ECONOMIC GAP IN THE QUALITY OF HEALTHCARE UTILIZATION UNDER UNIVERSAL HEALTH COVERAGE: EVIDENCE FROM THE DUBAI HOUSEHOLD HEALTH SURVEY 2018-2022.

The Insurance System of Advancing Health in Dubai (ISAHD) law, enacted in 2013 and mandating health insurance for all Dubai residents starting in 2016, aimed to examine the impact of ISAHD on healthcare utilization and out-of-pocket (OOP) expenditures across different economic subgroups.This research utilized data from the Dubai Household Health Survey (DHHS) conducted in 2018 and 2022, a representative survey of the city-state's population.The DHHS was stratified into four categories: Nationals, Nonnationals living in households, Non-nationals in collective housing, and Non-nationals in labor camps.To analyze the data, the probability that each household would incur expenditures was calculated, followed by multiplying this probability by a weighted estimate of the average total OOP expenditure.This approach provided an accurate measure of quality healthcare spending across the different subgroups.The results indicated a substantial increase in quality healthcare spending in Dubai, rising from 12.8 billion AED (3.4 billion US $) in 2018 to 16.8 billion AED (4.6 billion US $) in 2022.Concurrently, the OOP share of total health spending decreased significantly, from 25% in 2018 to 13% in 2022.The study revealed an overall increase in the utilization of outpatient, inpatient, and discretionary services from 2018 to 2022 for most groups, except for non-nationals residing in labor camps.In 2022, nationals had the highest per capita OOP expenditure at 1064.65 AED, followed by non-nationals in households at 675.01 AED, nonnationals in collective housing at 82.35 AED, and non-nationals in labor camps at 100.32 AED.The introduction of ISAHD led to a significant rise in OOP spending per capita for both nationals and non-nationals in households, attributed to increased qulity healthcare utilization.However, lower-income non-national households did not experience a similar increase in OOP spending.In conclusion, the ISAHD policy has effectively shifted the financial gaps of quality healthcare from households to the government and employers, resulting in reduced OOP expenses for residents.While healthcare utilization increased for Emiratis and expatriate households' post-ISAHD, blue-collar workers did not see the same benefits.Addressing non-financial barriers to healthcare for Dubai's blue-collar workforce remains essential.