Health is Wealth
As the countries of the Gulf Cooperation Council (GCC) seeks and the nations of the world battle the shade of an infectious pandemic, it is important for the GCC to now continue to invest (what will be left of) their oil bounty to secure the future of generations to come and build a confident society, one of the cornerstones of this transformation should be a healthcare system ready to combat a far more deadly (and costly) disease group — chronic diseases.
Indeed our governments have taken a significant number of bold steps on this front — witness the rapid (if not extreme) response to pandemics, private-public partnerships, changes in health insurance landscape, the building of entire Medical Cities etc. GCC government health bodies are mostly tone-deaf when it comes to identifying areas and specializations that require investment and planning. A common element behind many of these actions is, to invest for the sake of investing, based on learnings of other developed nations, primarily in building state of tangible healthcare facilities for its rapidly growing and aging population. Therapeutic hardware and not preventative software. Our governments need to go a step further as well to secure the healthcare of GCC citizens by covering the insurance of nationals (fully in the UAE and Qatar and partially in Saudi Arabia and Kuwait with universal healthcare coverage coming soon in Oman). One would think this points to a secure future.
However, a comparison with the US Auto industry has interesting parallels with this approach, implying a different solution. One could be forgiven for asking what possible healthcare parallels could exist between the GCC healthcare sector and US automakers. For starters in terms of size and scope of parallels we are talking similar order of magnitude, General Motors (GM) for example has over~1million members in its health plan and health expenses of ~$5B, similar to the UAE. The real learning, however, is in the experience of US automakers in managing healthcare for its employees. (Check out my article on the TPS as well).
During the 80s and early 90s — the boom times for the Detroit auto industry, the big three promised rich healthcare benefits for its active employees, including during retirement, typically giving them “first dollar coverage” i.e., paying for all their healthcare expenses in exchange for a modest monthly premium. These rich benefits it was hoped would secure the healthcare future of the employees well into retirement. However, a few decades later the story has turned out to be quite different on both fronts — auto industry and healthcare. On one hand, domestic auto companies have seen their fortunes wither due to competition while on the other hand healthcare expenses have risen at a greater than inflation rate without a breather. A famous fact is that healthcare cost per car is the single biggest expense item even more than steel or rubber. The result is that US automakers have struggled to meet their healthcare obligations promised to workers and ended up having to implement a combination of measures to control these liabilities including rescinding on some obligations, asking workers to pay more, and transferring the financial burden of healthcare to an independent legal entity etc. Ultimately there was no sustainable solution for a sick population with unhealthy lifestyles who had no initiative to take care of their health in a “company will pay the bills” environment.
While one hopes that the GCC economy continues to boom but the recent performance of the oil price has brought us back full circle to the tail end of the past decade when planning for a low-oil price future was last in vogue. Notice the similarities and hence a weak link in the chain i.e., the role of the population. The only sustainable solution for a secure healthcare future is a healthy population, where governments focus on prevention (mainly of chronic diseases). The GCC’s performance has not been great on that front. With increasing prosperity and the associated lifestyle has come a slew of real killer diseases most notably diabetes and circulatory system problems. One indicator — the GCC has one of the highest prevalence of diabetes in the world 1 out of 5 in population with the nationals having an even higher prevalence of the disease. These lifestyle issues can only be tackled by active participation by the population. The government for its part needs to make wellness an area of focus and take an aggressive role in managing key lifestyle indicators. A strategy that emphasizes only building hospitals, clinics etc. for a fast-growing and sick population ignores the time-honored adage “prevention is better than cure” and does not fulfill the broader vision of a secure and confident society. GCC governments must ensure that the population meets its part of the bargain in building a healthy citizenry. The experience of employers in the US has shown that this requires aggressive healthcare coaching and a holistic approach to manage health indicators like BMI, cholesterol, blood pressure etc.
For their part, the governments of the GCC have taken a few steps in this direction as exemplified by the periodical examinations “Weqaya” by the Health Authority of Abu Dhabi or the multiple health awareness campaigns run by the Ministry of Health in Saudi Arabia. However, a lot more effort is required in this direction to get the population actively engaged and build a wealthy and healthy future.