Market Analysis: United Arab Emirates (November 2019)
The objective of this report is to provide USCIPP members with context on the United Arab Emirates (UAE), including the factors influencing outbound medical travel and opportunities for international collaborations. The analysis draws on a number of sources for both quantitative and qualitative insights, including academic journals, data from the USCIPP annual benchmarking survey, consulting firm reports, news articles, publicly available information, data and reports purchased from the Office of Travel and Tourism Industries, the Economist Intelligence Unit, and others. From June 2015–July 2016, there were 1,456 inpatient admissions and 17,640 outpatient visits from the UAE at 40 and 33 USCIPP member organizations, respectively. Since the discovery of oil in the UAE, the country has experienced rapid economic growth. However, recent oil prices and OPEC-mandated production cuts have tempered growth, and the Emirati government has driven economic diversification efforts. Although the UAE presents many opportunities, there are also several challenges ahead. In healthcare specifically, there is considerable need for increased resources, particularly facilities and healthcare professionals, to meet the growing healthcare demand. Investment in healthcare is a priority for the federal government, as it is eager to diversify the economy, improve population health, reduce outbound medical travel, and avoid the political unrest seen elsewhere in the region. Healthcare spending per head – estimated at $1,618 in 2016 – is high for the Middle East. Following the rollout of mandatory public-private schemes following a 2008 decree, health insurance is now compulsory for both nationals and expatriates in Abu Dhabi and Dubai.
Table of contents
[to be inserted]
• 9.7 million (2018 est., world rank 93)
• Birth rate = 9.8 births/1,000 population (2018 est., world rank 196)
• Healthy life expectancy at birth = 78.7 years (2018 est., world rank 49)
• Arabic (official)
• Muslim (official) = 76%
• Christian = 9%
• Other (primarily Hindu and Buddhist, less than 5% of the population consists of Parsi, Baha’I, Druze, Sikh, Ahmadi, Ismaili, Dawoodi Bohra Muslim, and Jewish) = 15%
Most common causes of death
Figure 1. 2007 to 2017 change in most common causes of death rankings in UAE
Political geography and embassy and consulate information
Figure 2. Key US Department of Commerce contacts at the US Embassy and Consulates in the UAE
Table 1. Key US Department of Commerce contacts at the US Embassy and Consulates in the UAE
|City||Commercial officer||Commercial officer email||Locally engaged staff||Locally engaged staff email|
|Abu Dhabi||Thomas Bruns||Thomas.Bruns@trade.gov|
|Dubai||Shakir Farsakh||Shakir.Farsakh@trade.gov||Manal El Masry|
US Embassy in Abu Dhabi
US Consulate General in Dubai
Embassy of the United Arab Emirates
Consulate General of the United Arab Emirates in Boston
Consulate General of the United Arab Emirates in Houston
Consulate General of the United Arab Emirates in LA
Consulate General of the United Arab Emirates in New York
Economic and political environment
After two decades of relying on construction and services to drive rapid growth, the UAE needs a new growth model in the face of prolonged low oil prices and an overvalued exchange rate. The war in Yemen, the rift with Qatar since 2017, disruption of trade with Iran due to the re-imposition of American sanctions, and escalation of regional tensions have all contributed to a slowdown in economic activity. New businesses licenses are far fewer, and employment, particularly of expatriates (about 80% of the population), is shrinking. Weakness in the wholesale & retail trade and construction sectors continues, aggravated by the departure of some expatriates and further appreciation of the AED in real effective terms.
Nonetheless, nonhydrocarbon real GDP growth is expected to pick up to 1.9% in 2019 and 2.2% in 2020, supported by Abu Dhabi’s three-year stimulus package and Dubai’s spending linked to Expo 2020. Growth could ease to less than 2% beyond 2020 as the impact of Abu Dhabi stimulus and Expo 2020 fades. To achieve higher nonhydrocarbon growth over the medium term, deeper reforms are needed to raise total factor productivity growth by 1.5%.
Table 2. Main economic and financial indicators for UAE
|Nominal GDP in USD||357 billion||378 billion||421 billion||413 billion||419 billion|
|Real GDP, % change||3.1||0.5||1.7||2.1||1.9|
|Inflation rate, avg., %||1.6||2||3.1||-1.3||2.1|
|Fiscal balance, % GDP||-2||-1.7||-1.8||-2.3||-2.6|
|Current account, % GDP||3.7||7.3||9||6.8||4.2|
|External debt, % GDP||63.4||68.2||66.6||71.7||72.4|
|Public foreign assets, % GDP||206.7||217.6||209.6||219.3||217.4|
|Public debt, % GDP||62.2||60.4||56||59.4||58.5|
|Brent oil prices, $/bbl||44||54.4||72.6||64||58|
The main downside risks to the outlook include lower oil prices and slower global growth, which weigh on transport, logistics, tourism, and foreign investment. The impact on the UAE economy of a potential agreement to re-negotiate the nuclear deal with Iran is mixed. While it would lead to lower global oil prices by boosting supply, it could benefit trade with a large nearby market. As it stands, the UAE’s trade with Iran is expected to drop by more than half in 2019 due to US sanctions and the collapse of the Iranian currency. On the upside, implementation of deeper structural reforms could increase growth.
Figure 3. UAE budget balance
Fitch Solutions revised its budget balance forecasts for the UAE as of Q4 2019 and now expects a return to fiscal deficits in both 2019 and 2020 at 1.1% and 2.1% of GDP, respectively. The revision comes on the back of a shift in analysts’ oil price outlook from bullish to bearish for the next three years, negatively impacting revenue projections. Fiscal stimulus will likely continue in the near term in a bid to avoid disruptions to the gradual recovery in non-oil growth. Some offsetting non-oil revenue measures are likely to come into play from 2020 onwards in order to contain public debt accumulation.
Key fiscal challenges include raising spending efficiency, revenue diversification, and improving policy coordination and management of fiscal risks across the Emirates. The main economic challenge relates to adapting the UAE’s successful but complex diversification model to increasing competition among services hubs and technological shifts away from carbon as an energy source as North American shale transforms the oil sector. Further economic diversification will require deepening labor-market and education reforms to generate productivity gains and openness in sheltered sectors. Intergovernmental fiscal coordination and comprehensive fiscal/debt policy framework are needed to maintain macro-fiscal stability, achieve fiscal consolidation, and improve the effectiveness of government spending. The earlier consolidation of property companies in the wake of the 2009 slump is likely to be repeated in the financial sector and airlines, given overcapacity.
Key risks to the outlook include a global slowdown, trade protectionism, other trade/payment disruptions, financial volatility, disincentives to immigration with increased tax burden on foreigners, and regional instability. Hikes in US interest rates or market volatility could increase borrowing costs. Expo 2020 is exposed to overcapacity, property prices, and debt. Large investment projects, if not implemented prudently, may create macro-financial risks. The following table displays Fitch Solutions’ country risk index scores on a scale from 0 to 100, evaluating short-term and long-term political stability, short-term economic outlook, long-term economic potential, and operational barriers to doing business.
Table X. Risk index for the Gulf and select neighboring countries as of November 2019
|Short-term political risk||Short-term economic risk||Long-term political risk||Long-term economic risk||Operational risk||Operational risk|
*Note: scores are out of 100; higher score = lower risk.
The UAE is a federal, presidential monarchy comprising seven tribal, hereditary, absolute monarchies called emirates (principalities): Abu Dhabi, the oil-rich federation capital; Dubai, a large commercial hub; and the five smaller and less wealthy emirates of Sharjah, Ajman, Fujayrah, Umm al-Qaywayn, and Ras al-Khaymah. Sharjah and Ras al-Khaymah have a common ruling family—leaders of the Al Qawasim tribe. After Britain announced in 1968 that it would no longer ensure security in the Gulf, six “Trucial States” formed the UAE federation in December 1971; Ras al-Khaymah joined in 1972. The federation’s last major leadership transition occurred in November 2004, upon the death of the first UAE president and ruler of Abu Dhabi, Shaykh Zayid bin Sultan Al Nuhayyan.
Table X. UAE leadership
Name Title Khalifa bin Zayid al-Nuhayyan UAE president and ruler of Abu Dhabi Emirate; incapacitated since 2014 stroke Mohammad bin Rashid Al Maktum UAE vice president, prime minister, and defense minister as well as ruler of Dubai Emirate Mohammad bin Zayid al-Nuhayyhan Crown prince/heir apparent of Abu Dhabi and de facto president of UAE due to brother’s incapacitation Sultan bin Mohammad Al Qassimi Ruler of Sharjah Emirate Saud bin Saqr Al Qassimi Ruler of Ras al-Khaymah Emirate; his elder brother, Khalid bin Saqr, claims his 2003 removal as heir apparent was illegitimate; that claim is not recognized by the UAE Humaid bin Rashid Al Nuami Ruler of Ajman Emirate Saud bin Rashid Al Mu’alla Ruler of Umm al-Qaywayn Emirate Hamad bin Mohammad Al Sharqi Ruler of Fujairah Emirate Abdullah bin Zayid al-Nuhayyan Foreign minister Amal al-Qubaisi Federal National Council speaker; only woman to head a GCC legislative body Yusuf al-Otaiba Ambassador to the United States; son of former UAE Oil Minister Mani Saeed al-Otaiba
Shaykh Zayid’s eldest son, Shaykh Khalifa bin Zayid al-Nuhayyan, born in 1948, was elevated from crown prince to ruler of Abu Dhabi upon Zayid’s death. In keeping with a long-standing agreement among the seven emirates, Khalifa was subsequently selected as UAE president by the leaders of all the emirates, who collectively comprise the “Federal Supreme Council.” The ruler of Dubai traditionally serves concurrently as Vice President and Prime Minister of the UAE; that position has been held by Shaykh Mohammad bin Rashid Al Maktum, architect of Dubai’s modernization drive, since the death of his elder brother Shaykh Maktum bin Rashid Al Maktum in January 2006. The Federal Supreme Council meets four times per year to establish general policy guidelines, although the leaders of the emirates consult frequently with each other.
UAE leadership posts almost always change only in the event of death of an incumbent. The leadership of the UAE was put into doubt by Shaykh Khalifa’s stroke on January 24, 2014. He has not appeared publicly since and reportedly is incapacitated, but in order not to cause turmoil within ruling circles, there is unlikely to be a formal succession as long as he remains alive. His younger brother and the third son of Shaykh Zayid, Crown Prince Shaykh Mohammad bin Zayid al-Nuhayyan (born in 1961), is almost certain to succeed him in all posts. Shaykh Mohammad had been assuming day-to-day governing responsibilities prior to Khalifa’s stroke and has been de facto leader since. He is widely perceived as the key strategists of UAE foreign and defense policy.
Several senior UAE officials are also brothers of Shaykh Mohammad bin Zayid, including Foreign Minister Abdullah bin Zayid, deputy Prime Minister Mansur bin Zayid, deputy Prime Minister and Minister of Interior Sayf bin Zayid, and National Security Advisor Shaykh Tahnoun bin Zayid. In 2017, Shaykh Mohammad appointed his son, Khalid bin Mohammad, as deputy National Security Adviser.
As shown in the table above, each emirate has its own leader. The five smaller emirates, often called the “northern emirates,” tend to be more politically and religiously conservative and homogenous than are Abu Dhabi and Dubai, which are urban amalgams populated by many Arab, South Asian, and European expatriates.
The UAE’s elections to the Federal National Council (FNC) on October 5, 2019, will have no notable impact on policymaking. The FNC is the UAE’s only popularly elected body, and although it formally has influence over legislative matters – drafting, amending and passing or rejecting laws – these powers are eclipsed by the authority of the country’s monarchical hereditary rulers.
Policymaking pertaining to federal issues takes place in the Federal Supreme Council, comprising the rulers of the seven emirates, as well as in the cabinet that it appoints (with key portfolios assigned chiefly to members of the ruling families). Furthermore, authority tends to center on the ruler of Abu Dhabi, the richest emirate both financially and in hydrocarbon reserves, who acts as president of the federation. (This is formally the Emir Khalifa bin Zayed al Nahyan, but his half-brother, Crown Prince Mohammed bin Zayed al Nahyan, has been de facto ruler since the former suffered a stroke in 2014.)
Moreover, because of the UAE’s strongly federalized power distribution, many key decisions take place at the emirate level rather than nationally. Because none of the emirates have their own popularly elected institutions, most important decisions are made entirely by local rulers without popular oversight. The most salient implication of this is that each emirate has exclusive ownership of the resources found within its borders, meaning virtually all redistribution of oil proceeds is decided by the Abu Dhabi authorities.
Despite continued regional insecurity and intra-Gulf Cooperation Council (GCC) tensions, the UAE’s domestic political scene will be broadly stable through 2021, with little public criticism of or opposition to the current regime. Nevertheless, the authorities will remain sensitive to real and perceived threats and to criticism of their policies or those of their foreign allies – and will respond accordingly. The government will also continue to try to channel religious activity into state bodies, mostly as a means of maintaining tight control over Islamist sentiment. The government will remain particularly wary of Islamist groups both domestically and regionally, including al-Islah (the proscribed local branch of the Muslim Brotherhood), a group that the UAE authorities are very concerned about, even though it does not, in the estimation of some, pose any substantive threat.
Estimating outbound travel from the UAE
As of November 2019, USCIPP members are reporting Emirati patient volumes via the following referral pathways:
• Directly from the Department of Health-Abu Dhabi (increasingly the primary referral source)
• The Medical Office at the UAE Embassy in Washington, DC
• The Military Attaché Medical Office at the UAE Embassy in Washington, DC
• The Military Attaché Medical Office at the UAE Consulate General in Boston
• The Military Attaché Medical Office at the UAE Consulate General in Houston
• The Medical Office at the UAE Consulate General in Boston
• The Medical Office at the UAE Consulate General in Houston
The Department of Health-Abu Dhabi has publicly confirmed its interest in determining the overseas medical facilities where patients are sent for treatment in order to enhance their experience abroad and provide high-quality, safe care until their return to the UAE. The Department of Health-Abu Dhabi is thought to have nearly 70 coordination agreements with university hospitals and medical facilities worldwide.
The total number of patients sent overseas from Dubai in 2017 was 1,582; Thailand benefitted from the highest share of patients, followed by Germany. For more information about the service lines and destinations for Dubai patients, see tables 7–9 below. Total expenditure on overseas treatment was Dh623 million ($170 million). The average cost was Dh269,300 ($73,318) per patient; it was Dh344,600 ($93,819) for UK patients, Dh423,500 ($115,299) for Germany, and Dh1,168,400 ($318,102) for the US.
Table X. DHA overseas patients by country and specialty, 20178
Figure X. Average treatment cost for DHA overseas patients by country8
Table X. July 2017–June 2018 USCIPP annual benchmarking survey data: UAE
N* Country rank USCIPP total USCIPP average Adult inpatient discharges 13 7 233 17.9 Adult outpatient visits 16 13 1,443 90.2 Adult unique patients 18 6 1,458 81.0 Pediatric inpatient discharges 12 1 871 72.6 Pediatric outpatient visits 16 1 11,708 731.8 Pediatric unique patients 17 1 1,226 72.1
Figure X. July 2015–June 2018 USCIPP annual benchmarking survey data: Emirati inpatient discharges over time
While official statistics on the total number of Emirati citizens from all seven emirates traveling abroad for healthcare are not available, data are available for Dubai and Abu Dhabi. Table X displays available data regarding Emirati outbound medical travel and calculated estimates. For the OTTI data, there is currently no reliable method to differentiate “health and wellness” and elective medical travelers from those seeking tertiary and quaternary care, so the information below should be considered as the high end of total market size.
Table X. Estimating Emirati outbound medical travel
Source Data point Office of Travel and Tourism Industries (OTTI), International Trade Administration (ITA), US Department of Commerce Estimated 489 Emirati travelers to the US for health treatment (2016) International Medical Travel Journal (IMTJ) Estimated 30,000 outbound medical tourists (seems like a very high estimate) Dubai Health Authority (DHA) and the Health Authority – Abu Dhabi (HAAD) 7,277 reported overseas patients from Dubai and Abu Dhabi (2014; the last year both DHA and HAAD both reported overseas patient totals)
The OTTI of the ITA at the US Department of Commerce conducts the Survey of International Air Travelers (SIAT) continuously over time. The SIAT includes both non-US residents visiting the country and US residents traveling outside of the country. For medical service exports, the SIAT collects information on non-resident travelers by state and city visited and aggregates them to 11 world regions.
The SIAT asks questions about the traveler’s country of citizenship and birth, the main purpose of the trip, whether the trip has other purposes, cities and attractions visited and the length of time at each destination, the estimated amount of money spent during the trip and the amount of money spent for specific aspects (e.g., lodging, transportation, food and beverages, entertainment), and types of leisure activities in which the travelers engaged. The questions about the main purpose of the trip and other purposes of the trip offer an option for health treatment, which includes medical care and other non-medical treatments, such as spa treatments.
ITA surveys between 65,000 and 95,000 inbound and outbound travelers each year. Results of the survey provide an estimate of the inflows and outflows of consumers. Although it cannot be confirmed given existing data sources, it is assumed that persons who indicated that they traveled for the primary purpose of obtaining a health treatment were indeed seeking medical care rather than other health treatments. These estimates were used as the basis for the volume of inbound medical travelers from the SIAT.
The number of medical traveler respondents was weighted to the country level using population weights to calculate the number of medical travelers by country. Because of the potential variation in the weighted number of medical travelers given small numbers of underlying respondents to the SIAT for certain countries, the mean annual number of medical travelers was calculated for 2016.
In 2016, 75,686 Emirati travelers to the US accounted for less than 1% of total in-flight travelers. An estimated 489 Emirati travelers reported health as the main purpose for travel, representing .65% of the total travelers from the UAE. This is a significant drop from the spike of travelers reported in 2014 and 2015 with 3,797 and 2,630 respectively. The UAE ranks #16 for country of origin for travelers specifically seeking health treatment in the US. The top 10 US arrival locations in 2016 for all Emirati travelers are listed below.
• New York (JFK)
• Los Angeles (LAX)
• San Francisco (SFO)
• Houston (IAH)
• Dulles (IAD)
• Chicago (ORD)
• Boston (BOS)
• Dallas (DFW)
• Atlanta (ATL)
• Seattle (SEA)
Below is select demographic information for the 2,972 total Emirati travelers surveyed using the SIAT in 2016.
Percent of Emirati travelers to the US by age group
• 8–25 years: 9%
• 26–35 years: 43%
• 35–45 years: 25%
• 45–55 years: 19%
• 55–65 years: 3%
• 65+ years: 1%
Percent of Emirati travelers to the US by income group
• <$25K: 24%
• >$25K–$50K: 21%
• >$50K–$100K: 26%
• >$100K–$200K: 13%
• >$200K: 15%
Table 6. Occupation of Emirati travelers to the US
Management, business, science, and arts: 63%
Service occupations: 10%
Sales and office occupations: 6%
Natural resources, construction, and maintenance: 1
Production, transportation, and material moving:
|Management, business, science, and arts||63%|
|Sales and office occupations||6%|
|Natural resources, construction, and maintenance||1%|
|Production, transportation, and material moving||9%|
“The Department of Health in Abu Dhabi revealed that from the beginning of 2018 until the middle of this year, the Medical Committee of the Department of Treatment abroad issued 754 treatment decisions abroad, noting that the time period for deciding on very urgent requests for treatment does not exceed 48 hours, a maximum since receiving the application, including holidays Officially, the duration of non-urgent applications ranges from five to seven working days, and the duration of the dispatch depends on the status of the medical condition. In response to complaints received by Emirates Today, the owners confirmed the department’s refusal to approve their applications, despite medical reports that they need to travel and complete treatment outside the UAE, that it is working to ensure the provision of health care services in Abu Dhabi by intensifying its efforts. To attract expertise and provide services at the local level. In the absence of the necessary treatment and health care in government and semi-governmental health facilities within the Emirate, the Department of Treatment abroad , as the competent authority of the Abu Dhabi Health Department, will send patients to a select group of hospitals around the world to ensure that the patient receives treatment. Necessary at the best levels, including the provision of all medical, administrative and financial services. The Department indicated that the mechanism for approving applications for treatment outside the State includes the medical committee of the Overseas Treatment Service identifying cases requiring sending abroad through a medical committee made up of a select group of consultant doctors in different medical specialties, and making appropriate decisions. That’s in the patient’s best interest. According to statistics, incurable and rare cancers, which require high techniques, such as eye cancer, are at the forefront of sending out, followed by neurosurgery and blood diseases requiring bone marrow transplantation. Statistics also show that the most dispatched countries by the Medical Committee, in accordance with strategic contracts for capacity building and bridging gaps, are the United States of America, followed by South Korea, Spain and France. The Department stressed that the cost of treatment outside the country is not specified, but is keen to monitor the average cost of a patient. The duration of the patient’s stay outside the country for treatment depends on his condition. She said that the efforts devoted by the Department of Treatment abroad contributed to reducing the average duration of the patient for treatment abroad to 80 days, during the current year, compared to 120 days last year, pointing out that it allows the patient abroad to accompany escorts, according to the approved regulations, and bear the cost of travel And the daily allowance.
Follow-up of patients abroad The Department of Health in Abu Dhabi has confirmed its keenness in identifying the medical facilities where patients are sent for treatment to enhance the experience of patients abroad, and to provide the highest quality and safety until they return safely to the uae through a leading system in the management and coordination of treatment affairs abroad, which ensures Sito-patients to some of the world’s leading health providers and university hospitals. It also confirmed the signing of 31 coordination agreements, finally, with the best healthcare providers. In the coming period, she said, she will sign and renew 35 coordination agreements with elite healthcare providers to enhance the experience of patients sending treatment abroad and ensure that they are provided with the best quality healthcare. The Department stressed the follow-up of patients while receiving treatment abroad, through the Department’s 24-hour operations centre. It also provides free specialized numbers for patients from all over the world, to follow up on their affairs in coordination and direct communication with doctors inside and outside the country. • The duration of the patient’s stay outside the country for treatment depends on his condition.”
“The Ministry of Education has launched an e-learning programme, which allows distance study for students and children of citizens, whose circumstances do not allow them to attend school, both inside and outside the country. The ministry said in a tweet, finally, that the e-learning program is for citizen students and children of citizens in public and private schools, who find it difficult to commit to studying within the classroom, inside and outside the country, according to three conditions, which are to travel outside The state for treatment, accompanying a patient for treatment outside the state, and other difficulties prevent the student from committing to study at school inside and outside the country. The ministry explained in press statements that the students targeted are students from kindergarten until the twelfth grade, whose circumstances prevent them from attending the classes, in order to ensure that they continue their educational career, and this will be under a specific mechanism that is made available, pointing out that the student who finds it difficult In school hours for strong reasons, the guardian fills out a data form containing the name, grade and circumstances that prevent him from studying in the classroom, and send it to school for study by the competent committee, to determine whether the situation is worth studying within the program or not. The ministry said that the program was launched experimentally for students, last year, with one of the students of the UAE school who is receiving treatment abroad, stressing that the student continued his studies, and was able to achieve good results in all tests, during the last academic year. The Ministry indicated that the number of students studying within the program abroad is currently 10 students at different levels of study from kindergarten to grade 12, noting that it is required for a kindergarten student to receive his or her studies remotely, and that his guardian take a training course in how to deal with the program, To achieve the educational objectives of the subjects taught by the students of this stage. The Ministry added that the Department of Information Technology is currently working in coordination with the evaluation and curriculum sector in the ministry to develop a specific mechanism that allows students outside the country to pursue their studies “remotely”, by ensuring the operation of the student account in the intelligent learning system, and through the program “Diwan” which allows Teachers and students view the curriculum electronically on their computers, and interact with them in a smooth and interesting way. It also allows them to download electronic copies of the various books available for all subjects, access them at any time, from anywhere, and provide the system with explanations of lessons scheduled by voice or video, through the teachers of these subjects, so that the student can follow them.”
Emirates 71: http://uae71.com/posts/77031
Overall trends in Emirati outbound travel6
The UAE ranked 48th in terms of overseas visitors, excluding Canada and Mexico, to the US in 2015. According to the National Travel and Tourism Office (NTTO), a total of 107,594 travelers visited the US from the UAE.
Policies influencing Emirati travel to the US
Current visa requirements
Travelers from UAE to the US are required to obtain a visitor visa, specifically a B-2 visa for a medical traveler. To apply for a B-2 visa, a traveler must complete the following steps:
- Complete the Online Nonimmigrant Visa Application, Form DS-160, and include a photo
- Complete an interview (required for applicants aged 14–79) at the US Embassy or Consulate
- Enter a US port of entry once the visa is issued
Required documentation for medical travelers to bring to visa interview:
- Nonimmigrant Visa Application, Form DS-160, confirmation page
- Application fee payment receipt
- Medical diagnosis from a local physician, explaining the nature of the ailment and the reason for treatment in the US
- Letter from a physician or medical facility in the US stating that they are willing to treat the specific ailment and detailing the projected length and cost of treatment (including doctors’ fees, hospitalization fees, and all medical-related expenses)
- Proof that transportation, medical, and living expenses in the US will be paid; this may be in the form of bank or other statements of income/savings or certified copies of income tax returns (either the patient’s or the person or organization paying for the treatment)
Supplemental questions for visa applicants
In May 2017, the US State Department announced new supplemental questions for an estimated 65,000 visa applicants per year. The new set of questions does not target specific nationalities but would apply to visa applicants “who have been determined to warrant additional scrutiny in connection with terrorism or other national security-related visa ineligibilities.” The new questions include:
- Travel history during the last 15 years, including source of funding for travel
- Address and employment history during the last 15 years
- All passport numbers and country of issuance held by applicant
- Names and dates of birth for all siblings, children, current and former spouses, and civil or domestic partners
- Social media platforms and identifiers (handles) used during the last five years
- Phone numbers and email address used during the last five years
Additionally, applicants may be requested to provide details of their international or domestic travel if it appears that the applicant has been in an area under the operational control of a terrorist organization. The new requirements have been met with some opposition, as critics argue the process will become burdensome, and applicants with innocent mistakes or a lack of historical information are likely to get caught in the process. The request was submitted under the emergency review procedures and was approved on May 23, 2017. The approval is valid for 180 days.
Figure X. Adjusted UAE B-visa refusal rates over time, FY 2013–2018
The US’ 2018 overall B-visa (B1+B2) refusal rate for the UAE was 3.75%. Despite continued interest in the US as a travel destination, there are nevertheless some issues that may potentially limit growth figures. These include negative perception of the US as a travel destination given recent domestic political events and restrictive policies that may impact the UAE in the future, such as travel and laptop bans.
Emirati electronic payment methods,
In the UAE, the industry of mobile payments is directly linked to card usage, the ability to transfer mobile money, and initiatives related to e-identity. Unlike other advanced economies in the Middle East, the UAE lags in consumer readiness, according to the MasterCard’s Mobile Payments Readiness Index. While consumers are unaware or holding back, the infrastructure is ready for development. Being an established hub of money transfer and having favorable regulations and government support in the development of mobile payments, the environment in the UAE presents a positive picture.
Because electronic payments are not so widely used in the UAE, developing a mobile wallet solution that would be widely adopted is challenging. Additionally, to achieve the desired level of adoption, mobile wallets must provide real benefits to its users, benefits that cannot be achieved by using cash or credit cards. However, there are some examples of successful mobile wallet solutions in the UAE. In June 2011, Abu Dhabi Commercial Bank (ADCB) partnered with Mobibucks, a mobile payments solutions company based in the US, to offer Mobi. The solution is described as a cashless, cardless, paperless, and phoneless payment. Consumers create a virtual account online, based on their mobile number and a secret PIN, which they later use to make purchases. Mobi is currently used at select merchants in Abu Dhabi and Dubai. In the same year (2011), the National Bank of Abu Dhabi (NBAD) won best mobile payment application for its NBAD ARROW service enabled by Luup. NBAD Arrow application enables consumers to check account balances, pay utility bills, and transfer funds domestically and internationally. Arrow service is available to NBAD customers holding an active account or a NBAD prepaid account. This mobile banking application is available to all NBAD customers.
In December 2014, the UAE Banks Federation announced the completion of the pre-implementation phase of the Mobile Wallet Project. Initially unveiled in February of 2014, the Mobile Wallet comprises the design, construction, and rollout of a platform that interfaces with all banks operating in the UAE. The project incorporates the facility for smartphones and other digital devices to be used for cashless purchasing in UAE retail and other outlets as well as to store and transfer money.
In January 2017, the UAE Central Bank issued new regulations for “stored value digital payments.” The stated objectives of the regulations are to facilitate robust adoption of digital payments across the UAE in a secure manner and foster financial inclusion in the UAE. Companies had until January 1, 2018, to comply with the new regulations. The regulations specify four license categories under which entities can provide digital payments services: retail, micropayment, government, and non-issuing. They also establish regulations for user data storage, including the provision that all consumer data be physically stored in the UAE. These regulations will apply to payment service providers already operating digital payment platforms in the UAE, including PayPal, Beam, Etisalat Visa, and Emirates NBD:
- PayPal has one million active users from the Arab world. In the UAE, it is possible to set up a PayPal account and open a USD account in a local bank to receive payments, but PayPal does not currently accept AED (Dh) as a currency.
- Beam Wallet currently has over 100,000 users in the UAE and enables consumers to shop, earn rewards, and keep track of expenses.
- Telecom operator Etisalat introduced its mobile phone-based commerce service, Etisalat Wallet. The app allows customers to make purchases, pay utility bills, transportation fees, and top-up Etisalat’s mobile credit. Currently, funds transfer to friends and family is not available.
- Emirates NBD, one of the largest banks in the Middle East, currently offers mobile banking and contactless payment solutions to customers in the UAE.
In May 2019, the DHA signed a partnership with Emirates NBD to provide a Global Cash card to UAE national’s receiving healthcare abroad. The card allows citizens to withdraw money at any time through an ATM without need for review and approval from the DHA. The card will allow withdrawals in 14 currencies to cover treatment as well as related expenses while receiving medical care abroad.
Cultural context for working with Emiratis
Figures 5–6, which explore cultural differences between the US and the UAE, are drawn from The Culture Map by Erin Meyer. Based on rigorous sociological research, Meyer provides a structural framework for navigating international business interactions and promoting mutual understanding across cultures.
Figure 5. Cultural dimensions from The Culture Map
*The Persuading scale does not plot all world cultures, as the concept of Applications-first and Principles-first only applies to Western environments. Asian cultures, for example, are Holistic and neither Applications-first nor Principles first. For this reason, the Persuading scale will not appear on the map when some countries are plotted.
Figure 6. Cultural dimensions: US vs. UAE
UAE’s healthcare system
UAE healthcare indicators and demographics 21
The UAE’s healthcare indicators are better than most other countries in the GCC, and this is expected to remain the case through 2021. According to the World Bank, average life expectancy is expected to increase from 77.4 years in 2017 to 78.6 years in 2025. Infant mortality is expected to decrease from 10.3 deaths per 1,000 live births in 2016 to 9 per 1,000 in 2021. Approximately 14% of the UAE population is under the age of 15, and only 1.5% is over the age of 65. Despite a low old-age dependency ratio, factors including population growth, gradual aging, and lifestyle trends will drive demand for healthcare services in the long term. With a population bulge in the 20–40 age group, demand for maternity and pediatric care is high.
In 2016, non-communicable diseases accounted for 77% of deaths. Of these, cardiovascular diseases accounted for 40%, and cancers accounted for 12%. The World Health Organization’s (WHO) World Health Statistics 2016 report estimated that 27% of adult men and 39% of adult women in the UAE are clinically obese. At the same time, around 38% of men in the UAE are estimated to smoke tobacco. As a result of the above, diabetes, cardiovascular diseases, and cancer are increasingly prevalent. Diabetes is a particular problem, with the World Health Organization estimating that 8% of the population is diabetic.
At the federal level, the UAE operates within a constitutional framework under which “the community shall provide all the citizens with medical care and means of prevention and treatment from diseases and epidemics and shall promote the establishment of public and private hospitals, clinics, and treatment houses.”
The Federal Ministry of Health and Prevention (MOHAP) oversees the implementation of federal government policy in relation to the provision of comprehensive healthcare for all UAE citizens and residents. MOHAP works in collaboration with all health authorities to ensure that all public and private hospitals are accredited according to clear national and international quality standards of medical services and staff.
The emirates of Abu Dhabi, Dubai, and Sharjah have established their own health authorities—the Department of Health-Abu Dhabi, the Dubai Health Authority (DHA), and the Sharjah Health Authority, respectively. Accordingly, Dubai, Abu Dhabi, and Sharjah have the most developed rules and regulations among the seven emirates with respect to healthcare matters. The emirates of Dubai and Sharjah have also made provision for healthcare investment by establishing healthcare sector free zones, such as the Dubai Healthcare City (DHCC) and the Sharjah Healthcare City. The remaining Northern Emirates rely on MOHAP to act as their regulator to oversee delivery of healthcare services.
The UAE has always looked to other jurisdictions for inspiration in creating a legal framework for the healthcare sector. The priorities are to ensure adherence with international best practice and to support delivery of high-quality medical care to the population. The drive to achieve continuing improvements in healthcare services throughout the UAE is intended to reduce the need for people to travel abroad for specialized treatment and to encourage inbound medical travel.
The status of the healthcare economy in the UAE is inextricably linked to the general economy and the government’s diversification policy away from the oil and gas sector.
The healthcare sector has been identified by the government as a key sector for development. The private healthcare expenditure continues to be driven by medical travel and the continued rollout of compulsory health insurance.
ii The role of health insurance
The Insurance Authority was established under Federal Law No. 6 of 2007 (on regulating the insurance sector). Mandatory health insurance has begun to be introduced across the UAE. The UAE national Emirati population (and those of similar status) are covered by a government-insured scheme named ‘Thiqa’, which is administered by the UAE national insurance company, Daman, and provides for a comprehensive range of health insurance cover.
Abu Dhabi was the first emirate to fully implement mandatory health insurance for the expatriate population by Law No. 23 of 2005,5 which provides a basic level of cover for all employees and their families. A similar scheme is currently being implemented in Dubai pursuant to Law No. 11 of 2013,6 implemented from February 2014 over three phases according to employer workforce size, with the final phase completed in June 2016. Mandatory health insurance for expatriates has yet to reach every emirate in the UAE.
As the government reduces financial commitment to publicly funded services, which are largely accessed only by the Emirati population, the role of health insurance is critical to the ability of the remaining expatriate population to afford and access private medical services and medicines.
iii Funding and payment for specific services
Health insurance does not cover all healthcare needs. While the Thiqa cover for the Emirati population is reasonably comprehensive, recent cutbacks in spending have meant that access to certain Thiqa services has been withdrawn, and similarly, the expatriate population who benefit only from a basic level of cover must pay themselves for many services that are excluded from most policies. The extensive list of uninsured services means that expatriate patients must pay themselves, and in some cases, access services abroad, where they can be significantly cheaper.
The UAE’s healthcare sector is expanding rapidly to meet both the evolving needs of a growing population and the nation’s ambition to become a regional hub for medical travel. While healthcare provision in some emirates is regulated entirely by MOHAP, certain emirates or free zones also have their own regulatory authorities; these notably include HAAD and the DHA. This rapid expansion is challenging the ability of the UAE to provide adequate medical personnel while containing costs; however, Emirati governmental entities have adopted a series of long-term initiatives, above all UAE Vision 2021, to address these challenges and guide the sustainable growth of this sector. Lifestyle habits are also propelling this growth, with a high prevalence of chronic diseases induced by poor nutrition, sedentary behavior, and smoking.
There are shortages of skilled Emirati medical professionals, partly due to prevailing cultural norms. Shortages are particularly acute in the field of nursing, where just 3% of the 23,000–25,000 nurses in the country are Emirati; in Abu Dhabi, that figure is even lower, with only 2.3% of the 7,900 nurses employed by the Abu Dhabi Health Services Company (SEHA) being Emirati.
Public healthcare expenditure in the general government increased by over 0.5% of GDP in 2011–16, largely reflecting efforts by the government of Abu Dhabi to improve healthcare infrastructure. Overall, the WHO estimates public health expenditure at 2.6% of GDP, substantially below the OECD peers, even after accounting for the younger population structure in the UAE. At nearly $1,500 per year, total health expenditure per capita is also below the $3,800 OECD average (about $2,200 adjusted for demographics).
Improving healthcare outcomes requires boosting inputs, including raising the number of doctors and nurses over time. To approach the OECD levels, this would cost as much as 1.3% of GDP over the next few years. A gradual approach is warranted given fiscal and implementation constraints and to ensure that additional resources improve outcomes. Nevertheless, the gap in outcomes and expenditures compared to the OECD underlines the importance of protecting healthcare expenditure during fiscal consolidation.
Currently, the healthcare system is a mix of a mandatory health insurance model in Abu Dhabi and Dubai, including special insurance schemes for government employees and nationals, and a government-funded model in the northern emirates. Looking ahead, a more integrated system could prevent healthcare disparities and avoid duplication of services. This could be achieved through better coordination by insurers and service providers across regions, eventually considering a national insurance market. To this end, plans for separating the regulatory and service provision arms of MOHAP would be a step in the right direction; similar to what is being done in the education sector (Italy, Sweden, and the UK also separate such roles).
Enhancing monitoring and oversight is crucial to unlock the potential for the universal insurance model at an affordable cost. Robust regulation can help maintain proper standards across public and private service providers. To contain growth of healthcare costs, efforts to increase price transparency and implement payments by episode of care, whereby payments to providers are bundled by medical conditions, can increase the efficiency of service delivery. Promoting the use of health information technology that allows for data sharing across insurers and providers and benchmarking of costs would also be useful. In the medium term, reviewing the incentive and payment structure for public providers would contain fiscal costs and improve the quality of care. Today, public providers receive a budget allocation for current and capital expenditure. Over time, these allocations could be linked to indicators of quantity and quality of care to place public providers on the same footing as private providers. Care must be exercised when considering the use of public private partnerships (PPPs) to finance healthcare initiatives. The Ministries of Finance and Health could develop an inventory of all existing PPPs, clearly identifying existing commitments and the exposure of the government (for example, through demand guarantees).
PPPs can mobilize additional sources of financing and support the efficient and timely provision of infrastructure. If not managed properly, PPPs can also be a source of major contingent liabilities. Success in PPPs requires realizing efficiency gains while effectively mitigating fiscal risks. The UAE authorities have so far been vigilant in engaging in PPPs, reportedly doing so only if efficiency gains were larger than differences in the cost of capital of the government and the project. Dubai’s PPP law is a step in the right direction; regulations should aim at strengthening the legal framework by reducing fiscal risks. Other UAE governments could aim to prepare their PPP legal frameworks in line with best international practices.
In recent years, infrastructure services across the world have been delivered increasingly through PPPs. In collaboration with governments, the private sector can play an important role by supporting the efficient and timely provision of infrastructure. According to the World Bank (2017), over the past 25 years, more than 5,000 infrastructure projects in 121 low- and middle -income economies have been delivered through PPPs, representing investment commitment of $1.5 trillion. Under a typical PPP, a firm provides upfront financing and designs, builds, operates, and maintains an asset in exchange for a combination of user fees and/or periodic payments by the government over the life of the contract.
In an era of lower oil prices, PPPs are becoming attractive to oil exporters such as the UAE to reduce pressure on state finances. The UAE is engaging in sizeable infrastructure projects; while the bulk of the public investment is taking place through traditional public procurement procedures, PPPs are also being considered on a case-by-case basis. Dubai is evaluating the use of PPPs for overall infrastructure developments. Dubai is also exploring the appropriateness of using PPPs in projects using renewable energy and improving energy efficiency. Dubai enacted its PPP law in 2015, and Abu Dhabi is preparing PPP rules to encourage the private sector to participate in infrastructure projects. The federal government issued PPP guidelines in 2017.
UAE authorities have so far been vigilant in engaging in PPPs. The authorities indicated that they rejected PPP proposals where the weighted-average-cost-of-capital was higher than the cost of capital for the government and/or where the efficiency gains were insufficient to justify the higher cost. The legal framework adopted by Dubai includes several elements of good international practices. The law provides a clear definition of PPPs and describes the roles and responsibilities of the relevant institutional stakeholders, which should assure the private sector that the government would honor its commitments and hence reduce costs for the government. At the same time, the legal framework could be improved by introducing a limit on the aggregate government exposure to PPPs, strengthening the role of the Dubai Department of Finance during the whole life cycle of the PPP project, avoiding unsolicited proposals and providing guidelines for renegotiation of PPP contracts. Additional regulations could usefully strengthen the legal framework, containing fiscal risks.
The UAE federal government – which oversees the country’s healthcare sector and funds almost all non-private healthcare in the northern emirates – has developed strategic plans to both respond to the growing demand for healthcare and meet the associated challenges. The UAE’s Vision 2021, the highest-level UAE government strategic plan, makes achieving “world-class healthcare” one of its priority goals. It aims to do so by accrediting all public and private hospitals according to clear national and international standards. The 2021 Vision also seeks to reduce the prevalence of diabetes, obesity, and smoking among the population as well as decrease the number of deaths from cardiovascular diseases and cancer. In keeping with this vision, Abu Dhabi has developed its own emirate-level strategic healthcare plans. In December 2014, Sheikh Mohammed bin Zayed Al Nahyan, Abu Dhabi crown prince and deputy supreme commander of the armed forces, approved a strategy to improve healthcare in the Emirate. This strategy included 85 initiatives that aim to, among other objectives, elevate the quality of healthcare services, improve safety standards and patient experience, attract and retain medical professionals, and integrate IT systems and build on electronic data. Dubai has likewise developed strategic plans for its healthcare sector in keeping with Vision 2021. In 2013, Dubai announced a 12-year plan to reshape its healthcare system, including a Dh3 billion ($820 million) revamp of Rashid Hospital, 40 new primary healthcare centers, and three new hospitals. Then, in January 2015, it unveiled a complementary 10-year plan, the Dubai Clinical Services Capacity Plan, which involves building three new medical colleges and five nursing schools. This latter plan also calls for implementing strategies to make the nursing profession more desirable and attract and retain high-caliber medical and healthcare staff to fill gaps in certain healthcare specialties. Other emirates have also embarked on far-sighted plans to meet the anticipated growth in their healthcare sectors. Sharjah, for instance, has started building Sharjah Healthcare City in keeping with projections by Sharjah’s Investment and Development Authority (Shurooq) that the Emirate’s healthcare market could potentially grow from $2 billion in 2016 to 2.4 billion in 2019.
The Jawda-Abu Dhabi Healthcare Quality Index, which began in 2014 with a focus on hospitals and pharmacies, is set to begin publishing quality rankings of 2,130 providers from the region, including clinics, home-care providers, and diagnostic and rehabilitation facilities. The Jawda rankings collect data around patient safety and timeliness of service delivery, and they can positively influence outcomes — within a year of its inception, 87% of Emirati hospitals have reported improved waiting times.
Figure 7 Healthcare spending in UAE by source, 2016 and 2050 forecast2
Abu Dhabi healthcare indicators and demographics
The Department of Health-Abu Dhabi was created to regulate healthcare sectors in Abu Dhabi. It does not own, build, or manage healthcare facilities; treat patients; pay for treatment; or pay the private sector to partner. SEHA is the largest public provider and manages most of the public healthcare facilities in partnership with two international operators.
In 2015, there were 8,460 physicians, 1,561 dentists, 21,733 nurses, and 6,982 allied health professionals in the Emirate of Abu Dhabi. Additionally, there were 2,137 licensed facilities, including 52 hospitals (totaling 5,043 beds), 1,180 centers and clinics, and 637 pharmacies. In 2015, government-owned SEHA hospitals provided care for 52% of inpatient admissions and 31% of outpatient visits.
Dubai healthcare indicators and demographics
DHA oversees the health system in Dubai and directly oversees several facilities within its jurisdiction, including Latifa Hospital, Dubai Hospital, Rashid Hospital, and Hatta Hospital in addition to other specialty centers and DHA primary health centers in Dubai.
In 2017, there were 8,693 registered physicians in Dubai, an 82.4% increase from the year 2010. In 2017 more than 2 million patients visited DHA run facilities.
The UAE has a number of healthcare regulators at both the federal and emirate levels, each with their particular geographic or functional purviews. UAE healthcare regulation has recently been marked by two trends: (1) an expanding remit for MOHAP and (2) increasing coordination among regulatory authorities. The two most important federal regulatory authorities in the UAE healthcare sector are MOHAP and the Insurance Authority. MOHAP oversees the implementation of government policy in relation to the provision of healthcare for all UAE citizens and residents. According to Cabinet Resolution No. 10 of 2008, the Ministry is to provide UAE citizens with healthcare; prepare health, preventive, and training programs; organize the practice of healthcare professions; and establish, manage, and supervise health facilities. In practical terms, the Ministry provides both healthcare services and regulatory oversight in the northern emirates. It also licenses and controls the prices of drugs and medical devices nationwide. The current minister is H.E. Abdul Rahman Mohammed Al Owais, and the undersecretary is Dr. Mohamed Salim Al Olama. The Insurance Authority regulates and supervises the insurance sector in the UAE. His Excellency Sultan bin Saeed Al Mansouri, minister of economy, chairs its board of directors, and H.E. Ebrahim Obaid Al Zaabi serves as its director general.
The UAE Nursing and Midwifery Council regulates the nursing and midwifery professions in the country. Led by its president, Princess Haya bint Al Hussein (the wife of UAE Vice President and Prime Minister Sheikh Mohammed bin Rashid Al Maktoum), the council consists of key constituents with regards to these fields and meets four times a year. The Council’s work is organized by five standing committees and task forces that address the scope of practice requirements; registration and licensure; nursing and midwifery education; nursing and midwifery Emiratization; and nursing and midwifery research. While healthcare provision in some emirates is regulated entirely by MOHAP, certain emirates or free zones also have their own regulatory authorities (notably HAAD and DHA).
The UAE federal government has introduced a variety of legislation regulating the healthcare industry. The bedrock of this legislation is Federal Law No. 7 of 1975 concerning the practice of human medicine, which included sections on licensing and registration of physicians; laboratories, clinics, and private hospitals; and duties and responsibilities of a physician. Since then, additional legislation has been introduced, concerning communicable disease prevention, the detention and treatment of the mentally ill, pharmaceutical professions and establishments, the practice of some medical professions by persons other than physicians and pharmacists, the transfer and transplant of human organs, medicines and preparations derived from natural sources, medical liability, licensing of fertilization centers, and private health facilities.
HAAD regulates Abu Dhabi’s healthcare sector. It is charged with achieving the highest standards in health services in the Emirate and monitoring the operation of the health sector. To this end, it carries out a variety of activities, including collecting health data and launching screening programs. The chairman of HAAD is Sheikh Abdulla Bin Mohamed Al Hamed, and the acting director general is Mohamed Al Hameli. DHA is the main health authority in Dubai. DHA regulates all of Dubai’s healthcare sector services through licensing healthcare facilities and professionals and inspecting health facilities. DHA also regulates the cost of healthcare in the Emirate and runs special programs, such as one meant to encourage young Emiratis to enter medical professions. The President of DHA is H.H. Sheikh Hamdan bin Rashid Al Maktoum, deputy ruler of Dubai and UAE minister of finance. Humaid Al Qutami is the chairman of the board and director general.
Dubai Healthcare City Authority (DHCA) regulates Dubai’s healthcare free zone: Dubai Healthcare City (DHCC). As such, it is responsible for the licensure of all healthcare professionals and healthcare operators in the free zone. It is also responsible for setting and maintaining international best practices in healthcare delivery and patient care within that zone.
Sharjah Health Authority (SHA) regulates Sharjah’s healthcare system. SHA has also partnered with hospitals to offer free health screenings.
Payers and financing4
According to the WHO, out-of-pocket expenses constituted 64% of private spending on health and 18% of total healthcare spending in 2014. Public spending accounted for 72.3% of healthcare expenditure in 2014, falling marginally from 73.4% in 2013. The share of private expenditure is expected to increase in 2017–2021 with the expansion of compulsory health insurance schemes and other health initiatives, many of which operate through PPPs. The shift to private healthcare is noticeable in Dubai, where two-thirds of the total expenditure on health was provided by the private sector in 2014 – an increase of 37% from 2012.
Table 11. Select country-level health indicators4,
|Life expectancy, average (years)||76.6||76.8||76.9||77.1||77.3||77.4||77.2||77.4||77.5||77.7|
|Life expectancy, male (years)||75.9||76.1||76.3||76.4||76.6||76.7||76.6||76.7||76.9||77.1|
|Life expectancy, female (years)||78.1||78.3||78.4||78.6||78.8||78.9||78.7||78.9||79.1||79.2|
|Health expenditure, total (% of GDP)||3.4||3.5||3.6||3.6||3.5||3.8||3.8||3.9||3.8||3.8|
|Health expenditure per capita (current US$)||1,442||1,556||1,613||1,401||1,323||1,687||1,742||1,852||1,895||1,999|
|Healthcare spending (Dh million)||46,802||50,185||53,307||52,583||55,073||58,216||61,010||65,821||68,257||72,925|
|Healthcare spending (US$ million)||12,744||13,663||14,513||14,316||14,994||15,850||16,611||17,920||18,583||19,854|
|Healthcare (consumer expenditure, US$ million)||2,244||2,362||2,602||2,298||2,291||2,367||2,525||2,665||2,864||3,079|
|Health expenditure, private (% of GDP)||0.9||0.9||1.0||-*||–||–||–||–||–||–|
|Health expenditure, public (% of GDP)||2.6||2.6||2.6||–||–||–||–||–||–||–|
|Health expenditure, public (% of total health expenditure)||74.0||73.4||72.3||–||–||–||–||–||–||–|
|Health expenditure, public (% of government expenditure)||8.7||8.7||8.7||–||–||–||–||–||–||–|
|Out-of-pocket health expenditure (% of total expenditure on health)||16.7||17.1||17.8||17.8||18.5||–||–||–||–||–|
|Out-of-pocket health expenditure (% of private expenditure on health)||64.4||64.4||64.4||–||–||–||–||–||–||–|
*Data not available.
Figure 8. Healthcare spending in the UAE
Gross health insurance premiums collected in the UAE are estimated to have risen by about 19% to Dh44 billion ($12 billion) in 2016 after the expansion of the compulsory health schemes in Dubai and Abu Dhabi. Health insurance premiums are likely to rise sharply across the UAE in 2018 after a federal decision to impose value-added tax (VAT) on all non-life insurance policies from January of that year.
The market for health insurance in the UAE is fragmented; each emirate has its own health insurers. All Abu Dhabi native nationals are enrolled in the Thiqa health insurance system, which is provided by the state-owned Daman National Health Insurance Company. Employers in Abu Dhabi are required to provide health insurance for all expatriate employees and their families as well as for UAE nationals who are not enrolled in the compulsory Thiqa program or other schemes. In 2015, Thiqa covered 3.15 million people and operated through 40 licensed health insurers.
Daman is a public joint stock company that is 80% owned by the Abu Dhabi government and 20% owned by Munich Re. It exclusively manages the aforementioned Thiqa program for UAE nationals in Abu Dhabi as well as the Abu Dhabi Basic Plan for low-income expatriates in the Emirate. His Highness Shaikh Mohammad Bin Zayed Al Nahyan, crown prince of Abu Dhabi and deputy supreme commander of the UAE Armed Forces, visited the Burjeel Hospital on April 30, 2017. During his visit, he ordered that holders of Thiqa health insurance cards would no longer pay the deductible of 20% of the treatment cost when visiting private medical facilities in the Emirate of Abu Dhabi. HAAD, the regulator of the healthcare sector in Abu Dhabi, previously announced a number of changes to the Thiqa plan. One of the changes was that cardholders will receive 80% coverage of fees for treatment services at private healthcare facilities in Abu Dhabi. These changes were due to become effective in July 2016, resulting in part from the current heavy financial burden placed on the Abu Dhabi mandatory health insurance funding scheme.
Given the above announcement of the removal of the deductible 20% payable by Thiqa cardholders, here is an updated set of key changes to the Thiqa plan:
- Thiqa holders will continue to receive full coverage (100%) for treatment services available at all governmental healthcare facilities in the Emirate
- Thiqa will cover 50% of the cost if cardholders should seek medical services outside Abu Dhabi networks; however, in cases where specialized services and treatments are unavailable at healthcare facilities within Abu Dhabi, Thiqa will cover 100% of the treatment cost
- Changes also exclude coverage for ‘orthodontic braces’ for those who are 18 years of age or above from the plan unless there is a medical necessity identified
- Thiqa holders will also be offered full coverage of IVF treatment if availed at a governmental healthcare facility in addition to one attempt per year at any private medical facility in Abu Dhabi
- All prescriptions from private healthcare facilities will only be dispensed at private pharmacies
- Dispensing medications for patients with stable chronic diseases without visiting a physician unless it is necessary
- Coverage of all emergency services all over the world
- Coverage of a dead body repatriation costs
- Hospitalization in a single room at the healthcare facility
- Prior approval required for treatment, hospitalization and dental services, some outpatient diagnostic services, and a second medical opinion
The Abu Dhabi Basic Plan is offered to expatriate workers with a visa issued in Abu Dhabi. Pursuant to Abu Dhabi law, subscription to the health insurance scheme is compulsory for non-UAE nationals and their families who are residing and working in the Emirate (and optional for others). All employees and their family members should be covered by their employers. Every individual must provide cover for those they sponsor at the date of arrival in Abu Dhabi (for example, a husband sponsoring his wife).
HAAD has modified the Basic Plan to include age banding for certain age groups to cover their own costs of medical services through the introduction of co-payments and deductibles under the Basic Plan. Under the recent modifications to the Basic Plan, workers over the age of 40 may have to contribute up to 50% of their policy’s premium. However, this co-payment percentage is flexible and can be agreed between staff and their employers. Employees will also have to pay half of the policy’s premium for their dependents (e.g., wife and up to three children), depending on their dependents’ ages, if the employer does not agree to cover these costs. The cost of insurance for other dependents, such as parents, will also have to be fully borne by the individual.
In Dubai, the provision of health insurance by employers has been mandatory for both nationals and expatriates since 2014. However, the minimum cover requirements for nationals and non-nationals differs, with nationals able to access additional preventive and therapeutic health services in the Emirate free of charge. There are currently 12 insurers licensed to offer the basic package of care.
Companies in Dubai are required to register their employees with a private health insurer. Those with 1,000 or more employees had to register by the end of October 2014 and those with 100 to 999 by the end of July 2015. In the final phase of the rollout, smaller companies with fewer than 100 employees as well as domestic workers and employee dependents faced a fine ranging from Dh500 ($136) to Dh500,000 ($136,000) if they failed to register by the end of March 2017. As of mid-April 2017, 25 institutions and companies had been fined.,4
Before these modifications were introduced, the basic coverage was at an annual premium of Dh600 ($163). This has now increased to Dh800 ($218) for expatriate employees between the ages 18 to 59 and Dh5,500 ($1,497) for employees at the age of 60 and above. For married females between the ages of 18 to 50, there is an additional mandatory maternity surcharge of Dh750 ($204).
Regulations issued pursuant to the Dubai Law set out the Essential Benefits Plan (EBP) for the Mandatory Insurance Scheme in Dubai. The premium under the EBP is Dh500 ($136) to 700 ($191) per year to provide insurance services up to a total coverage amount of Dh150,000 ($40,838) per year. However, the EBP cover can only be sold by an insurer if it is specifically licensed to sell such plans. Such insurers are called Participating Insurers and can only offer their products to lower salaried band workers earning Dh4,000 ($1,089) or less. Other insurers licensed with a Health Insurance Permit (HIP) under the DHA licensing regime can offer “Enhanced Products” to residents not within the salary band mentioned above, and these will be typically underwritten medical products following the DHA’s Standard Notices, Circulars, and Policy Directives. The regulations also contain excluded healthcare services except in cases of medical emergencies, excluded (non-basic) healthcare services, and healthcare services outside the scope of health insurance.
The compulsory health insurance is linked to the visa system. As of 2017, the visa system will not accept applications from residents who do not have the mandatory health insurance cover. There is a parallel, ongoing project in which health insurance cards (that are provided to all insured individuals by health insurers) will be abolished, and information on the individual’s insurance will be captured on their national identity card (Emirates ID). Similar projects are being considered in other emirates. Indeed, Sharjah is planning to implement this from the very beginning of its mandatory health insurance system.
Supplemental insurance plans with international benefits in the UAE can be meaningfully stratified into three types: (1) plans for individuals who travel internationally and may have emergent healthcare needs; (2) plans offering coverage for international medical travelers outside of the US; and (3) plans including the option to receive care in the US. Table 12 lists some of the major health insurers that USCIPP has identified as having plans involving international care providers.
Table 12. Select major health insurers offering plans with international benefits in the UAE
|Aetna International||https://www.aetnainternational.com/en/employers/health-plans/summit-plans.html||Aetna Summittm – plans for expatriate employees while working in other countries; also advertises services for governments|
|Allianz Care||https://www.allianzworldwidecare.com/en/||Allianz Worldwide – plans for students and professionals while living in other countries|
|AXA||https://ae.axa-gulf.com/en/individuals/health-insurance||International plans – plans enable consumers to choose medical treatments in well-known hospitals in the Gulf region or anywhere in the world|
|MSH International||http://americas.msh-intl.com/index.php?option=com_content&view=article&id=122&Itemid=379&lang=en||MSH ExpaGard – “comprehensive international insurance to … expatriate employees on long-term assignments”|
|Cigna||https://www.cignaglobalhealth.com/why-cigna/network.html||CignaLinks – a specialized solution, providing coverage for employees living and working in other countries|
|Oman Insurance Company & Bupa Global||https://www.bupaglobal.com/en/campaigns/uae/international-health-insurance||Individual health plans – range of global health plans designed for those who want the ability to choose their treatment anytime, anywhere, be that in the UAE or abroad|
|UnitedHealthcare Group||https://www.uhcglobal.com/global-insurance/group-insurance/expatriate-insurance/||Global Insurance – plans for expatriates offering medical coverage|
|Blue Cross Blue Shield||https://www.geobluetravelinsurance.com/products/longterm/xplorer-5-overview.cfm||GeoBlue – plans for expatriates living and working in other countries|
Major healthcare providers
While public sector institutions play a relatively large role in UAE healthcare provision, the private sector is assuming an increasingly prominent role.
Public sector providers
SEHA is an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi. SEHA claims to be the largest healthcare network in the UAE, consisting of 12 hospitals, 46 primary healthcare clinics, 10 disease prevention and screening centers, three mobile clinics, one school clinic, two blood banks, four dental centers, two employee healthcare centers, and one vaccination center. SEHA’s flagship business entities are – in decreasing order of patients served – Tawam Hospital, Sheikh Khalifa Medical City, Al Ain Hospital, Al Gharbiya Hospitals, Al Mafraq Hospital, Al Rahba Hospital, and Corniche Hospital. Over the last several years, SEHA has embarked on the enlargement of its health facilities in the Western Region as well as several highly publicized expansions of Sheikh Khalifa Medical City, adding a dialysis center, psychiatry center, and pediatric dialysis unit. It has also added new facilities, such as Al Towayya Children’s Specialty Center in Al Ain. The chairman of the board of SEHA is Dr. Mohamed Rashid Al Nuaimi.
In addition to its role as a regulator, the DHA operates Dubai’s public healthcare facilities, including Dubai Hospital, Rashid Hospital, Latifa Hospital, and Hatta Hospital. As well as building new facilities, DHA continues to develop its existing facilities (for instance, by expanding the trauma center and gastroenterology unit at Rashid Hospital and adding a kidney transplant center at Dubai Hospital). In October 2018, it was announced that the UAE’s largest hospital would open, the Sheikh Shakhbout Medical Center. In addition, in the next two years the 4.4 billion AED ($1.2 billion) 719-bed New Al Ain hospital is scheduled to be completed.
As part of its role as a regulator as of January, 2019 the DHA is rating all private and public sector health facilities in Dubai on both their level of care and expertise.25
In addition to its countrywide regulatory functions, MOHAP directly manages public healthcare services in certain areas of the country. As of July 2019, the Ministry oversaw 17 hospitals and 81 clinics across the country, especially in the northern emirates. It has recently made a strong push to improve healthcare in the northern emirates through both the expansion of existing hospitals (such as Fujairah Hospital) and the construction of new specialist clinics and health centers. Beginning in 2017, the Ministry embarked on a major change whereby its hospitals will begin regularly catering to all residents instead of exclusively Emiratis.
The Medical Office of the Ministry of Presidential Affairs (MOPA) has made a major push to expand the quantity and quality of healthcare provision in the UAE, particularly in the northern emirates. MOPA funded the Dh750 million ($204 million) Sheikh Khalifa General Hospital in Umm Al Quwain, which officially opened in December 2012 and features clinics specializing in pediatrics, gynecology, emergency care, dialysis, and dermatology. MOPA also funded the Dh1 billion ($272 million) Sheikh Khalifa Specialty Hospital in Ras Al Khaimah, which officially opened in February 2015 and, at 248 beds, claims to be the largest specialist hospital in the Middle East. In September 2017, MOPA approved funding the 300-bed Sheikh Khalifa Central hospital in Fujairah at a cost of 866 million AED ($236 million).
Mubadala, an investment and development company established by the Abu Dhabi government, has actively spurred the development of healthcare in the Emirate through one of its sector verticals, Mubadala Healthcare. Mubadala Healthcare works with prominent international partners, such as Cleveland Clinic and Wooridul Hospital, to fill gaps left by public sector providers. Mubadala Healthcare assets include the Capital Health Screening Center, National Reference Laboratory, Cleveland Clinic Abu Dhabi, and Tawam Molecular Imaging Center. The executive director of Mubadala Healthcare is Mr. Abdulla Abdul Aziz Al Shamsi. In January of 2018, MOHAP and Mubadala entered into a MoU to improve health services across the UAE.
Members of UAE ruling families have also patronized healthcare in the UAE. In December 2008, Sheikh Mohammed bin Rashid Al Maktoum, vice president and prime minister of the UAE, announced the establishment of a dedicated 200-bed, Dh692 million ($188.4 million) children’s specialty hospital. Likewise, Sheikh Hamdan bin Mohammed, Sheikh Mohammed’s son and crown prince of Dubai, donated Dh22 million ($6 million) in March 2015 toward the completion of a new facility for the Dubai Autism Center.
Private sector providers
- Al Sharq Healthcare, a wholly owned division of the Fujairah National Group conglomerate, manages several healthcare facilities in the eastern part of the UAE. Its flagship facility is the 100-bed Al Sharq Hospital in Fujairah. It also runs four medical centers, two specialized clinics, and a chain of retail pharmacies.
- Arabian Healthcare Group is a global healthcare management and consulting firm set up in 2011 by the government of Ras Al Khaimah. Comprising a network of hospitals, diagnostic centers, pharmacies, and wellness services, its flagship facility is the 65-bed RAK Hospital, which is managed in cooperation with Sonnenhof Swiss Health.
- Aster DM Healthcare (Aster and Medcare), a Dubai-based healthcare company with 280 establishments in nine countries in the Middle East and India, operates seven healthcare facilities in the UAE under the high-end Medcare and midrange Aster brands. In January 2016, it announced that it had invested Dh1.25 billion ($340 million) in the construction of three projects in Abu Dhabi, two in Dubai, and two in Sharjah. It is currently planning to launch an initial public offering in India to continue its expansion plans.
- Avivo Group is a brand of premium medical practices offering specialized healthcare services in Abu Dhabi, Dubai, Sharjah, and Kuwait. As of June 2019, it owned 47 healthcare assets, including hospitals, clinics, and dentistry services.
- Gulf Medical Projects Company (GMPC) has several facilities in the UAE. In 1981, GMPC established the 132-bed Al Zahra Hospital Sharjah. Over a decade later, in 1993, GMPC opened its second facility, Al Zahra Medical Center Dubai. Then, in 2013, it inaugurated the 187-bed Al Zahra Private Hospital Dubai.
- King’s College Hospital, one of London’s largest teaching hospitals, opened a clinic in Abu Dhabi in November 2014. It recently opened a 100 bed facility Dubai Hills in Mohammed bin Rashid City as well as two other King’s College Hospital clinics.
- Mediclinic Middle East (Mediclinic and Al Noor), a branch of Mediclinic International, has five hospitals and 39 clinics with more than 700 inpatient beds in the UAE. This follows the reverse takeover by Al Noor Hospitals Group of the Johannesburg-based Mediclinic International Limited.
- The Middle East Healthcare Company, the largest healthcare provider in Saudi Arabia, owns and operates hospitals under the brand name Saudi German Hospitals. In March 2012, it opened the 316-bed Saudi German Hospital in Dubai, and in December 2014, it announced it would expand its UAE presence with a 300-bed facility in Ajman. Saudi German Hospitals Group and Ajman Bank merged via a financial agreement to build the Dh300 million ($82 million) Saudi German Hospital Ajman, a 200-bed facility in the Emirate of Ajman. The Saudi German Hospital of Ajman opened in April of 2019.
- NMC Healthcare claims to be the UAE’s largest private healthcare provider. A publicly listed company, it has around 40 facilities and over 6,000 employees in four emirates of the UAE. Moreover, it is rapidly expanding its operations. In 2016 it opened the NMC Royal Hospital in Khalifa City, a 500 bed facility. In the same year it acquired the Al Zahra Hospital in Sharjah. In 2018 it acquired the outstanding share share of Fakih IVF and a 70% stake in CosmeSurge a cosmetic surgery and aesthetic medicine provider.
- The Thumbay Group, an international business conglomerate headquartered in Dubai International Financial Center, claims to be one of the largest healthcare providers in the region. It operates a 250-bed hospital in Ajman, a 150-bed hospital in Dubai, a 60-bed hospital in Fujairah, and a medical and dental specialty center in Sharjah. It also runs a pharmacy chain, five diagnostic centers, and Gulf Medical University in Ajman.
- UEMedical, part of United Eastern Group, has a portfolio of healthcare projects in the UAE that includes a women and children’s hospital, 6 specialty centers, and 14 family clinics. UEMedical established the 150-bed Danat Al Emarat Hospital in Abu Dhabi, which opened in August 2015 and is managed by leading Singaporean healthcare provider ParkwayHealth. It also set up the HealthPlus network of premium outpatient centers and partnered with Moorfields Eye Hospital to launch Moorfields Eye Hospital Center in Abu Dhabi.
- VPS Healthcare (Burjeel, LLH, and Lifecare), an integrated healthcare provider, operates 20 hospitals in Abu Dhabi, Dubai, Oman, and India under the luxury Burjeel and the midrange LLH and Lifecare brands. VPS healthcare is developing the Burjeel Meical City in MBZ City in Abu Dhabi. This facility will be over 1 million square feet of facilities covering a wide array of healthcare services.
- The Zulekha Healthcare Group established Zulekha Hospital in Sharjah in 1992, which grew from a 30- bed facility to a 185-bed, 240,000 square-foot hospital. Since then, the Zulekha Healthcare Group has also established a 179-bed hospital in Dubai, a diagnostic center, three medical centers, and three pharmacies. In addition to its’ facilities in the UAE the Zulekha Healthcare Group has opened the Alexis Multispecialty Hospital a 210 bed hospital in Nagpur India.
According to the latest data from the Federal Competitiveness and Statistics Authority (FCSA), the UAE had 45 public hospitals and 98 private hospitals in 2017. The number of public hospitals was increased by 6 between 2016 and 2017, while the number of private hospitals rose by 5 in the same period. Despite this increase, the public sector still accounted for 54% of the UAE’s 13,312 beds in 2017.
In 2015, there were just 1.5 beds per 1,000 people, a comparatively low rate in the GCC region. The Economist Intelligence Unit predicts that the ratio will continue to improve despite an anticipated population growth of 1.4% annually in 2017-21.
Table 13. Government health services statistics, 2012-2017
|Number of hospitals||33||34||38||38||39||45|
|Number of beds||6,354||6,100||6,564||7,022||6,865||7,232|
|Number of clinics & centers||127||126||127||124||149||149|
|Number of physicians||5,224||7,076||7,453||6,952||7,018||8,322|
|Number of dentists||583||634||787||737||751||841|
|Number of nurses||13,974||15,442||17,464||16,832||16,453||20,480|
Table 14. Private sector health services statistics, 2010-201530
|Number of hospitals||65||73||78||88||93||98|
|Number of beds||3,281||3,660||4,051||5,412||5,725||6,080|
|Number of clinics & centers||3,350||3,531||3,866||4,228||4,522||4,819|
|Number of physicians||8,275||9,246||10,932||13,529||15,177||14,785|
|Number of dentists||2,560||2,547||3,222||4,179||4,414||4,848|
|Number of nurses||13,541||15,281||19,014||29,323||35,324||33,435|
Despite the availability of modern medical equipment, the shortage of health professionals in the UAE is limiting the standard of care. In 2017, there were 23,107 physicians in the UAE, a 4% increase from 22,195 in 2016. The number of private sector doctors fell by 2.6% year-on-year from 15,177 in 2016 to 14,785 in 2017. The number of nurses rose from 27,515 in 2012 to 53,915 in 2018, with private sector nurses accounting for 62.0% of the total. Currently, 80% of doctors and 90% nurses in the UAE are expatriates.
Over the coming years, the UAE will need an influx of medical personnel to meet its growing demand for high-quality medical services. HAAD projected in a September 2015 report that the Emirate will need 4,800 new doctors and 13,000 new nurses by 2022. Meanwhile, the director general of DHA estimated in early 2015 that Dubai will need 7,323 more doctors and 8,510 nurses over the next decade. The UAE will need certain types of medical personnel that are already in short supply.
- Nurses: The World Health Organization’s 2016 World Statistics Report found that the UAE had just 55.8 nursing and midwifery personnel for every 10,000 people. While this ratio is higher than many countries of the world, it is lower than most Gulf States, including Kuwait (69.7), Saudi Arabia (57), and Qatar (66.0). It is also lower than most Western countries, such as the United Kingdom (82.8), France (96.9), and Germany (132.0).
- Psychiatrists: The World Health Organization’s 2016 report also found that the UAE had one of the lowest ratios of psychiatric beds per head in the world, with just under 1 bed for every 100,000 people.
- Other medical specialists: These shortages extend beyond nurses and psychiatrists to other medical specialists as well. Even in relatively affluent Abu Dhabi, HAAD found in 2014 that there was a severe shortfall in specialist healthcare workers, especially those in intensive and critical care medicine, emergency care, neonatology, pediatrics, oncology, orthopedics, rehabilitation, and psychiatry.
Several factors will complicate adequate staffing of qualified medical personnel in the years to come.
- There are shortages of skilled Emirati medical professionals, partly due to prevailing cultural norms.
- The threat of criminal proceedings for medical treatment complaints discourages some foreign medical professionals from working in the UAE.
- The northern emirates, Abu Dhabi’s Western Region, and more rural areas of the UAE face difficulties recruiting and retaining talent.
- There tends to be high turnover among expatriate medical staff, as many medical personnel consider the UAE either a temporary locale or a stepping-stone to gain experience before seeking careers in the West.
Like other countries in the GCC, the UAE is currently investing in a number of projects to meet the growing demand for healthcare services.
- Burjeel Medical City, Abu Dhabi is a healthcare area, containing a multispecialty hospital focusing on specialties such as oncology, acute care, and long-term care.
- Mediclinic City Hospital expansion (130 beds) and New Mediclinic Parkview Hospital, Dubai (220 beds) which opened in September of 2018.
- University Hospital DHCC is a 400-bed general hospital with academic medical and postgraduate programs expected to come online in 2018.
- Saudi German Hospital in Ajman is a multispecialty hospital with 150 beds set up to serve patient needs in the northern emirates. It opened in the first quarter of 2019.
- Sheikh Moh’d Bin Rashid Trauma Center is a 220-bed facility being set up in close proximity to Expo 2020 developments.
- Fakeeh Academic Medical center is a 300-bed university hospital in Dubai Silicon Oasis in association with Fakeeh Medical University. The hospital will specialize in diabetes and endocrinology, muscles, bone and joints, emergency medicine, and pulmonary medicine and cardiology. It is scheduled to open before the end of 2019.
In line with the UAE’s Vision 2021, the UAE has recently made a major push to reduce the incidence of chronic diseases by adopting relevant legislation and launching public health campaigns.
Above all, the UAE has focused on combating smoking. In January 2014, the UAE announced the implementation of a new law that, among other things, made it illegal to smoke in houses of worship, universities, and schools; prohibited smoking in a vehicle when a child under 12 was present; forbade the sale of cigarettes to individuals under the age of 18; banned all tobacco advertising and promotion; and mandated a large warning label on the packaging of tobacco products. Building on this legislation, in November 2014, MOHAP announced a nationwide ban on smoking in all enclosed public spaces, and it also announced the construction of eight new anti-smoking clinics to have at least two such clinics in each emirate by the end of 2015. In 2017 the UAE introduced an excise tax of 100% on tobacco products.
In addition to implementing anti-smoking measures, the UAE has made strident efforts to promote early cancer detection. In September 2015, MOHAP launched an official cancer screening initiative to raise awareness about cancer and the importance of early detection through regular medical check-ups. This initiative complemented the longstanding efforts of the Friends of Cancer Patients. Founded by Sheikha Jawaher bin Mohammed Al Qasimi, this group has organized the high-profile “Pink Caravan” every year since 2011 to raise awareness about breast cancer early detection and screening. Beginning in 2018, MOHAP began regularly offering free breast cancer screenings across the UAE.
On top of its efforts to combat smoking and cancer, the UAE has tried to fight growing rates of obesity and associated ailments through regulation and taxation of the food industry. Along these lines, in December 2013, the UAE cabinet announced that it would require calorie counts to be printed on food products, limit the size of soft drinks that can be sold, regulate advertising of fast food, and enforce healthy food standards at school cafeterias. In 2017 the UAE introduced an excise tax of 50% on sugary beverages. UAE health authorities have complemented these efforts with additional initiatives. For instance, HAAD has launched the Weqaya program, which screens individuals for cardiovascular disease, diabetes, and the risk factors associated with these two ailments. UAE nationals must undergo Weqaya screening to qualify for the elite Thiqa health insurance program.
The UAE pharmaceutical market is growing at a rapid rate. In 2016, according to BMI figures cited by the UAE Ministry of Health and Prevention, UAE pharmaceutical sales were worth 9.61 billion AED [$2.62 billion], up from 8.84 billion AED [$2.41 billion] in 2015. These sales are expected to increase at a compound annual growth rate of 8.2% to reach 13.13 billion AED [$3.58 billion] by 2020 and 14.11 billion AED [$3.84 billion] by 2021.
The UAE follows a very strict marketing approval process for drugs with US Food and Drug Administration and European manufacturing licenses to avoid counterfeits. The prices of medicines are fixed by MOHAP. A review of the drug market by the Ministry in 2010 found that drug prices in the UAE were higher than in neighboring countries and prompted a series of price cuts focusing on treatments for chronic illnesses.
After cuts in December 2017 the review has led to price cuts on over 8,700 different pharmaceutical products. The move has achieved the intended goal of reducing prices of almost 80% of all innovative drugs since the first round of price cuts in 2011.
Table 15. List of hospitals in the UAE with active JCI accreditation
|Abeer Al Noor Polyclinic||Dubai||Clinical Laboratory Program||2016|
|Advanced Care Medical Center||Dubai||Clinical Laboratory Program||2016|
|Ain Al Khaleej Hospital||Al Ain||Hospital Program||2014|
|Airport Medical Center – Rashid Hospital||Dubai||Ambulatory Care Program||2010|
|Al Ahalia Hospital||Abu Dhabi||Hospital Program||2010|
|Al Ain Fertility Center||Al Ain||Ambulatory Care Program||2018|
|Al Ain Hospital||Al Ain||Hospital Program||2010|
|Al Amana Home Health Care LLC||Abu Dhabi||Home Care Program||2017|
|Al Dhafra Family Medicine Center||Abu Dhabi||Primary Care Program||2012|
|Al Dhaid Hospital||Sharjah||Hospital Program||2015|
|Al Khail Medical Center||Dubai||Clinical Laboratory Program||2015|
|Al Kuwait Hospital||Dubai||Hospital Program||2015|
|Al Manama Primary Healthcare Center||Ajman||Primary Care Program||2015|
|Al Marfa Hospital||Abu Dhabi||Hospital Program||2013|
|Al Mashaher Medical Center||Dubai||Laboratory||2017|
|Al Oraibi Hospital||Ras Al Khaima||Ambulatory care Program||2017|
|Al Qasimi Hospital||Sharjah||Hospital Program||2018|
|Al Qassimi Women & Children Hospital||Sharjah||Hospital Program||2018|
|Al Rahba Hospital||Abu Dhabi||Hospital Program||2006|
|Al Rashidiya Al Noor Polyclinic||Dubai||Laboratory||2017|
|Al Salama Hospital||Abu Dhabi||Hospital Program||2010|
|Al Sharq Hospital||Fujairah||Hospital Program||2013|
|Al Shrooq Health Services Center||Al Ain||Home Care Program||2017|
|Al Tadawai Medical Center||Deira Dubai||Ambulatory Care Program||2017|
|Al Taif Medical Center||Dubai||Clinical Laboratory Program||2014|
|Al Zahra Private Hospital Dubai||Dubai||Hospital Program||2014|
|Al Zahrawi Hospital LLC||Ras Al Khaimah||Amulatory Care Program||2018|
|AlAmal Psychiatric Hospital||Dubai||Hospital Program||2019|
|Ali Medical Center||Dubai||Clinical Laboratory Program||2016|
|Amana Healthcare Medical and Rehabilitation Hospital||Abu Dhabi||Long Term Care Program||2017|
|Ambulatory Healthcare Services (Network)||Abu Dhabi||Ambulatory Care Program||2012|
|American Academy of Cosmetic Surgery Hospital||Dubai||Hospital Program||2009|
|American Hospital Dubai||Dubai||Hospital Program||2000|
|Americare L.L.C.||Abu Dhabi||Home Care Program||2016|
|Amina Hospital||Ajman||Hospital Program||2018|
|Apple International Polyclinic||Dubai||Laboratory||2018|
|Arab Euro Home Nursing LLC||Abu Dhabi||Home Care Program||2017|
|Aster Hospital Mankhool Dubai||Dubai||Hospital Program||2016|
|Aster Jubilee Medical Complex||Dubai||Ambulatory Care Program||2015|
|Bayti Home Healthcare LLC||Abu Dhabi||Home Care Program||2017|
|Belhoul European Hospital LLC||Dubai||Hospital Program||2009|
|Belhoul Speciality Hospital||Dubai||Hospital Program||2009|
|Beverly Hills Medical Center||Abu Dhabi||2018|
|Biosytech Medical Laboratory||Dubai||Clinical Laboratory Program||2009|
|Bourn Hall Clinic||Dubai||Ambulatory Care Program||2016|
|Burjeel Home Care Services LLC||Abu Dhabi||Home Care Program||2017|
|Burjeel Hospital||Abu Dhabi||Hospital Program||2013|
|Burjeel Hospital For Advanced Surgery||Dubai||Hospital Program||2015|
|Cambridge Medical Rehabilitation Center||Abu Dhabi||Long Term Care Program||2015|
|Canadian Specialist Hospital, Abu Hail||Dubai||Hospital Program||2011|
|Central Private Hospital||Sharjah||Hospital Program||2017|
|Cleveland Clinic Abu Dhabi||Abu Dhabi||Hospital Program||2016|
|Conceive Gynaecology and Fertility Center – Network||Sharjah||Ambulatory Care Program||2017|
|Corniche Hospital||Abu Dhabi||Hospital Program||2007|
|Curewell Diagnostic Center||Dubai||Clinical Laboratory Program||2010|
|Danat Al Emarat Hospital for Women and Children||Abu Dhabi||Hospital Program||2018|
|Dar Al Shifaa Hospital||Abu Dhabi||Hospital Program||2011|
|Deira City Medical Diagnostic Center||Dubai||Clinical Laboratory Program||2014|
|DHA Medical Fitness Services – Network||Dubai||Ambulatory Care Program||2018|
|Dr. A.R. Shamma Medical Center||Dubai||Ambulatory Care Program||2009|
|Dr. Abdul Rahman Shihabi Clinic||Dubai||Clinical Laboratory Program||2013|
|Dr. Azzam Al Abdul Razzak Clinic||Dubai||Clinical Laboratory Program||2012|
|Dr. Badani Diagnostic Center||Dubai||Clinical Laboratory Program||2014|
|Dr. Faris Medical Laboratory||Dubai||Clinical Laboratory Program||2013|
|Dr. Ismail Polyclinic Clinical Laboratory||Dubai||Clinical Laboratory Program||2013|
|Dr. Sanjay Medical Center||Dubai||Clinical Laboratory Program||2016|
|Dr. Sirajudeen Medical Center||Dubai||Clinical Laboratory Program||2014|
|Dr. Sulaiman Al Habib Hospital, Dubai||Dubai||Hospital Program||2015|
|Dr. Taher H. Khalil Clinic||Dubai||Clinical Laboratory Program||2013|
|Dubai Aluminum Company LTD Clinic||Dubai||Clinical Laboratory Program||2014|
|Dubai Health Authority Primary Healthcare Service Sector (Network)||Dubai||Primary Care Program||2016|
|Dubai Dental Hospital||Dubai||Ambulatory Care Program||2018|
|Dubai Diabetes Center (DDC), Specialized Healthcare Sector (SHS), Dubai Healthcare Corporation (DHC), HQ||Dubai||Ambulatory Care Program||2018|
|Dubai Healthcare Centers – (Networks)||Dubai||Primary Care Program||2018|
|Dubai Hospital||Dubai||Hospital Program||2007|
|Dubai London Clinic||Dubai||Laboratory||2017|
|Dubai London Clinic and Specialty Hospital||Dubai||Hospital Program||2017|
|Dubai London Clinic Festival City||Dubai||Ambulatory Care Program||2018|
|Dubai Police General||Dubai||Ambulatory Care Program||2015|
|Dulsco Medical Clinic||Dubai||Clinical Laboratory Program||2019|
|Elite Medical Center||Dubai||Clinical Laboratory Program||2019|
|Elitecare Health Home Center LLC||Abu Dhabi||Home Care Program||2018|
|Emirates French Hospital||Abu Dhabi||Home Care Program||2017|
|Emirates Hospital||Dubai||Hospital Program||2009|
|Emirates International Hospital||Al Ain||Hospital Program||2011|
|Emirates Specialized Laboratory (A Branch of Alborg Medical Laboratory – GCC)||Dubai||Clinical Laboratory Program||2012|
|Emirates Speciality Hospital||Dubai||Laboratory||2018|
|Exeter Medical Center For Bone & Joint Health||Abu Dhabi||Ambulatory Care Program||2016|
|Ganin Medical Center||Sharjah||Ambulatory Care Program||2018|
|General Medical Center Laboratory||Dubai||Clinical Laboratory Program||2014|
|Ghayathai Community Hospital||Abu Dhabi||Hospital Program||2016|
|Gulf Diagnostic Center Hospital||Abu Dhabi||Hospital Program||2009|
|Gulf International Cancer Center||Abu Dhabi||Ambulatory Care Program||2011|
|Hatta Hospital||Hatta||Hospital Program||2017|
|Health Plus Medical Services L.L.C.||Abu Dhabi||Ambulatory Care Program||2018|
|Health Point Hospital LLC||Abu Dhabi||Hospital Program||2016|
|Health Shield Medical Center||Abu Dhabi||Ambulatory Care Program||2018|
|HMS Al Garhoud Private Hospital and External Clinics||Dubai||Hospital Program||203|
|Ibrahim Bin Hammed Obaidullah Hospital||Ras Al Khaima||Hospital Program||2015|
|Imperial College London Diabetes Center||Abu Dhabi||Ambulatory Care Program (also certified for Outpatient Diabetes since 2010)||2009|
|International Modern Hospital||Dubai||Hospital Program||2007|
|Jehad International Medical Clinic||Dubai||Ambulatory Care Program||2012|
|Jwan Murad Medical Center & IVF & Test-Tube Babies||Sharjah||Ambulatory Care Program||2017|
|Kalba Hospital||Kalba||Hospital Program||2013|
|Karama Medical Center||Dubai||Clinical Laboratory Program||2015|
|Khalidha Medical Center L.L.C||Dubai||Clinical Laboratory Program||2016|
|Latifa Women and Children Hospital||Dubai||Hospital Program||2007|
|Lifecare Hospital L.L.C||Abu Dhabi||Hospital Program||2015|
|Lifecare Hospital, LLC, Branch – 1||Abu Dhabi||Hospital Program||2015|
|Lifewise Home Healthcare LLC||Abu Dhabi||Home Care Program||2017|
|LLH Hospital||Abu Dhabi||Hospital Program||2009|
|LLH Hospital (Musaffah)||Abu Dhabi||Hospital Program||2012|
|Long Term Medical and Rehabilitation Hospital LLC||Al Ain||Long Term Care Program||2014|
|Madinat Zayed Hospital||Abu Dhabi||Hospital Program||2011|
|Mafraq Hospital||Abu Dhabi||Hospital Program||2011|
|Magrabi Eye and Ear Center – Daycare Surgery Center – Mushrif Branch||Abu Dhabi||Ambulatory Care Program||2013|
|Magrabit Eye Center – Day Care Surgey||Al Ain||Ambulatory Care Program||2017|
|Magrabi Eye Hospital – Outpatient Surgery Center||Dubai||Ambulatory Care Program||2014|
|Manzil Health Care Services||Abu Dhabi||Home Care Program||2016|
|Medcare Hospital L.L.C.||Dubai||Hospital Program||2007|
|Medcare Orthopaedics and Spine Hospital||Dubai||Hospital Program||2013|
|Medcare Women & Children Hospital||Dubai||Hospital Program||2019|
|Medeor 24*7 Dubai||Dubai||Hospital Program||2016|
|Medeor 24×7 Hospital||Abu Dhabi||Hospital Program||2016|
|Medeor 24×7 International Hospital||Abu Dhabi||Hospital Program||2019|
|Medical Services Department, General Directorate for Finance and Services, Abu Dhabi Police GHQ, Ministry of Interior||Abu Dhabi||Ambulatory Care Program||2014|
|Medical Specialists Center Al Barsha Laboratory||Dubai||Clinical Laboratory Program||2015|
|Mediclinic Airport Road Hospital||Abu Dhabi||Hospital Program||2009|
|Mediclinic City Hospital||Dubai||Hospital Program||2010|
|Mediclinic Dubai Mall||Dubai||Ambulatory Care Program||2013|
|Mediclinic Middle East (Network)||Dubai||Ambulatory Care Program||2013|
|Mediclinic Middle East (Network)||Abu Dhabi||Ambulatory Care Program||2016|
|Mediclinic Ibn Battuta Network||Dubai||Ambulatory Care Program||2019|
|Mediclinic Welcare Hospital||Dubai||Hospital Program||2010|
|Medicorp Gulf Medical Clinic||Dubai||Laboratory||2017|
|Medinova Diagnostic Center||Dubai||Clinical Laboratory Program||2008|
|Medsol Al Abbar Laboratory for Research and Medical Analysis||Dubai||Clinical Laboratory Program||2010|
|Medsol Dubai Medical Laboratory||Dubai||Clinical Laboratory Program||2009|
|Medsol Histopathology and Specialty Laboratory||Dubai||Clinical Laboratory Program||2009|
|Micro Health Medical Laboratories||Deira||Clinical Laboratory Program||2014|
|Musherif Healthcare Center||Ajman||Primary Care Program||2015|
|Naif Medical Center||Dubai||Laboratory||2018|
|Nasser Medical Consultant Center||Dubai||Clinical Laboratory Program||2013|
|National Ambulance||Abu Dhabi||Medical Transport Program||2014|
|Neuro Spinal Hospital||Dubai||Hospital Program||2013|
|New Apollo Polyclinic||Dubai||Clinical Laboratory Program||2014|
|New Hope Gynaecology & Fertility Hospital||Sharjah||Ambulatory Care Program||2017|
|New Medical Center Specialty Hospital||Dubai||Hospital Program||2009|
|New Medical Center Specialty Hospital||Al Ain||Hospital Program||2009|
|NMC ProVita International Medical Center||Abu Dhabi||Long Term Care Program||2013|
|NMC Royal Hospital LLC||Abu Dhabi||Hospital Program||2017|
|NMC Royal Women’s Hospital||Abu Dhabi||Hospital Program||2017|
|NMC Specialty Hospital LLC||Abu Dhabi||Hospital Program||2010|
|Nurses Without Borders Home Healthcare||Al Ain||Home Care Program||2017|
|Oasis Hospital||Al Ain||Hospital Program||2007|
|Obaidallah Geriatric Hospital||Ras Al Khaima||Hospital Program||2017|
|Oriana Hospital for One Day Surgery||Sharjah||Ambulatory Care Program||2018|
|Orthoplus Bone and Joint Center||Al Ain||Ambulatory Care Program||2019|
|PH Diagnostics||Dubai||Clinical Laboratory Program||2015|
|Primary Healthcare Centers in Dubai-Ministry of Health and Prevention (Network)||Dubai||Primary Care Program||2016|
|Primary Healthcare Centers in Sharjah||Sharjah||Primary Care Program||2015|
|Primary Healthcare Centers in Umm Al Quwain-Ministry of Health and Prevention (Network)||Umm AlQaiwain||Primary Care Program||2016|
|Prime Hospital||Dubai||Hospital Program||2016|
|Prime Medical Center LLC, Deira||Dubai||Ambulatory Care Program||2016|
|Qamar Al Madina Medical Center||Dubai||Laboratory||2017|
|RAK Hospital||Ras Al Khaimah||Hospital Program||2008|
|Ras Al Khaima Health Centers – Network||Ras Al Khaima||Primary Care Program||2018|
|Ras al Khaimah College of Dental Sciences Fzc Medical Center||Ras Al Khaimah||Ambulatory Care Program||2014|
|Rashid Center for Diabetes and Research||Ajman||Ambulatory Care Program||2013|
|Rashid Hospital||Dubai||Hospital Program (also certified for Acute Myocardial Infarction Program since 2009)||2007|
|Ruwais Hospital||Al Ruwais||Hospital Program||2015|
|Samaya Specialized Center||Abu Dhabi||Ambulatory Care Program||2016|
|Saudi German Hospital – Dubai||Dubai||Hospital Program||2013|
|Sharjah International Holistic Health Center||Sharjah||Ambulatory Care Program||2016|
|Sheikh Khalifa General Hospital||Umm AlQaiwain||Hospital Program||2015|
|Sheikh Khalifa Medical City||Abu Dhabi||Hospital Program||2008|
|Sheikh Khalifa Specialty Hospital||Ras Al Khaimah||Hospital Program||2016|
|Sheikh Khalifa Women and Children Hospital||Ajman||Hospital Program||2013|
|Sunny Specialty Medical Center||Sharjah||Clinical Laboratory Program||2015|
|Tawam Hospital||Al Ain||Hospital Program||2006|
|Thalassemia Center||Dubai||Ambulatory Care Program||2007|
|Thumbay Hospital, Ajman||Ajman||Hospital Program||2013|
|Thumbay Hospital, Dubai||Dubai||Hospital Program||2016|
|Thumbay Hospital, Fujairah||Fuhairah||Hospital Program||2016|
|Thuriah Medical Center||Riyadh||Ambulatory Care Program||2019|
|Trust Medical Laboratory||Al Mamzar||Clinical Laboratory Program||2013|
|Universal Hospital – Al Ain||Al Ain||Hospital Program||2015|
|Universal Hospital LLC||Abu Dhabi||Hospital Program||2016|
|University Hospital Sharjah||Sharjah||Hospital Program||2015|
|UpToDate Medicare Center||Dubai||Clinical Laboratory Program||2013|
|Valiant Healthcare LLC||Dubai||Ambulatory Care Program||2018|
|Yas Healthcare LLC||Abu Dhabi||Ambulatory Care Program||2019|
|York Diagnostic Laboratories, JLT||Dubai||Clinical Laboratory Program||2013|
|Zayed Military Hospital||Abu Dhabi||Hospital Program||2011|
|Zulekha Hospital||Dubai||Hospital Program||2007|
|Zulekha Hospital Sharjah||Sharjah||Hospital Program||2007|
USCIPP members’ involvement in the UAE
Several USCIPP members have active collaborations with organizations in UAE. Publicly available information about some notable relationships is available on the USCIPP International Healthcare Collaborations Map.
Inbound medical travel
As part of Health Strategy 2021, Dubai aims to attract 500,000 foreign patients a year by encouraging investment in the sector’s infrastructure and in e-health systems. Government officials estimate that revenue from medical tourism will reach Dh2.6 billion ($708 million) in 2020.
In 2016, the Emirate of Dubai had 326,649 medical tourists, generating $381 million in revenue. This is a 9.5 % increase over 2015, and the most popular areas of treatment were orthopedics, dermatology, and ophthalmology.
Asians are the largest international patient group, accounting for 37% of visitors. Arab and GCC countries accounted for 31%, and Europe amounted to 15% of the total, with all other markets accounting for the remaining 17%. These statistics are international patients and include expatriates working in Dubai and elsewhere in the UAE; the government doesn’t clarify which countries are included in each region.
The DHA and the General Directorate of Residency and Foreign Affairs Dubai signed a MoU to promote medical tourism in Dubai, exchange knowledge, and elevate health services offered at DHA facilities. The MoU aims to strengthen Dubai’s position as a global destination for medical tourism by easing visa procedures for medical tourists seeking treatment in Dubai. As part of the MoU, both parties will also join hands in promoting their services that support medical tourism in Dubai and coordinate to establish a mechanism to issue medical tourism visas for patients coming from abroad.
Telemedicine and remote second opinions in the UAE
In order to market healthcare services in the UAE, a healthcare provider must establish a legal presence and hold a commercial license to do business in the UAE (or in a free zone in the UAE) and also hold the relevant healthcare provider license. The authorities that regulate the licensing of healthcare in Abu Dhabi; Dubai; and DHCC are HAAD, DHA, and DHCCA, respectively.
Abu Dhabi has a sophisticated regulatory regime for telemedicine and has issued a telemedicine license to the Abu Dhabi Telemedicine Center. However, telemedicine licensing has been suspended in Abu Dhabi for the time being, and it is not known if or when such suspension will be lifted. If the suspension were lifted, a healthcare facility wishing to provide teleconsultation services based in Abu Dhabi would need to be a HAAD-licensed healthcare facility specifically licensed to provide teleconsultation or an existing HAAD licensed facility that is authorized by HAAD to provide teleconsultation. Additionally, HAAD allows physician-to-physician teleconsultation in the following circumstances: 
- If a patient’s access to services is limited by capacity or remoteness (e.g., lack of clinical service line or specialty area or underserved areas), a requesting healthcare professional must only practice within their HAAD license
- The treating specialist has limited skills in the concerned specialty area, but their practice remains within their HAAD license and privileges granted by the employing facility
- Complex case that requires input and support from other specialists and/or a multidisciplinary team
The DHA regulations do not address the practice of telemedicine in Dubai, with the exception of providing for teleradiology services, and the DHA is not issuing licenses to practice telemedicine at this time.
The DHCC appears to be taking the lead in the region for the development of telemedicine, and one telemedicine establishment licensed by DHCCA has been operating in DHCC for four years. The DHCCA licenses telemedicine to entities operating as outpatient clinics. An entity in the DHCC can take the form of a free zone limited liability company, a branch of a foreign company, or a branch of a UAE company. An advantage of practicing telemedicine in DHCC is that because it is a free zone, there are no national restrictions on foreign companies wishing to establish a legal presence in DHCC. One of the key drawbacks in practicing telemedicine in the UAE at this time is that it is unlikely that any regulator will allow a healthcare provider to prescribe medication for patients without an in-person consultation. Currently, telemedicine practices in Abu Dhabi aren’t allowed to prescribe medication per HAAD regulations, with the exception of over-the-counter medications. The telemedicine practice operating in DHCC doesn’t prescribe medication without an in-person consultation, but there aren’t any regulations limiting medication prescriptions in Dubai.
Current telemedicine and RSO programs
Abu Dhabi Telemedicine Center is a joint venture between Mubadala and Switzerland’s leading telemedicine provider, Medgate. The center was established to address the overutilization of outpatient visits in the UAE by offering insured patients the opportunity to speak with a doctor regarding diagnosis and treatment. Doctors can prescribe over-the-counter medications or refer the patient to a nearby specialist if a prescription is required. The clinic, based on Al Maryah Island, has 11 full-time doctors who work in shifts to cover the calls 24/7. The center offers consultations in both English and Arabic.
In 2016, DHA launched a pilot telehealth project. As part of the pilot, a robot was placed in Hatta Hospital’s emergency department and linked to Rashid Hospital’s Trauma Center. Multiple specialists from the Trauma Center can provide immediate consultations for a patient in Hatta Hospital. Thus, the RoboDoc will help reduce transfer of patients to Rashid Hospital’s Trauma Center and enhance the function of other DHA emergency departments and ICUs. Another robot was placed in the Nad Al Hammar primary 24-hour healthcare center, and again this robot will be linked to Rashid Hospital’s trauma center so specialties can provide immediate medical care. The pilot of the RoboDoc program was completed in March 2017 and DHA announced that it plans to expand the service to all DHA hospitals and health centers.
DHA and UAE-based Etisalat are partnering to implement a telemedicine program in Dubai intended to speed the start of effective treatment to stroke and heart attack victims. Paramedics will gain access to JOIN, a system that sends patients’ ECGs to hospitals from an in-route ambulance. The program was launched as a pilot study at Rashid Hospital’s stroke unit and may be expanded to other DHA hospitals and private hospitals with stroke units in 2018. JOIN is already in use in Japan and Brazil, but Dubai is its first application in the Middle East.,
A regulatory framework for telemedicine has been completed and, in the future, helpline numbers will be available for people to make medical queries under DHA’s ongoing rollout of policies and plans across different specialties, under its Strategy 2021. Phase 1 allows doctors in Dubai to be connected remotely as part of a testing phase project.
Author Contact Information
Callie Lambert (email@example.com; +1 312.563.6856)
Research Manager, USCIPP
Jarrett Fowler, MPPA (firstname.lastname@example.org; +1 312.563.3554)
Senior Manager, USCIPP
Tricia Johnson, PhD (tricia_j_Johnson@rush.edu; +1 312.942.7107)
Research Director, USCIPP
Professor and Associate Chair of Research & Education, Department of Health Systems Management, Rush University
Director, Rush Center for the Advancement of Healthcare Value
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