The Managerial Functioning of Kuwait's Health Care System
General Description of the Kuwait Health System
Kuwait claims to have one of "the most comprehensive health care systems, and one of the most all-encompassing social service systems in the world" (KIO, 2003). This health care system has offered free - or nearly free - services to the entire population of Kuwait for about fifty years.
If a Kuwaiti citizen is sick, that person is cared for at no charge; if a person is in an auto accident, or needs an examination for an emerging skin irritation, health service is provided. Free health service is also extended to veterinary medical care for livestock and animals. If a sheep herder finds one of more of his animals is diseased, veterinarians will provide care for that disease. If a family dog is hit in the road and suffers broken legs, a Kuwaiti government veterinarian will provide medical service for that family's dog.
A brief history of the origins of the Kuwait health care system is germane to a thorough understanding of the issues. The very first medical clinic for men in Kuwait was built in 1911, and the first hospital for women was established in 1919. These facilities were developed by the Arabian Mission of the Dutch Reform Church (from the United States), and their development was at the request of Amir Sheik Mubarak Al-Sabah. And in 1934, the Olcott Memorial Hospital opened, followed by the Amiri Hospital in 1949. All medical services were "socialized" by the 1950s, as massive oil revenues began to pour into the government's coffers from the rich oilfields being developed in Kuwait.
As an empirical indication of the progress in preventative health care in Kuwait, the incidence of rheumatic fever - in children from 5 to 14 years of age - declined from 3.7 cases per 100,000 people in 1984, to 2.5 cases per 100,000 in 1988 (Majeed, 1993). Further, the nutritional status of Kuwaiti elementary school children ages 6 through 10 was studied in 1985, and then again in 1995, by researchers from the International Journal of Food Sciences and Nutrition (al-Isa, 200). The results of the study - which surveyed 8,957 children - showed that the children "...to be fatter and slightly taller, but nonetheless more nutritionally sound than a decade earlier." Thus, the health system in Kuwait is clearly providing more than just care for the ailing; they are also addressing nutrition, which of course is one aspect of preventative medicine.
Planning and Organization of the Kuwait Health System
Planning and organizing health care for a fast-growing population requires that there be a basic and solid infrastructure upon which to train staff, conduct research, and build upon knowledge previously obtained in Kuwait and elsewhere in the civilized world.
The Kuwait health care system, both private and government-run aspects of it, consists of primary care (preventative, curative, and rehabilitative services), provided through health clinics, or centers; and secondary care (in-patient and out-patient curatives services), provided through general hospitals. Those hospitals are supplemented by specialty hospitals which provide tertiary care (Burney, 1999). In terms of modernity, all six general hospitals and 9 specialized hospitals in Kuwait provide 24-hour emergency services, and full outpatient care. And the six hospitals - and the government-operated clinics - are staffed by professionals trained at the Faculty of Medicine (FOM), which was established in 1973. (It should be noted that the Faculty of Medicine also trains doctors and nurses and technicians for other Persian Gulf nations.) The number of students enrolled at FOM has risen from 48 in 1976, to the current 80 students per year in 2003. In the seven-year medical program, 564 students are presently enrolled. The FOM is situated in Jabriya, near the Mubarak Al Kabeer Teaching Hospital. There are 354 administrative, technical and academic, technical staff members - which provide training and technical services to 493 Allied Health students, in addition to the medical students enrolled.
The Faculty of Medicine departments include, in alphabetical order: Anatomy, Biochemistry, Community Medicine and Behavioral Science, Medicine, Microbiology, Nuclear Medicine, Obstetrics and Gynecology, Pediatrics, Pathology, Pharmacology and Toxicology, Physiology, Primary Care, Psychiatry, Radiology and Surgery. Additionally, there are graduate programs in Microbiology, Pathology and Physiology. Since the graduate programs were launched in 1983, more than 45 students have received their advanced degrees. The FOM offers a Bachelor of Medical Sciences (B. Med. Sc.), and a Bachelor of Medicine and Bachelor of Surgery (B.M., B. Ch.). "The technical facilities available to academic staff and students for research and teaching compare to those of older and more established institutions elsewhere in the world; for example, FOM equipment inventory in excess of [$18million U.S. dollars].
The graduating student from FOM programs must of course be familiar with diseases, with human anatomy and medical science, and with proper steps for care and healing. But additionally, FOM graduates must have "high ethical standards" and an "attitude" befitting a health care professional, according to the KIO fact sheet.
Among the institutions planning for the continuing delivery of health services to Kuwait are the Faculty of Allied Health Sciences and Nursing. This faculty provides training and degrees in nursing, physical therapy, biological and chemical sciences, health administration, radiological science, among other related fields. The Faculty of Pharmacy offers a 5-year study program, ending in a Bachelor of Pharmacy (B. Pharm.). The Faculty of Dentistry requires the completion of a Bachelor of Medical Science, plus five semesters of dentistry study prior to receiving a degree.
How does Kuwait Finance their Health Service System?
Kuwait has the good fortune of being one of the leading oil producing states in the world. Being a giant oil-producing nation means having enormous amounts of financial resources in hand. Those resources allow Kuwait to provide its citizens - and foreigners living in Kuwait - with nearly 100% free medical care and services. As to the amount of oil in Kuwait, according to the U.S. Dept. Of Energy (EIA, 2003), Kuwait is blessed with ownership of about 9% of the world's known oil resources, some 96.5 billion barrels. In addition, Kuwait claims ownership of about half of the "Neutral Zone" area oil - which it shares with Saudi Arabia - totaling some 2.5 billion barrels of oil. All that oil translates into an impressive 40% of Kuwait's Gross Domestic Product (KIO, 2003). At the present time, Kuwait's production capacity is approximately 2.5 million barrels per day - and with the price of crude presently about $30 per barrel on the international market, and Kuwait exporting 60% of its crude that translates to a substantial profit. This year, Kuwait's real GDP is expected to grow by 3.3% (EIA, 2003), and of course oil is what drives those GDP figures upward. Kuwaiti net oil export revenues in 2003 are projected at $15.4 billion, up 32% over 2002 revenues, and significantly higher than the $9.7 billion in revenues assumed by Kuwait for its 2003/2004 budget. Moreover, Kuwait is forward-thinking as to its rich reserves of oil. Kuwait knows oil will not be in the ground forever, so it has a program called "Future Generations Fund," which channels about 10% of its oil revenues each year into a special untouchable account. As of the year 2,000, Kuwait had amassed about $50 billion in that account.
When did oil production begin in Kuwait? It's important to understand that for hundreds of years, oil seepages in the Kuwaiti desert had indicated that there was oil below the surface. This bounty of oil came to the attention of European and U.S. companies.
In 1911 the Anglo-Persian Oil Company (APOC), which was building oil fields in Iran, asked permission to negotiate a concession from Kuwait. The British government refused the request (as it was entitled to do so under an 1899 treaty, when Britain was authorized to take substantial control of Kuwait's foreign policy); but two years later the British government conducted a survey of the geology of the area, and in 1913 the British reached an agreement with Kuwait's Shaykh Mubarak the Great. Mubarak promised to grant concessions only to those oil firms approved by the British government. World War I interrupted another effort to negotiate a concession. By this time, the British government had purchased 51% ownership in APOC as part of an effort to ensure oil supplies for the Royal Navy. In the 1930s, the U.S. pressured Britain to share some of the oil rights, and Gulf Oil developed some wells in a joint agreement with the British. Still, though, not much oil exploration was being done by the Kuwait government.
After WWII, however, on June 30, 1946, Kuwait began its own commercial export of crude oil, as Sheikh Ahmad Al-Jaber Al-Sabah, the Amir of Kuwait, opened the valve to load Kuwait's first shipment of crude. The oil went into a 12,000 metric ton British Petroleum Company tanker, called the "British Fusillier."
Implementation of Kuwait Health System
How is health care implemented for Kuwaiti citizens in 2003? There…