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

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.

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.

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).

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.