Oman Health System

Abstract

This essay explores the health system and health delivery in Oman country. The Oman health system is categorized into two, public health system and private health system. Oman’s healthcare system is funded by the government, where the funds come from general revenue. In the private sector, the source of funds is from co-payment of patients while receiving care. The country uses an insurance system that ensures every citizen access health care thus increasing accessibility and cost effective. In comparison to the US, it is controversial as it lacks a universal health care coverage and no universal health system. Unlike Oman health care system that operates on a national health service, the US runs on a hybrid system where it does not work on a multi-payer universal health insurance fund, single-payer national health insurance system, or a national health service. Heart failure is a global problem and more specifically in Oman due to increase in life expectancy, more prevalent in aging population and a correlation between the incidences of heart failure and aging population. The paper also illustrated that heart failure is caused by risk factors that are controllable, modified or treated, like lack of physical activity, diabetes, tobacco use, overweight/obesity, cholesterol, and high blood pressure. Heart failure has high incidence and mortality rate and are caused by high dietary intakes of trans-fats, salt, and saturated fats and low consumption of fish, vegetables, and fruits are linked to heart failure risk. Therefore, as a public health issue, heart failure requires the Oman government to include programs that use primary health care. This will ensure early detection of individuals at risk, treating them, reducing bed occupancy and hospitalization and readmissions

Introduction

Oman is an Arabian Peninsula nation with a terrain encompassing desert, long coastlines and riverbed oasis on the Arabian Sea, Gulf of Oman and Persian (Arabian) Gulf. According to World Bank (2017), the Muscat is the capital port of Oman, and it is a home of the large contemporary Sultan Qaboos Grand Mosque, old waterfront Muttrah quarter, with a busy fish market and labyrinthine souk. The Wahiba Sands is inhabited by Bedouins and contains dunes. The population of the country is 4.491 million, and it uses the Omani rial currency. Sultanate of Oman is the largest country (309,500square kilometer) in Arabian Peninsula after the Republic of Yemen and Saudi Arabia.

Organization of the Healthcare System in Oman

In Oman, before 1970, no organization was taking charge on healthcare. The illness patterns in the country were characterized by an estimate of 118 per 1000 live births Infant Mortality Rate (IMR) and 181 per 1000 live birth Under 5 Mortality Rate (U5MR). The country was also experiencing high morbidity and mortality rates mainly due to disease burden due to non-communicable illness and proportion of disease burden due to communicable diseases (ALZadjalI, 2014). During this period, the prevalent childhood diseases were malaria, Pulmonary Tuberculosis, Pertussis, Mumps, Diphtheria, Measles, Tetanus and Acute Poliomyelitis.

The beginning of the modern health system was after the issuance of a Royal Decree to establish the Ministry of Health (MOH) in 1970. The MOH became the principal health agency in Oman to provide, coordinate and steward the health sector. It is the MOH’S responsibility to ensure overall health sector development per se about other key social sector (ALZadjalI, 2014). The role makes the MOH act as the principal health system design architect as it takes responsibility to achieve inter-sectoral collaboration. It develops programs and policies for the Oman health sector, and their implementation of in ordination with all other related ministries, the private sector and the government health services institutions.

Therefore, the Oman Health System is categorized into two: the private sector and the public or government sector. Alshishtawy (2010) explains government sector is then categorized into the ministry of health and non-ministry of health. The primary agency for the government in the provision of therapeutic care is the MOH. The body runs health centres and hospitals at national, local, sub-regional, regional and national levels where they are integrated using a referral system (continuum of care). However, the curative care is supplemented by other government clinics and hospitals such as those run by Royal Oman Police, Ministry of Defense, Petroleum Development Oman and the Sultan Qaboos University. In the private sector, there are three private hospitals and several clinics all playing a crucial role to provide care.

The Oman MOH is responsible for making the primary medical attention available through local hospitals, extended health centers, and local health centers. The four national referral hospitals offer tertiary medical care while the regional referral hospitals primarily offer secondary medical care. The MOH in Oman ensures no citizen is left without medical care benefits. It achieves this by an extra mile of sponsoring patients abroad if they lack the necessary treatment facilities. It also recognizes the importance of preventive, promotive and rehabilitative health care components and provides all its services by use of the newly equipped infrastructure. According to Al Dhawi, and West, Jr, (2006), the private sector represents 12% of the health system. However, although the private sector is supported and encouraged by the MOH, the efforts are not well organized and cultivated at present.

Oman Health System Financing

Oman’s healthcare system is funded by the government which provides funds to more than 80% of the healthcare systems. According to a survey in 2002, the Ministry of Health (MOH) accounted for 5.75% of total Oman’s healthcare expenditure from the government (Alshishtawy, 2010). According to TWAS (2014), a  health care system public financing comes from the revenues of the general country while the private healthcare resources come from co-payment for public health services and “out of pocket payments” for private health services. In Oman, the health insurance is not established. However, the country uses automobile insurance system that covers road traffic accidents. The MOH allocates 60% of their budget to acute care services, and the primary care is assigned a third of the amount.

Comparison between Oman and the United States Health System

The US health care system among other developed country is unique. ALZadjalI (2014) explains that the US lacks a universal healthcare coverage, no universal health system, and has recently enacted legislation mandating healthcare coverage for all citizens. Unlike Oman health care system that operates on a national health service, the US runs on a hybrid system where it does not operate on a multi-payer universal health insurance fund, single-payer national health insurance system, or a national health service. In the US, the citizens are responsible for their personal bills unlike in Oman where the government pays for all the bills and pays part of the amount in case a resident travels to another country for a health issue that cannot be managed in the home country. Therefore, in Oman, the health insurance is evenly covered while in the US, it is uneven covered.

Heart Failure in Oman

Heart failure is a public health issue in Oman. Cardiovascular diseases are important as they are disabling, common, costly and deadly. However, these conditions are also treatable. Heart failure cannot be referred as a disease; in fact, it is a complex clinical syndrome that distorts the heart’s ability to pump blood, reducing it, which results in functional or structural non-cardiac or a cardiac disorder. The condition is classified by symptoms such as fatigue, breathlessness on exertion and signs like fluid retention. Heart failure arises from consequences like an electrical problem, endocardial, pericardial, valvular and myocardial.

Heart failure is a global problem and more specifically in Oman due to increase in life expectancy, more prevalent aging population and a correlation between the incidences of heart failure and aging population. Unfortunately, there is limited evidence of heart failure in Oman. According to ALZadjalI (2014) the country has only a few annual published reports in 2010, 20111, and 2012 about admitted patients in hospital with heart failure. By use of this method, the incidences were restricted to mortality rates and readmission rates at tertiary care in several regional hospitals.

Additionally, the need of heart failure services emerges not only as a result of poor management but also due to heart failure diagnosing complexities. Patients who have heart failure may have a multiple and frequent co-morbidities, and its therapies have numerous side effects. In addition to all this, heart failure patients are prone to frequent hospitalization and readmission rates. Consequently, heart failure leads to confusion, resulting in patchy therapy adherence.

Burden in Oman

According to an annual report by the Ministry of Health (MoH), illustrated that the number of deaths due to circulatory system diseases was 15,671, out of which 1,265 and 3,080 were patients initially suffering from myocardial infarction and essential hypertension respectively. Approximately, 227 of the patients had cardiomyopathy, while 1400 had heart failure. In the estimate, 52 per 10,000 of Oman males admitted to hospitals in 2010 had heart failure. Studies illustrate that heart failure prevalence increases with age, with 34% among the 60 years and older, 6% among the 55-59 age group, and 3% among the 45-49 age group.  Therefore, the condition incidences increase as the aging population growth (ALZadjalI, 2014).

Another burden of heart failure in Oman is bed occupancy in hospitals. ALZadjalI (2014) explains that in 2010, the number of the bed occupied by patients with heart failure was high in regions like North ALBatina, ALDakhalia Region and Muscat Region (Royal Hospital). For example, approximately 233 patients suffering from heart failure were admitted in North ALBatina, while in Royal hospital, 258 patients were admitted. In ALDakhalia Region, there were 276 patients occupying hospital beds. These figures indicate the burden facing Oman, where bed occupancy due to heart failure is high.

Worldwide Situation

A survey estimates that in the UK, 1% and 2% of the total population suffers from heart failure, whereby the elderly has a tenfold increase. Currently, the National Health Service NHS Expenditure is approximately 1% with the majority of the costs related to hospital admissions.  Among all medical conditions in the world, heart failure accounts for 5%, and 25% to 30% of the patients being annually readmitted. Globally, Patients with Chronic Heart Failure (CHF) experiences a reduced quality of life, with more than 34% having prolonged and severe depressive illness with an annual mortality rate ranging between 10% and 50% depending on severity.

Social, Cultural, Economic Contributing To Heart Failure in Oman

Heart failure is caused by risk factors that are controllable, modified or treated, like lack of physical activity, diabetes, tobacco use, overweight/obesity, cholesterol, and high blood pressure. One of the social factors includes smoking, which in Oman contributes to 10% of heart failure (WHF, 2012). High dietary intakes of trans-fats, salt, and saturated fats, and low intake of fish, vegetables, and fruits are linked to heart failure risk. The unhealthy diet intake in Oman has increased the rate of heart failure due to raised blood cholesterol that increases the risk of heart failure. Family history of heart failure increases the risks of an individual, where the degree of risk is elevated in case a blood relative is infected

The environments in which individual works, lives, and engages in leisure activities have a great impact on their health. In Oman, WHF (2012) explains that the policies formulated to guide the daily processes and procedures of the citizens has a significant impact on their health outcome. Despite the 20th century the legal segregation dismantling, there is a high level of segregation in Oman. The majority of people in Oman are gaining excess weight which is linked with high cholesterol levels which cause heart failure. The most affected group is women, who are gaining dangerous weight than men. Excessive weight gain is reduced by physical exercise. Physical inactivity is the fourth leading risk factor for mortality, however, in Oman; the majority of citizens are too busy to exercise.

Threats of Heart Failure in the USA

In the United States, approximately 610,000 people die annually due to heart failure that is 1 in 4 deaths. Heart failure is the primary cause of deaths in both women and men where in 2009, more than half of deaths in men was from heart failure (CDC, 2015). Heart failure is the main cause of death for people in all ethnic groups in the United States including Whites, African Americans, and Hispanics. According to a study in United State CDC, (2015) detecting the condition earlier increases survival rates as emergency treatment begins early. Approximately, 47% of sudden cardiac mortalities occur outside of a health facility which is an indication that majority of people with heart failure do not act on early warning signs.

Components of Heart Failure Program in Oman

The Oman heart failure services have unique features specific local resources, disease prevalence, geographical location, and barriers to optimal care. According to ALZadjalI (2014), services provide to its community a comprehensive care, which assists in improving the heart failure outcome regardless of the patient’s entry point to health care. The country also has follow-up clinics for a patient diagnosed with heart failure, which treats the clients with optimal evidence-based medications. The heart failure services in Oman also include local guidelines that are utilized at all health care levels, consistency of approach and care.

The ministry of health in Oman avails heart failure services to heart failure patients whenever they start their health care journey. According to ALZadjalI (2014) the services are provided in the coronary care unit, admission in internal medicine ward, primary care, or as a referral to tertiary or secondary. The primary objective of Oman’s national program is on time detection of persons at high risk of contracting heart failure, provision of an accurate diagnosis, and encourages a uniform heart failure management. By use of efficient health care system, the MOH maintains a quality of life and health, provides a quality and sustainable health education to heart failure patients, their relatives and the community as a whole. The government is encouraging proper management and treatment of heart failure to decrease the burden on health facilities and readmissions. Additionally, it monitors its programs through outcome indicators and a set of process and lastly, support research related to heart failure control.

A Proposal of Health System Changes

To reduce heart failure burden in Oman, it is important that the programs cooperate with primary health care. Through this, patients at risks of heart failure will be identified early, for example, patients suffering from Hypertension, Diabetes, Atrial Fibrillation, and Coronary Heart Disease. The Oman heart failure program should offer treatment advice to these groups at risk to reduce the likelihood of heart failure. Additionally, it is important that the heart failure program establishes chronic diseases registers that increase heart failure risks, so as to improve the practice ability to target appropriate interventions that reduce the diseases’ risks. They also consequently reduce heart failure development by the provision of regular care for these patients.

Conclusion

The paper has reviewed the current situation of heart failure in Oman. Heart failure is a burden and of public health importance in Oman. It burdens hospitals as it increases hospitalization and readmission, high bed occupancy, and increased costs. As a way of achieving a standard care throughout the region of Oman, it is essential to provide comprehensive heart failure program with standard procedures and policies that are cost-effective and warranted. Therefore, the high incidences of heart failure can be reduced by use of a comprehensive program that cooperates with primary care.

References

Al Dhawi, A., & West, Jr, D. (2006). Challenging health care system sustainability in Oman. Journal Of Health Sciences Management And Public Health.

Alshishtawy, M. (2010). Four Decades of Progress: Evolution of the health system in Oman. PMC, 12–22. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074664/

ALZadjalI, M. (2014). Heart Failure – a public health issue in Oman: would heart failure program be cost effective? Universal Journal of Public Health, 2(8), 226- 229. http://dx.doi.org/10.13189/ ujph.2014.020803

CDC. (2015). Heart disease facts:Centre of Disease Control and Prevention. Retrieved from https://www.cdc.gov/heartdisease/facts.htm

DPE. (2016). The US health care system: an international perspective. Department For Professional Employees. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

TWAS. (2014). In Oman, transforming health care. The World Academy Of Sciences. Retrieved from https://twas.org/article/oman-transforming-health-care

WHF. (2012). Cardiovascular disease. World Heart Federation. Retrieved from http://www.world-heart-federation.org/fileadmin/user_upload/documents/Fact_sheets/2012/PressBackgrounderApril2012RiskFactors.pdf

World Bank. (2017). One World Nations Online. World Bank. Retrieved from http://www.nationsonline.org/oneworld/oman.htm