This study aimed to delineate the current picture of the Afya Healthcare Insurance Policy in Kuwait. The policy’s success in the country is assessed by considering three main aspects: 1) the scheme’s efficiency, inclusivity, effectiveness, and service quality; 2) delivery of total healthcare services as per the stages of the revenue management cycle; and 3) suitability and long-term sustainability in Kuwait. Consecutively, the survey questionnaire addressed 1) the utilization and evaluation of services by inquiring about the type and frequency of usage and medical service satisfaction and 2) the evaluation of front-end services by inquiring about private and public hospitals, preliminary information dissemination and overall beneficiary satisfaction. The study results showed that although all of the respondents had participated in the scheme, Afya was unable to fulfill the beneficiaries’ expectations while achieving overall beneficiaries' satisfaction (15.6%, Table 10).
Resource allocation, such as healthcare spending, is determined by the share of GDP [18], and in 2020, Kuwait's GDP share for health expenditures was 6.3% [19]. Overall development in Kuwait is hampered by frequent changes in health ministers [2].
Afya is a health insurance scheme initiated by the Kuwait government for retired nationals seeking access to services from private hospitals. Private health insurance for retired individuals is beneficial not only for individuals but also for the growth of the private medical industry. Apparently, Afya helps to increase access to health services and patient choices, enable the expansion of private sector specialized services and quality, decrease waiting periods, and reduce patient load in public hospitals [4].
According to the first aim of the study, in Al-Sabah’s research (2020), hospital managers stated that private hospitals are more efficient in terms of agility, dynamics, and adaptability to change, while public hospitals are slow and centralized and lack the skills required for proper functioning [4]. Moreover, Table 4 shows that most participants used private hospitals every time or often (95%), which is naturally due to efficient management, as discussed earlier. This also led to high beneficiary satisfaction (78.5%, as shown in Table 5) with its high utilization. In contrast, when utilizing medical services from government hospitals (Table 11), respondents preferred to repeat the same services to guarantee accurate laboratory results, diagnosis, and medication, as well as due to inadequate service quality (Fig. 4). This may lead to duplication of reports, services and patient records, as shown in Alsabah’s study (2020).
Our study showed (Table 3) that approximately 65.2% of the respondents said they had used specialty services mostly for chronic diseases, while outpatient services (29.4%, Table 2) were least common among those provided by hospitals. In Kuwait, almost three-fourths of deaths are due to noncommunicable diseases (NCDs), and the prevalence of these diseases is expected to increase, with 12% of adults aged 30 to 70 years dying from cardiovascular diseases, cancer, respiratory diseases, or diabetes [20]. With the increasing incidence of NCD, also called chronic diseases, Kuwait's healthcare system is unable to adapt to challenges arising from such conditions [2]. Additionally, there will be a population of 5.2 million people, approximately 35% of whom are predicted to increase by more than 50 years by 2027 [19]. This further establishes the need for an improved healthcare system to support the increasing number of high-risk retirees. The number of aging patients suffering from multiple chronic conditions is alarming. One major cause of prevailing NCDs is believed to be lifestyle-related factors such as inactivity, high-calorie diets, and high sugar intake.
The second aim of our study is to understand the Revenue Management Cycle (RMC) of the health insurance industry. The health insurance RMC includes numerous stages, depending on the case, usually starting with patients reserving an appointment and ending with making payments. However, there are additional phases for inpatients and patients with chronic conditions. The stages also included scheduling, insurance registration, insurance plan discussion, and verification (see Fig. 1). In our study, the assessment of briefings delivered by insurance workers showed an acceptable execution of the benefit plans and their variety (see Table 6), followed by satisfaction with the swiftness of service authorization (61%, Table 7), as well as an adequate representation of front-end services, i.e., scheduling and registration services (see Table 8), and services during verification (see Table 9). Overall, Table 10 shows that retirees were happy with their experience with insurance coverage (63%) and considered Afya to be ‘excellent’ or ‘very good’ in comparison to public sector services (69.1%). This led to a statistically significant correlation (p < 0.001; Table 12) between beneficiaries' insurance packages offered by Afya and satisfaction with the scheme.
Proceeding toward the third aim, research executed in Nepal [13, 21, 22] and India [23–25] showed that a substantial population of the study areas was unaware of the health insurance schemes available to them. Despite beneficiaries being fulfilled with Afya, 109 entries (21%) were excluded from the study because the individuals were not registered under the scheme. The lack of awareness of healthcare insurance policies could be a driving factor caused by societal [26], cultural [26], and religious [14] characteristics. Adequate knowledge and awareness about insurance schemes are directly proportional to the high usage of health insurance [27–29]. Although public participation in the decision-making of healthcare resource allocation can be beneficial for awareness creation [5, 30], some studies have found that a) public priorities are costly, b) inequitable solutions are generated [5, 31, 32], and c) common services are overlooked (e.g., mental health) [5, 32, 33]. Given the public’s willingness to participate in the decision-making of healthcare priorities, participation can contribute to people’s acceptance of a system and increase favorable results (e.g., increasing beneficiaries count, improving satisfaction level). Another method to boost awareness implemented by the Kingdom of Saudi Arabia (KSA) is collaborating with the national media to disseminate information about the healthcare insurance system, benefits and policies [5, 14]. Other recommendations include a thorough study of the country’s healthcare system to identify and address concerns, possibly through modernization, market competition and regulatory reforms [26].
For a well-informed public, to create voluntary participation in long-term sustainability and proper integration of the private and public sectors, the issues need to be identified, and reformation of the existing policies or complete suspension may be needed. Al Sabah’s study (2021) showed that the majority of people wanted to reform their treatment package and increase the number of beneficiaries [5]; however, although 94% were asking to improve Afya’s coverage plan (see Fig. 5), more than half suggested suspending the scheme to improve the service with proper research and to avoid financial burdens on the government (see Fig. 6).
By analyzing the causes of service repetition (Fig. 4) and beneficiaries' need for improvement (Fig. 6) and reviewing the literature, we identified five major problems, as listed in Table 15, along with plausible resolutions for each.
Table 15
Major problems and solutions
Problems | Solutions | Sources |
1. Poor delivery of health services causes to send patients abroad for treatments creating an additional financial burden and misuse of the service. | a) Improving the service provided by public and private hospitals. b) Training of service providers c) Accreditation of hospitals. | [5] [2, 14] [14] |
2. Lack of awareness and demand for healthcare/health insurance. | a) Broadcasting healthcare-related information through mass media b) Encouraging public participation in healthcare-related decision-making. | [14, 29] [5, 30] |
3. Shortage of health service providers such as doctors, nurses, etc. | a) Increasing job opportunities. b) Providing a better work environment for healthcare workers using healthcare workforce plans and supporting careers in healthcare. | [14] [2] |
4. Poor managerial skills and managerial structures, such as billing systems and budgeting. | a) Including degrees and providing education in healthcare management to improve healthcare employee skills and decrease international employment of professionals. | [2, 14] |
5. Increasing NCDs | a) Prevention of diseases by promoting health which will minimize dependence on specialized treatments. b) Identifying major NCDs to integrate strategies accordingly. c) Legislative bans and restrictions to reduce the consumption of chronic disease-inducing food and drinks. d) Regular health examinations for early diagnosis. | [14] [34] [35] [35] |