By Geoffrey Martin
Rai Insights Contributor
Kuwait: Kuwait has been a hotspot for expatriates for decades. The main reason, beside the highly floating Kuwaiti dinar is the excellent healthcare system, which is available to expatriates at minimal cost. Although there is much griping waiting times at Kuwaiti hospitals are minimal and the quality of care is equal to Europe and North America at a fraction of the price.
In August the Kuwaiti health ministry announced a new fee structure for health services. While parliamentarians have been threatening expatriates with new fees for years it finally happened. Since non-Kuwaiti residents make up around 70% of the Kuwaiti population they are the primary user of healthcare and thus the impact has large repercussions on the population.
New fees for regular medical checkups are 2 dinars, 5 dinars at emergency clinics, and 10 dinars at outpatient clinics. Cost of admission is 10 dinars and the cost at intensive care units is 30 dinars. Patients who take private rooms will be charged 50 dinars with a 200 dinar deposit. While admission fees cover medicine, it will not cover surgeries, X-rays, and lab tests. Starting this month increased fees include charges for natural child delivery, cardiac surgery, 74 types of nuclear medicine tests, 32 kinds of radiology tests, lab tests, and artificial limb replacements. The fees range from 40 to 500 dinars. Radiological tests in particular saw a sharp increase in pricing, reaching up to one hundred and twenty dinars per test.
Health Minister Jamal Al-Harby said the pricing changes will eventually increase by 500%, although he noted the fees and services are only 20% of those in the private hospitals (i.e. Mowasat Hospital). Private sector healthcare, heavily used by Kuwaitis and many wealthier expatriates (especially for dental and eye care) have not been exempt from price increases. According to the national provider, the Kuwait Health Assurance Company, private healthcare insurance for expats in Kuwait set to jump 165% from 50 to 130 dinars.
The usage of healthcare in Kuwait ranges depending on the class of the expatriate but there are common ailments that have take up a large proportion of healthcare costs. Many of the common health problems of male bachelors (which make up a large proportion of the expat population) is attributed to loneliness and depression. In general, there is a high instance of alcoholism, heavy smoking, and prescription drug addiction in the country and the government is pressured to catch up and provide the necessary services to deal with these complexity of addictions, personality disorders, and taboos against their treatment. Respiratory problems and dehydration are also a serious issue, with the heat of the summer, and dust mixed with pollution from the oil refineries and exhaust of the myriad of vehicles on Kuwait’s roads causing serious breathing problems. Connected to the long working long hours and hard labour in the construction and service industry a variety of ailments lower the immune system and lead to widespread outbreaks of flu, cold viruses, and other illnesses. Although these maladies are rather minor they are time consuming for healthcare workers and fill waiting rooms and expend considerable resources.
While the rise in charges does not even closely reflect the actual cost of health services being offered to expats in Kuwait, the hikes are high enough to ensure that most low-income expatriates cannot afford any of the expensive surgeries or technical procedures necessary for cardiac issues, diabetes, various cancers, and complicated geriatric illnesses. Most salaries range from 300 to 600 dinars monthly, far below the cost necessary to afford treatment for the above illnesses or emergencies in the long-term. This is especially relevant for sole-income homes, where a single provider may need to provide for numerous family members.
The reasons for the fee hike are complicated but are usually viewed as political and part of the public versus private argument that has been going on in Kuwait for years between those who think that the government should begin reducing subsidies and privatize much of the national welfare state.
The health budget is a general burden on the government budget, primarily due to “rise in prices of medication and medical equipment.” For example, global prices have skyrocketed for the radioactive isotopes necessary for making certain cancer drugs, and all countries have struggled to keep pace with strains on the pharmaceutical industry. The budget deficit in 2017 is already projected at $6 to 6.5 billion KD, straining government resources at a time of low oil prices and the increasing burden of Kuwaiti government salaries.
Parliamentarians, like Safa Hashem have been pressuring the government to decrease Kuwait’s subsidized healthcare. This is part of the “blame expatriates’ mantra” that ebbs and flows in Kuwaiti politics. MP Mubrak Al-Hajraf, has also called on the government to reduce the dependence on foreign labour and increasing healthcare costs is one way to do it. Specific criticisms have risen about the high number of people in foreign positions when young Kuwaitis are finding it difficult to get jobs in the private sector. The belief is that many expatriates take advantage of the legal loopholes in employment law, transferring visas, taking freelance jobs, or buying visas and working on their own. I am not really sure how realistic these claims are even though they are widely supported by segments of the Kuwaiti populations.
In my opinion the reality is the vast majority of Kuwaitis do not want to work the eight to ten-hour shifts that most expatriates do. Furthermore, the expatriates that have been targeted by high healthcare costs are in occupations (construction, low level managers, secretaries, and accounting staff) that no Kuwaiti would ever be seen working in. More than 80% of the workforce of Kuwait is made up of Indian, Egyptian, Pakistani, Turkish, Syrian, and Iranian nationalities and the salaries for these jobs are much lower than what is necessary to pay most Kuwaitis, meaning private businesses do not have any incentive to decrease the number of expatriates regardless of fee increases. For the salary of one Kuwait citizen two or three expatriates can be hired from these nationalities. Even with the healthcare increases, this will not change. It will only mean that the same workers, who cannot afford the new healthcare costs will stay in the country, with their families and not be as healthy. The healthcare systems in most of their own countries do not come anywhere near the quality of care in Kuwaiti citizens so there is no better option for them.
While the Kuwaiti government is currently planning to remove 100,000 expatriates a year within the next ten years, this will be a difficult task. In 2016, 29,000 expatriates were deported and this campaign stretched resources. Over half the deportees were Egyptian and Indian and these are the groups that are specifically targeted by the healthcare increases as they usually have large families living with them in Kuwait. If the plan was put into effect the population of these two communities (Egyptians 600,000 and Indians 900,000) would not be allowed to exceed 500,00 people.
It is largely unknown what the effect of the impact of these fee hikes will be. Officially, according to Minister Al-Harby, this will be studied in the coming months. Already groups of doctors are protesting the healthcare increases, and saying it is against their ethics to refuse service to those in need. As the battle between those who want (Egyptian and Indian) expatriates to leave in large numbers, and others who see expatriates in general as vital to the viability of the country, the coming months will shed new light on who increases of fees for expatriates will affect their standing in the country. Personally, I worry about the cohesiveness of the country, and the welfare state, which provides much to offer to all people of Kuwait and in as example to other parts of the world on a governments’ responsibility to provide for all people.
*Geoffrey Martin is a PhD student in Political Science at the University of Toronto in Canada. He studies Kuwaiti politics, focusing on the historical development of social and political power in the cooperative societies since the 1940s. Geoffrey is also a freelance write for Zenith Magazine in Germany and an Advisor at Gulf State Analytics in Washington, DC.