A managed care model for the UAE’s labourer workforce

The sprawling high-rise cityscapes of Dubai or Abu Dhabi are breathtaking. What has been achieved here in the United Arab Emirates in just a few decades is testament not only to the progressive thinking of governments and petro-dollars, but also the open approach to immigration.

Indeed, Dubai and Abu Dhabi are cities built on immigration – just like any great global metropolis – and the same could be said of rapidly expanding urban conurbations in most other emirates too.

To put a few figures to it, some 85-90% of residents in Dubai alone are from overseas, and the buildings and broader infrastructure were literally built by the hands of immigrant workers. And while a good proportion of the expat workforce are white collar, it is the blue collar and lower-middle class foreign workforce that makes up the biggest section of the population – accounting for approximately two-thirds of all workers in Dubai, for instance.

And let’s be clear: As the UAE continues with its grand ambition to expand and become one of the leading countries in the world – for everything from commerce and culture to sport and leisure – it becomes evermore reliant on the blue collar section of its society to achieve those goals. It is, therefore, the responsibility of us all – but companies who stand to profit, in particular – to recognise the sacrifice that many migrant workers make, and to continue to improve the support they require in every way possible.

So what in particular can corporations do to constantly improve their efforts towards ensuring the wellbeing of these unsung heroes of the UAE? One way – and the focus of this article – is to move towards a managed healthcare model. It is essentially a framework that takes a more balanced approach to how corporations manage the health needs of their workforce – and in the process their own expenditure in this area.

Let’s take a look at some of the key pillars.

Meeting the workforce needs with a managed healthcare model

Adequate care: One of the topics on the table when it comes to our migrant labourers is ensuring they always receive an adequate level of care. This is a growing challenge in the world of mandatory health insurance, where companies face the dilemma of selecting policies based on either price or value. With the Dubai basic cover priced at Dhs 625 per annum, and seven insurers committed to offering this irrespective of past claims history, this naturally creates a frugal approach to the benefits covered, as after deducting broker fees, insurance company or TPA charges, the net Dhs 300-350 simply cannot go too far. In a utopian environment, companies would top up the cover to provide greater protection, but for businesses with 5,000 staff or more, the existing cost of over Dhs 3m is already a significant expense.

But nonetheless, within this dilemma of balancing care and economics, companies must take responsibility to ensure that they have control of their healthcare network to tightly manage the delivery of care.  Under a managed care model, employees would ideally receive first-line care at onsite clinics or through visiting doctors, a framework that would act as triage or “gatekeeper” system. While onsite care is common in many residential compounds or at factories or worksites across the UAE, a proper managed care model aims to elevate the delivery of this level of care while also controlling healthcare spend. This would result in control over access to any wider network to ensure the quality of providers, and to, for example, secure agreement on testing and diagnostics permitted (also reducing over-testing) and to use generic medications rather than the more expensive branded drugs.

Health screening: Under a managed care framework, blue collar workers would be encouraged to take part in regular screenings for a host of common conditions such as, for example, hypertension and pre-diabetes. This preventative approach not only gives workers additional peace of mind that they are being cared for, it also provides a great opportunity for employees to meet healthcare professionals and gain a better understanding of the control they have over their own health. This leads to improved wellbeing generally. And of course I’d be remiss not to mention that it is likely to bring down the cost of medical bills associated with preventable treatments that often go unchecked.

A closer look at living and working conditions: As well as screening employees themselves, managed care also involves the screening of living and working environments – to remove anything that may cause a risk or hazard and to ensure the overall comfort level is there. The managed care model takes a physical and mental health approach to the issue of living conditions, bringing this topic to the forefront of the overall labourer demographic wellbeing picture.

It is not unusual, for example, to have many staff living or working in close proximity, and so introducing simple procedures which may include checking the filters in air conditioning units or demonstrating the correct handwashing techniques can stop the spread of communicable diseases. In the heat of the summer it is also important to have the right number of breaks and to ensure hydration is always maintained.

Addressing cultural differences: Under a managed care system, cultural habits and customs are factored in and addressed where changes could lead to better health. Such things, for example, as adapting the traditional menu to find a healthier balance or at least ensuring that fats used in preparation are of the healthiest available. And it is likely that tobacco use is particularly high among migrant labourers (often chewed rather than smoked), and therefore smoking cessation advice and oral cancer screening should be offered as a matter of routine, and a monitoring system should exist to avoid other substances being abused.

Tackling mental health issues: Although there are already many safeguards in place to look out for the physical health of workers, mental health is not so far along – and not so easy to address given the taboo nature of this subject. This is particularly concerning when it comes to low-income migrant workers as – being so far from their families with relatively long hours and little downtime – they are particularly vulnerable to stress-related mental health conditions. Again, a managed care model would look to address this. Psychological counsellors could be made available – either face-to-face or over the telephone – in a range of languages. Just as with the approach to physical health, this would focus very much on prevention – spotting early warning signs before serious conditions take hold.

Absence management: Although a benefit to the companies specifically, it is necessary to add this issue to the list. One of the advantages of a well-structured and controlled health management program is that it can lead to increased productivity. Under UAE law a worker may take up to two weeks of paid leave, but if uncontrolled a workforce can rapidly start to take this as a contractual right. A company with 5,000 staff abusing this can lose 70,000 work days, but controlled it should be no more than 25-30,000.

The direction of travel is positive

There is much more to the framework, of course, but the concept should be clear: We need to constantly keep an eye on how we can improve the overall wellbeing of the UAE labourer demographic, and so any type of holistic framework that addresses the challenge is welcome indeed.

The great news is that we are already making huge steps forward – and not just in the obvious core ways that may come to mind. For example, companies such as Emirates Flight Catering are raising the bar by building accommodations that are complete with cinemas, basketball courts and social clubs.

The aim then now is to ensure that these improvements continue across the board, to allow the UAE to take its place as one of the best countries in the world to live, visit and work – regardless of the job you do, the country you come from or the amount of money you earn.

It is not too much to ask in a place where tomorrow is built today. The resources are there, we just need the will to push through change at a faster rate. All the signs are positive, suggesting this is going to happen – that it is happening.