Health system development and utilisation in Kuwait, 2011-2022: insights from national healthcare data.

BACKGROUND

Despite substantial public investment, no study has examined Kuwait's health-system inputs and service utilisation or quantified COVID-19's impact across nationality strata.

METHODS

A retrospective interrupted time-series analysis examined 39 indicators from Kuwait Ministry of Health reports (2011-2022), stratified by nationality, covering infrastructure, expenditure, workforce, utilisation, and vaccination. Segmented regression with a 2019.5 breakpoint modelled the pre-pandemic trend (β 1), pandemic-onset level shift (β 2), and post-pandemic slope change (β 3), fitted by ordinary least squares (OLS) and AR(1) generalised least squares (GLS) for all indicators, with the AR(1) estimates used where autocorrelation was detected.

RESULTS

Hospital beds rose pre-pandemic (β 1 =  + 88.9/year, p < .001) and increased at onset (β 2 =  + 842, +11.5%, p = .002), with no further change (β 3, p = .28). Government salaries grew pre-pandemic (β 1 = +KWD 61.2 million/year, p < .001), rose at onset (β 2 = +KWD 95.8 million, +9.5%, p = .025), then decelerated (β 3 = -KWD 71.4 million/year, p = .002). Kuwaiti nurses fell pre-pandemic (β 1 = -20.6/year, p < .001) but recovered afterwards (β 3 =  + 42.6/year, p = .013). Utilisation showed the sharpest disruption: Kuwaiti general-practitioner (GP) visits dropped at onset (β 2 = -7.07 million, -68.3%, p < .001) before recovering (β 3 =  + 1.40 million/year, p < .001), while non-Kuwaiti GP visits fell by 2.32 million (-48.6%, p = .012) without recovery. Kuwaiti diabetes-care visits declined at onset (-68,601, -17.0%, p = .006) then recovered (β 3 =  + 25,919/year, p = .012). Non-Kuwaiti influenza vaccinations fell at onset (β 2 = -106,731, p = .027) before recovering (β 3 =  + 41,184/year, p = .044); meningitis and most routine vaccinations showed no significant change (p > .05).

CONCLUSION

Kuwait's health system expanded over 2011-2022. COVID-19 caused significant utilisation disruption with substantial recovery, reflecting resilience. Nursing remains expatriate-dependent; sustained investment in primary and preventive care is critical.