSURE UAE 
COMPLIANCE WITH ITS WTO PATENT PROTECTION OBLIGATIONS. 
AS THE RESULT OF WASHINGTON'S AGGRESSIVE CAMPAIGN TO RID 
THE UAE MARKET OF CHEAP ILLEGAL COPIES OF PATENT- 
PROTECTED MEDICINES, THE UAE HEALTH SECTOR NOW IS 
LARGELY DEPENDENT ON DRUGS FROM EUROPE AND THE UNITED 
STATES -- IN TURN PUSHING UP PRICES OF BASIC MEDICINES. 
 
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COMPULSORY PRIVATE HEALTH INSURANCE IS THE SOLUTION 
--------------------------------------------- ----------- 
 
5.  THE QUASI-PARLIAMENTARY FEDERAL NATIONAL COUNCIL 
FIRST RAISED MANDATORY EMPLOYER-PROVIDED PRIVATE HEALTH 
INSURANCE IN 1999.  THE PROPOSITION WAS RECOGNITION BY 
THE UAEG THAT ITS CURRENT HEALTH CARD SCHEME FALLS SHORT 
OF PROVIDING BASIC HEALTH SERVICES TO THE UAE'S MORE 
THAN 3 MILLION EXPATRIATE WORKERS.  THE UAEG, HOWEVER, 
MAY NEVER SIGN THE PLAN INTO LAW.  THE UAE'S CONFEDERAL 
STRUCTURE REQUIRES THAT THE RULERS OF ALL SEVEN EMIRATES 
RATIFY LEGISLATION, THE PRESIDENT GIVES HIS FINAL 
APPROVAL, AND THE LAW IS PUBLISHED AS OFFICIAL -- A 
LENGTHY AND DIFFICULT PROCESS THAT HAS MIRED MANY GOOD 
PROPOSITIONS IN THE BUREAUCRACY FOR YEARS.  POLITICAL 
SENSITIVITIES AND SECURITY CONCERNS ALSO HINDER THE 
PROVISION OF CODIFIED RIGHTS AND PRIVILEGES FOR THE 
UAE'S MASSIVE FOREIGN POPULATION. 
 
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PREVAILING PRACTICE: MANDATORY HEALTH INSURANCE 
--------------------------------------------- -- 
 
6.  PROPOSITIONS, SUCH AS MANDATORY HEALTH INSURANCE, 
OFTEN ARE THE PREVAILING PRACTICE WITHOUT EVER BECOMING 
OFFICIAL LEGISLATION.  AS PART AND PARCEL OF THEIR 
EFFORTS TO PROVIDE A SAFE WORKING ENVIRONMENT AND 
ACCEPTABLE LIVING STANDARDS FOR THEIR EMPLOYEES, OUR 
COMPARATORS AND MANY OTHER LOCAL EMPLOYERS ARE PROVIDING 
PRIVATE HEALTH INSURANCE TO STAFF.  COUNTERPART 
DIPLOMATIC MISSIONS (AUSTRALIA AND UNITED KINGDOM) 
DETERMINED IN 2001 THAT IT WAS NECESSARY TO PROVIDE 
HEALTH INSURANCE FOR THEIR STAFF.  THE UAE'S MONOPOLY 
TELECOM PROVIDER AND LARGEST EMPLOYER RECENTLY 
CONTRACTED A NATIONAL INSURANCE COMPANY TO PROVIDE 
PRIVATE HEALTH INSURANCE FOR ITS MORE THAN 20,000 STAFF 
COUNTRYWIDE. 
 
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DELAY OF FSN HEALTH INSURANCE HAS TRAGIC CONSEQUENCES 
--------------------------------------------- -------- 
 
  7.   ALTHOUGH NO ONE CAN PREDICT WHETHER A TRAGIC DEATH COULD 
      HAVE BEEN AVOIDED BY THE PROVISION OF BETTER HEALTH CARE, OUR 
      EMBASSY FAMILY HAS SUFFERED RECENT LOSSES THAT COULD HAVE BEEN 
      AVOIDED BY BETTER HEALTH CARE.  FOR EXAMPLE, IN MAY 2003, AN 
      EMBASSY DRIVER WHO WAS ONLY ONE WEEK AWAY FROM RETIREMENT 
      SUDDENLY DIED FROM A PROBABLE HEART ATTACK.  HE PREVIOUSLY HAD 
      SOUGHT TREATMENT FOR CHEST PAINS AT THE EMBASSY HEALTH UNIT, BU 
      TOLD HIS SUPERVISOR THAT HE WAS DELAYING THE RECOMMENDED FOLLOW 
      UP CARE UNTIL HE RETURNED TO INDIA -- WHERE HE COULD AFFORD 
      TREATMENT.  ALTHOUGH POST'S HEALTH UNIT HAS IMPLEMENTED A PROGR 
      OF REGULAR MEDICAL REVIEWS OF DRIVERS AND OTHER FSN EMPLOYEES, 
      THE LACK OF HEALTH INSURANCE CONTINUES TO DISSUADE OUR EMPLOYEE 
      FROM SEEKING FOLLOW-UP CARE AT LOCAL HEALTH FACILITIES. 
 
  8.   CONCLUSION/ACTION REQUEST:  WHILE THE UAEG HAS YET TO PASS 
      LEGISLATION (AND MAY NEVER DO SO) FOR MANDATORY EMPLOYER-PROVID 
      HEALTH INSURANCE, THEY ARE RELYING ON THE FACTS ON THE GROUND T 
      SOLVE THE PROBLEM.  AS MENTIONED IN PARA 6, MOST INSTITUTIONS A 
      NOW PROVIDING HEALTH INSURANCE AND WE STRONGLY BELIEVE THE U.S. 
      MISSION SHOULD AS WELL.  POST REQUESTS BUDGET ALLOCATION TO FUN 
      FSN HEALTH INSURANCE AS OF SEPTEMBER 21, 2003. 
 
 
WAHBA