AFYA Crossroads: Balancing Public Expectations With Fiscal Responsibility in Kuwait's Health Insurance for Retirees

The AFYA health insurance scheme, introduced in 2014, aimed to supplement state healthcare services for retirees through private coverage. Initially celebrated as a progressive reform to alleviate pressure on public healthcare services, AFYA expanded to include widows and housewives, reaching nearly 200,000 beneficiaries by 2024. Consequently, escalating costs, care quality, and limited competition led to the program's suspension by the Ministry of Health in September 2024. Despite limited academic research on AFYA, our nationally representative survey conducted in early 2024 reveals high public awareness (96.12%) and strong support for the program (76.37% agree it serves the public interest), with significant backing for its continuation and expansion. This commentary reviews AFYA's legislative history, evaluates existing literature, and contextualizes the relevant survey findings to highlight the program's challenges and public perceptions. Based on these insights, we propose policy recommendations to enhance AFYA's sustainability. These include refining eligibility criteria to focus on those most in need, exploring alternative funding mechanisms such as cost-sharing measures, strengthening program oversight through robust regulation and accountability, and integrating AFYA with broader health system reforms to improve coordination and efficiency. Addressing these challenges is imperative to maintain public trust and ensure the program's value and viability. The lessons learned from AFYA are pertinent not only for Kuwait but also for other Gulf Cooperation Council nations undergoing major healthcare reforms. © 2025 Elsevier B.V., All rights reserved.