Clinical guidelines in healthcare aim to bring order into the chaos of medical opinions, practices, and traditions. As the saying goes, “Two doctors mean three opinions.”

In other words, these are methods developed by official professional communities led by top experts in a specific field. They are based solely on evidence-based medicine principles. As such, guidelines standardize modern and evidence-based approaches to diagnosis and treatment, offer reliable support for doctors, and help predict treatment outcomes in most cases.

Naturally, diseases and human bodies can vary greatly, and no single guideline can cover every possible scenario. Such regulation shifts more responsibility to the doctor - not only to treat the patient effectively, but also to follow the formal guidelines, or else, risk accusations of negligence. This legal pressure affects both the doctor and the patient's well-being.

This raises the question: In the medically advanced countries around the world, are these truly guidelines - or are they law?

The modern form of such guidelines appeared rather recently - mid to late 20th century - and has since become a standard part of healthcare in many countries, both in public and private sectors.
Besides serving the interests of doctors and patients, these guidelines also help control healthcare costs in the countries where they hold legal authority.

publication date:

May 27, 2025

TAGS:

Health insurance

One Size Doesn’t Fit All

Order in the Chaos

Canada

2 Guidelines are mandatory for government programs, but not for private practices

Global Overview: Guideline or Law?

Mandatory for Some, Not All

Australia

Similar to Canada: public institutions must follow them, private ones have more flexibility

3 NICE guidelines are mandatory within the NHS. The private sector is not obligated but often follows them

UK (NHS)

1 Guidelines from USPSTF, AHRQ, CDC, NIH, etc., are not legally binding but influence insurance, accreditation, and court decisions. Private providers choose their own

USA

1

2 Guidelines by IQWiG and G-BA guide public insurance but are not formally binding, especially in private medicine

Germany

3 HAS guidelines are not mandatory, but following them impacts reimbursement and regulation

France

Japan

Guidelines are generally advisory. Doctors decide case by case

4 Saudi Arabia

2 Guidelines from the Saudi Health Council are mandatory in all sectors

China

Official guidelines, especially for chronic or socially significant diseases, are mandatory in most provinces for both public and private clinics

5

4 Guidelines are mandatory in many cases, such as under the Ayushman Bharat scheme, including for private providers participating in public programs

India

3 In Emirates like Dubai and Abu Dhabi, guidelines issued by MOHAP and DHA/DHAA are mandatory for all licensed facilities

UAE

Medical care procedures based on approved clinical guidelines and standards are mandatory for all medical institutions

Russia

1

Guidelines as Law

WHO guidelines are never legally binding in any country. In fact, some countries are leaving the WHO - for example, Argentina in 2025.

Guidelines as Recommendations

Strengths of National Guidelines

Still, national guidelines offer advantages that the international ones can’t replace:

Official language – No translation errors.
Local expertise – Authors understand local healthcare systems and legal frameworks, as well as cultural specifics.
Consistency – National guidelines often include priority rankings, which helps in real-world application, while international ones may conflict.

Limitations of National Guidelines

Despite their importance, national guidelines have limits:

Slow updates – Reviews may occur only every 5–10 years due to bureaucracy and politics, while science evolves much faster.
Access and cost – Some drugs or services are excluded due to availability or price, especially if public funding is required.
Rare or complex cases – Guidelines do not always cover them.
Lack of standardization – Some diseases have no unified approach due to missing regulations.

In such cases, independent medical judgment and international context can become especially valuable – they are updated more often, written by independent associations, and less focused on cost-saving.

Conclusion

MOH guidelines focus on oral iron therapy, avoid early use of IV iron even with poor tolerance or absorption issues, and rely mainly on Hb and ferritin for monitoring. Investigations for chronic blood loss are selective.

National Approach

A Broader View

International Practice (WHO & BSH)

Recommends personalized iron therapy (oral, IV, different salts), early IV use when needed (e.g., inflammation, pregnancy), expanded lab tests (CRP, transferrin saturation, soluble transferrin receptor), and active search for root causes (GI endoscopy, celiac screening). Also includes behavioral and dietary strategies.

2. Saudi Arabia: Iron Deficiency Anemia (IDA)

WHO

Recommends pneumococcal vaccines in high-burden countries but adoption is slow due to cost and logistics. Countries must adapt based on local needs.

South Africa was the first in Africa and globally (with high HIV rates) to include PCV7 in 2009 and PCV13 in 2011. It also uses Pneumovax 23 across age groups to cover more strains.

National Approach (EPI-SA)

UAE offers expanded vaccination programs for expats and residents, including vaccines for meningococcus, yellow fever, and Japanese encephalitis, especially for healthcare or travel-related jobs.

National Approach (MOHAP / DHA)

WHO

Provides universal recommendations focused on minimum standards, mostly for low-income countries. Rarely includes vaccines for migration or tourism unless there’s an outbreak.

South Africa demonstrates a proactive, tailored approach based on its HIV epidemiology.

UAE protocols are better adapted to local and global mobility risks.

3. UAE: Vaccination for Expats and Travelers

UAE MOHAP guidelines rely mainly on JNC-8 (2014), with a diagnostic threshold of ≥140/90 mmHg and a focus on drug therapy. Screening usually occurs during clinic visits, with little focus on early detection in asymptomatic patient.

National Approach

International Practice (WHO & ACC/AHA)

WHO and the American Heart Association recommend a lower threshold (≥130/80 mmHg), emphasize prevention through lifestyle changes, reduced salt intake, more physical activity, and support home BP monitoring and patient education.

1. UAE: Hypertension (HTN)

4. South Africa: Pneumococcal Vaccine

These global guidelines are more flexible and personalized.

Now let’s see examples where national guidelines go beyond international standards.

Alexander Petrov

Maria Trusova

Authors:

The best clinical decisions come from a combination of:

National guidelines developed with international standards,
International guidelines,
Independent medical judgment.

This integrated approach considers a broader range of patient situations and leads to better outcomes.

Both national and international clinical guidelines are developed with a model patient in mind — a hypothetical clinical profile constructed from a set of key characteristics that most significantly influence the selection of appropriate medical interventions.

Medical expertise, logic, and awareness of both national and global context help adapt guidelines to individual cases.

Between Formality and Real Life

At Mains Lab, we use over 4,000 clinical guidelines from 12 countries. Every month, we review them and add new national and international standards to our tools to analyze insurance data.

Let’s look at some practical examples of where the international guidelines offer a broader perspective than national ones.

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