Kuwait’s health system has capacity; measuring its value is the real challenge

Kuwait has spent the past century building a health system that contains all six building blocks the World Health Organization considers essential: service delivery, a health workforce, health information systems, medical products and technologies, financing, and leadership and governance. National data from 2011 to 2022 show substantial expansion and resilience amid global shocks, and the country compares favourably on headline outcomes, with life expectancy of roughly 80 years and an under-five mortality rate of 8.56 per 1,000 live births. Yet a new opinion article published in Frontiers in Health Services argues that the central policy question facing Kuwait is no longer whether it has capacity, but how that capacity is governed, measured and directed towards value.

The article, written by a team of researchers affiliated with Kuwait’s Ministry of Health, examines the system through the WHO framework and lays out a reform agenda organised into three interconnected paths: data, financing and governance. Its core argument is that capacity is necessary but not sufficient for value. Under the WHO framework, the building blocks are system inputs, while goals such as improved and equitable health, responsiveness, social and financial protection, and efficiency are outcomes. Value, as the authors define it, describes how a system’s resources achieve those goals — a definition broader than the economic notion of health outcomes per unit of cost, and one that aligns with the European Expert Panel’s multidimensional concept spanning personal, technical, allocative and societal dimensions.

The authors contend that Kuwait’s key issue is not which institutional reform model it adopts, but whether any model can measure cost, need and outcomes at the patient level. Structural reform without adequate analytic capacity, they warn, risks changing only the system’s architecture without improving results. Three gaps persist: limited data infrastructure for decision-making, a service mix still focused on curative care, and a budget process not linked to cost or outcome data.

The service delivery picture illustrates the orientation problem. Healthcare is organised across six regions in a three-tier system linking primary care with general and tertiary hospitals. From 2011 to 2022, the number of hospitals increased from 14 to 20, beds rose by roughly 30% to 8,735, and 19 primary health centres were added. The challenge is therefore one of direction rather than volume. At the time of the 2018 Kuwait health system review, about 85% of expenditure remained curative, even though non-communicable diseases accounted for around 80% of disability-adjusted life years and nearly one in five adults dies from an NCD before age 70. In the authors’ view, better value requires stronger primary care, screening and longitudinal NCD management.

The workforce section highlights a subtler shortfall. Kuwaitis now make up about 75% of dentists and 41% of physicians, but only 5% of nurses, and national recruitment strategies have focused on traditional patient-facing cadres. The 2018 review found shortages in health informatics, biostatistics and health economics, and noted that these disciplines lack defined civil service career pathways. Without a specialised analytical workforce, the authors argue, digital infrastructure serves administrative rather than analytical objectives.

Health information systems reveal where the data gap actually lies. Kuwait has digitised much of its primary care, implementing electronic records and ICD coding, but the deficit is in aggregation rather than collection: there is no centralised system consolidating primary care, hospital and private-sector records into a linked, case-level resource. The authors point to an analysis of 4.4 million claims from the AFYA scheme for retirees, which showed that routinely collected administrative records can identify variations in coverage definitions, coding practices and service rejection patterns. Such analyses, however, remain uncommon and are not yet standard practice in planning, even though linked data would be crucial for purchasing, premium setting, costing, prevention and accountability.

On financing, Kuwait performs strongly in financial protection: government sources account for 88% of current health expenditure, the highest share in the Gulf Cooperation Council, while out-of-pocket spending stands at 10%. Yet allocation remains input-based, with providers receiving block budgets rather than payments adjusted for risk, activity or outcomes, and full costing and health technology assessment not embedded in coverage decisions. Mandatory expatriate health insurance covers about 3.5 million people. After inflation eroded the original KWD 50 premium, Ministerial Resolution No. 306 of 2025 set the standard annual residency contribution at KWD 100, near its inflation-adjusted 1999 level, and introduced exemptions and lower fees for selected groups. But the resolution lacks indexation, so real erosion will resume unless periodic review is institutionalised, and co-payments remain uniform despite large income differences.

Governance completes the diagnosis. The 2018 review found that the Ministry of Health remains funder, provider and regulator simultaneously, a concentration associated with overlapping responsibilities and weak evidence use in decision-making. Governance is dispersed across health regions, insurance oversight sits partly outside the health sector — although under the 2025 resolution, insurers licensed by the Insurance Regulatory Unit now also require MOH approval of their health-insurance products — and accreditation results were not published, with providers that failed to meet standards facing no penalties. In medical products, registration, licensing and quality assurance are well established and Kuwait buys part of its requirements collectively through the GCC secretariat, but the 2018 review found no formal national generics policy to guide substitution, prescribing or procurement.

The authors draw cautiously on regional neighbours. Bahrain has introduced national health insurance for citizens and residents; Saudi Arabia is separating regulator, provider and funder roles through health clusters; and Abu Dhabi has established a dedicated group purchasing organisation for its public provider network. Because these reforms are recent and not yet evaluated, they are treated as illustrative rather than established models. The proposed Kuwaiti agenda proceeds in stages: in the near term, the MOH can mandate coded case-level reporting from public facilities, institutionalise periodic premium reviews and pilot case-level costing in selected hospitals; in the medium term, case-mix information may inform hospital budgets, an HTA function can be established and analytic career pathways developed with the Civil Service Commission; longer-term reforms, such as a distinct regulatory function and private-sector data integration, would require new legislation. The authors also propose upgrading the existing National Health Information Centre into an independent national health information institute, consistent with Kuwait’s research agenda and Health Pillar White Paper.

The article is candid about its limitations. Most assessments it relies on predate the current reforms, regional reforms are too recent for their outcomes to be judged, and measurement adds costs and burdens for clinicians. Case-mix or outcome-based payment can lead to upcoding and selective admission, linking patient records raises privacy issues, and publishing performance differences may be resisted. Other approaches remain defensible, including separating functions first or keeping reform minimal given that access is already good. The authors’ judgement — that adding more facilities and staff will add less value than understanding what existing services achieve — is, as they note, a hypothesis that would require the very data they propose to test. They also cite survey evidence that Kuwaiti policymakers rate the value of research highly but report limited use of it in policy development, with more than half reporting no access to the research resources they needed. Closing that gap, the article concludes, is a precondition for judging reform by value rather than by cost alone.

Subject of Research: Health-system reform in Kuwait assessed through the WHO building-blocks framework

Article Title: From capacity to value: reframing health-system reform in Kuwait

Article References: Alqashaan, A., Alsalahi, S. E., Alhenaidi, A., & Kelendar, H. (2026). From capacity to value: reframing health-system reform in Kuwait. Frontiers in Health Services, 6, 1991280. https://doi.org/10.3389/frhs.2026.1991280

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1991280

Keywords: Kuwait, health systems, WHO building blocks, health financing, health information systems, governance, value-based healthcare, Gulf Cooperation Council, non-communicable diseases, strategic purchasing, health workforce, health technology assessment