DAMMAM , 23 April — When policymakers originally drafted the labor law, it included clauses relating to the need for health coverage for workers. Since then, the labor law has been amended several times, but the issue of health coverage has consistently been retained.
In contrast to this dedication, many companies in the private sector have consistently pushed the health care of their employees to the bottom of their agenda. Initially, they exploited the fact that government hospitals provided free medical treatment by just leaving their workers to make their way to them. The inevitable result was a drain on the Kingdom’s medical resources.
To put an end to this practice once and for all, the government made it mandatory for the private sector to cover their workers’ medical expenses. The new regulation of course eased the pressure on government hospitals. What it did not do, however, was improve the health care provided to employees in the private sector, particularly those with menial jobs. They predictably slipped through the net.
Then came another amendment, which addressed the new problem by making it compulsory for private sector companies to provide medical insurance cover for all their employees. The planners thought it was foolproof, and the Kingdom was soon witnessing a dramatic growth in the medical insurance sector. Almost all the major companies followed the rules. Some on their own initiative even went one step further and extended insurance cover to the families of their employees.
However, there are hundreds of businesses which flouted the law, and continue to do so.
An Arab News investigation has found, for example, that the leading chain of hospitals in the Eastern Province does not provide full medical coverage for most of its employees. While some get a free medical consultation, all have to buy the prescribed medicine out of their own pocket.
Hundreds of limousine companies, which are already flouting the country’s labor law by hiring drivers on a commission basis instead of on fixed salaries, similarly fail to provide any kind of health coverage.
Bangladeshi Minhajul Hasan, a taxi driver in Dammam for nine years, had to go back to his home country for a hernia operation. “I was sick for weeks and finally a customer of mine took pity on me. A doctor friend of his examined me and advised that I should have a hernia operation immediately,” he said.
He informed his company, which told him that it would not cover the cost of the operation — leaving him with no choice but to return home.
“The worst thing that could ever happen to an expatriate in the Kingdom is falling sick,” says Muselhi, an Egyptian Hepatitis-C patient undergoing treatment at his own expense.
Even those covered by insurance are often victims of a kind of tug-of-war between insurance companies and hospitals. Many major insurance companies — like NCCI, Gulf Union and a dozen or so more — do provide excellent facilities to those covered under their schemes; but just as many are out to make a quick buck and do not honor either the letter or the spirit of their contracts.
Many Saudis and expatriates have also complained that the hospitals listed by their insurance companies refuse to accept them because the insurance companies themselves have defaulted on payments.
Last year, one such Bahrain-based insurance company played havoc with the health of thousands of its employees. Many of them were working for corporate enterprises. The insurance company was black-listed by almost all the hospitals in the region and as a consequence its employees were refused treatment everywhere.
Another major problem faced by the employees is the constant changes to the hospital lists by the insurance companies. One year, they will list one set of hospitals; the next year, the list will be completely different.
Those with chronic ailments in particular fall victim to such to-ing and fro-ing.
Imran Haider, who had a by-pass surgery six years ago, has been shifted to five different hospitals in six years. “And every new doctor has disputed the line of treatment of the previous doctor,” he says.
Of course, there are many diseases which require continuous treatment. In such cases, doctors should have knowledge of the complete medical history of each patient. Frequent change in hospitals breaks this continuity, and the consequences can be fatal.
There is a more general complaint that many hospitals recommend unnecessary tests and X-rays just because the patients are under medical insurance cover. A recent study conducted by NCCI proved this to be a fact.
There have also been reports that hospitals even opt for a cesarean delivery during childbirth because they will be able to charge more money that way. Indeed, a sad experience for many patients on being admitted to hospital is being asked not about his ailment but whether any subsequent treatment will be at his own or his company’s expense. It is as though the answer to that question will determine how treatment will proceed.
Another study revealed that doctors suggested, after diagnosing no more than a common cold, X-rays of the chest, a blood test and a sputum test.
To make matters worse, these unnecessary tests provoke outrage on the part of the insurance companies themselves, which can result in them stopping their payment to the hospitals — and the hospitals then refusing to treat patients. It is a vicious cycle, in which the loser is always the patient.
It is a matter of great urgency that an independent body with real power be established to sort out once and for all the health insurance mess. Above all, it should have as its guiding principle the belief that a refusal to give workers basic medical coverage is an act of inhumanity.
