Decision to reserve government hospitals exclusively for citizens isto be delayed until the primary and secondary healthcare facilities planned for expatriates, under Health Assurance Hospitals Company (Dhaman) scheme is completed, hopefully by the end of the year, said the Ministry of Health (MoH).

Under this initiative, Dhaman, which is the largest Public-Private Partnership (PPP) healthcare project in the Middle East, will manage and operate Kuwait’s first Health Maintenance Organization (HMO). The HMO plans to provide its services to the nearly 3.2 million expatriates and their dependents through three new secondary healthcare hospitals with a total capacity of 900 beds, and 15 primary healthcare centers located in areas with a heavy expatriate population.

The decision to develop the Dhaman project stems from the fact that it had become no longer feasible for the government to continue providing free healthcare to everyone in Kuwait. Faced with the option of providing quality healthcare to citizens or incur exorbitant costs to provide quality healthcare to everyone in Kuwait, the government understandably opted to take the PPP pathway and privatize healthcare for expatriates.

Setting aside the humanitarian and egalitarian aspects and instead evaluating the Dhaman project from a solely economic perspective, shows that it is beneficial to the state and to the private healthcare sector. It will benefit the state in that the health ministry will not have to find funds and facilities to provide services to the large expatriate population and can provide high quality healthcare to citizens.

For private sector employers and expatriate workers, especially those who cannot afford the expensive private healthcare facilities available in the country, the Dhaman project offers a viable alternative that is cost effective while providing adequate level of healthcare coverage.

According to various statistical sources on population, 51 percent of the total expatriate workforce in Kuwait can only read and write only, that is, they do not hold any educational qualification. This is
divided into 722,000 workers, or 47 percent of the total workers in the private sector, and 470,000 workers, or 64 percent of the total workers in the domestic sector.

Records also show that there are 44,000 illiterate workers, who cannot read or write in the private sector, and 39,000 such workers in the domestic sector, plus an additional 1,683 workers in the government sector who cannot read or write. Together, around 1.3 million expatriates in the country do not have any academic qualifications or cannot read and write.

Even if we exclude domestic and government workers and focus only on the approximately 1.5 million non-Kuwaiti workers in the private sector, we find that while 1.2 million workers hold a basic degree or less, they constitute nearly 82 percent of the total number of Kuwaiti citizens.

Left with the choice of deciding to continue providing high quality healthcare services to everyone in Kuwait at exorbitant costs to the state, or using available facilities to provide high quality healthcare solely to citizens, the government chose to go with the second option while also providing adequate healthcare facilities for expatriates in the form of the Dhaman project.

Critics of this approach may point out that in many developed countries such as the United Kingdom, Canada and others, there is no differentiation in treatment between citizens and expatriates. However proponents of Dhaman say that what detractors of the project often fail to mention is that in most developed countries every resident, and indirectly every visiting tourist, pays taxes to the state. In Kuwait there are no such equivalent taxes levied on expatriates.

Moreover, in most of the developed countries expatriates form only a small segment of the population relative to citizens. Meanwhile, in Kuwait, expatriates account for over 70 percent of the total population, and hence the comparison between Kuwait and certain developed countries is not correct from an economic point of view.

They add that if we are to solve this dilemma in human terms, we can only do so by providing adequate healthcare to low-income immigrants at a level similar to the level of health care they receive in their country or slightly higher, while ensuring that for those with higher incomes, the employer bears the costs of appropriate healthcare, given that the employer benefits from the experience and knowledge of these workers.

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