The United Arab Emirates (UAE) is a confederation of seven emirates. The most well-known are Dubai and Abu Dhabi. The other emirates are Sharjah, Ajman, Fujairah, Umm al-Qaiwain and Ras al-Khaimah, often collectively referred to as the 'Northern Emirates'. At the federal level, the UAE operates within a constitutional framework, which makes provision for the health and welfare of the population in that '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'.2
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, and 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 (DOH), the Dubai Health Authority (DHA) and the Sharjah Health Authority respectively, and 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 the 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 specialised treatment, encourage medical tourism, and is a key driver in widening the scope of services provided and building a healthcare sector that is supported by private sector and insurance investment.
In 2020 the healthcare sector was hit very hard by the arrival of the covid-19 pandemic. The health regulators issued numerous instructions to public and private sector operators on the handling of the situation and as we now emerge into the post-covid-19 environment we examine how some of those measures have accelerated the transformation of the health sector into the digital era. A number of these measures are discussed in this chapter, but this is not an exhaustive account of the collective effort to fight covid-19.
The healthcare economyi General
The status of the healthcare economy in the UAE is inextricably linked to the general economy and the government's policy of diversification away from the oil and gas sector. The indications for the general economy predicted by the IMF in April 2021 are that the UAE will grow 3.1 per cent in 2021. The National Agenda 2021 includes the objective of making the UAE a world-class healthcare system. Currently ranked 42 in the Healthcare Quality Index, a range of measures are currently under discussion to achieve this objective, and improve basic health outcomes, health infrastructure and preventative care, and physical and mental health satisfaction.3ii The role of health insurance
The Insurance Authority established under Federal Law No. 6 of 2007 (as amended) introduced mandatory health insurance across the UAE.4 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.
Primary/family medicine, hospitals and social carei Primary/family medicine
UAE patients can directly access medical specialist consultants without first transitioning through a primary care service. Direct access to specialist services is responsible for pushing up the costs of healthcare for both the government and insurers, with patients 'shopping' for services and seeking advice from a number of specialists for the same complaint.
Direct access is now being curtailed, with primary care becoming an increasing focus for healthcare regulators, with a view to improving the coordination of treatment throughout a continuum of care. The goal is the delivery of healthcare throughout the entire life cycle, in a process extending from the initial visit to a primary care physician, through the referral process, to the completion of treatment. Initiatives such as these should produce developments in the use of the expertise of primary care professionals through care pathways, and coordinated care between primary, secondary and tertiary healthcare services.
The DOH identified the need for primary care gateways as part of the emirate's master plan for delivery of healthcare services, and recently issued a standard for primary healthcare services in 2016.7 Similarly, the DHA has approved licences for 20 healthcare centres and clinics around the emirate providing primary healthcare services.
Insurers are increasingly taking the lead on adjusting health insurance policy terms and conditions to require patients to access primary care services and to have appropriate referrals from primary gateway providers before approving fees. In terms of future developments, as the UAE rolls out licensing for telehealth services, we also expect the ability of patients to access teleconsultation pathways.8, 9ii HospitalsPublic sector
The main public sector institutions that oversee delivery of healthcare services and quality are the DHA (with its subsidiaries the Healthcare Corporation and the Dubai Healthcare Insurance Corporation (DHIC)), the Abu Dhabi Health Services Company (SEHA) and the MOHAP. Within the scope of secondary care services provided by public hospitals are trauma facilities, obstetrics and gynaecology, orthopaedic, surgical services and the treatment of lifestyle diseases. The policy aim is to overlay these with more specialised services.
The DHA operates Dubai's public healthcare facilities, including Dubai Hospital, Rashid Hospital, Latifa Hospital and Hatta Hospital. It is currently building new facilities and expanding the range of services, including gastroenterology, a kidney transplant centre and specialist paediatric services.
SEHA is an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi, consisting of 12 hospitals, 46 primary healthcare clinics, 10 disease prevention and screening centres, along with mobile clinics, a school clinic, blood banks, dental centres and a vaccination centre.10
Mubadala Healthcare, a division of the Abu Dhabi government investment vehicle Mubadala Development Company, has also played a prominent role in the provision of public healthcare services, also catering for privately insured or high net worth self-paying patients. Projects include the Cleveland Clinic-Abu Dhabi, Healthpoint Hospital, the Imperial College London Diabetes Centre and the Abu Dhabi Telemedicine Centre.
The MOHAP manages public healthcare services in the Northern Emirates, overseeing 16 hospitals and over 60 clinics. While historically servicing the Emirati population, MOHAP will soon extend services to all residents, such as through Ras al-Khaimah's flagship Sheikh Khalifa Specialist Hospital under the management of Seoul National University Hospital, and which now offers specialist cancer services.Private sector
The expansion of the private sector is well advanced and expected to play a significant role in the provision of healthcare in the future, with recent amendments to Federal Law No. 4 of 2015 (on Private Health Facilities), and Law No. 22 of 2015 Regulating Partnership between the Public Sector and the Private Sector in the Emirate of Dubai. For further details pertaining to private-sector hospitals, see Section IV.11iii Social care
The Ministry of Community Development was created to oversee social care in the UAE,12 and largely focuses on development projects for Emirati families and persons with special needs. Since social care laws were first introduced in the 1970s, the concept of social care has remained immature. There has been very little focus on geriatric or dementia care services, resulting in an underdeveloped network supporting the transition of elderly or vulnerable patients from hospital care to home care with appropriate social care support. This burden was typically left to families to bear, but they will now benefit from additional support being made available through new initiatives by this Ministry and through the establishment of a Community Development Authority in Dubai, and a Department of Community Development in Abu Dhabi. There are now a number of initiatives in place that support transition to home care, such as a collaboration in Abu Dhabi to transition patients from Cleveland Clinic Abu Dhabi to Amana Home Care services, enabling good quality home care.iv Data and patient health information
The UAE does not have a comprehensive data protection law. Privacy obligations stem from legal duties under the Penal Code as to the use or disclosure of 'secrets' without the consent of the person to whom the secret relates.13 However, there have been developments regarding new provisions that apply specifically in a healthcare context.
Federal Law No. 2 of 2019 (with implementing regulations), concerning the Use of Information and Communications Technology in Health Fields, regulates the use of information and communication technology in the areas of health in the country.14 The Law aims to achieve (among other things) the following objectives:
- require health authorities to set standards for the confidentiality and control of electronic patient records;
- create a central health record storage system; and
- restrict the transfer of patient health data outside the country without permission granted by the health authority, or in an exempt category.
The following laws also make provision for patient confidentiality, and remain in place alongside the new law.
Federal Law No. 5 of 2019 (concerning the Practice of Human Medicine Profession), which governs doctors licensed in the UAE, provides that in the absence of the patient's consent, no doctor has the right to divulge a private secret, either if the patient has directly confided it to him or her, or if he or she has come to know it by himself or herself in the course of his or her work.
The MOHAP Code of Conduct 1988 governing medical practitioners, pharmacists and other healthcare professionals licensed in the UAE requires complete confidentiality of information related to patients (including medical records and personal information related to the patient) and prohibits disclosure without the patient's prior informed consent.
DHCC Regulation No. 7 of 2013 (on Health Data) regulates the use and disclosure of Patient Health Information (including personal information and medical information relating to a patient's physical or mental health) by entities licensed in the DHCC.
The DOH Data Standard 2008 requires that healthcare providers in the emirate of Abu Dhabi develop and institute policies and procedures relating to confidential health information, which includes information that can be used to identify a patient. Policies developed pursuant to the Data Standard must ensure that only the minimum necessary personnel have access to confidential health information, and such information must be kept from unauthorised access.
The DHA introduced the Salama Electronic Medical Record System in 2017. This is a unified electronic medical record system currently connecting the government hospitals. In the long term, this scheme will be rolled out to all hospitals in the emirate of Dubai. The DOH has completed the implementation of a centralised electronic medical record central database, MALAFFI, mandating that all licensed health facilities in Abu Dhabi join the system and upload patient health information to the system.