A children’s specialist hospital, new facilities and staff to deal with mental health, and a shift towards a primary care model are among the priorities identified in an analysis of health care provision in Abu Dhabi. The Capacity Master Plan (CMP) was published by Health Authority - Abu Dhabi (HAAD) in August 2016, to give stakeholders in both the public and private sectors a view of the emirate’s existing and emerging needs. The CMP looks ahead as far as 2035, and anticipates a need for significant investment in people, services and property. Achieving top-quality care “is about much more than new buildings,” the plan noted. “Clarity is also required as to the types of health care appropriate for the evolving communities and population.”
Supply & Demand
Using data from a 2014 survey and indicators from its Knowledge Engine for Health, a data warehouse containing information on health claims in Abu Dhabi, HAAD has brought together an assessment of existing and anticipated supply and demand to produce a gap analysis. The challenge will be to ensure public and private sector responses complement each other to prevent oversupply of facilities in one speciality or geographic area while others are underserved, as well as the optimum use of facilities and staff. The CMP also identifies projects that could be achieved through public-private partnerships, such as the partnership between Mubadala Healthcare and Cleveland Clinic Abu Dhabi, or Johns Hopkins Medicine International’s agreement with Tawam Hospital.
Among the key areas identified is an overreliance on secondary or tertiary care facilities by patients seeking treatment by a specialist doctor. It suggests there is a major shortfall in primary care clinics and calls for the development of a consultant-led family care model. The CMP also notes that demand for primary care is the fastest growing of all health care service types, and that a well-developed primary care system produces better health outcomes while reducing costs by diverting patients away from tertiary care facilities. It envisages 7.3% annual growth in demand for outpatient consultation rooms, from 900 in 2015 to 1140 in 2020 and 2227 in 2035. In terms of demand for full-time equivalent (FTE) general practitioners, the CMP suggests a current gap of 425 FTEs, with 1920 general practitioners working in the emirate, but anticipates a demand of 4513 general practitioners in 2035, a gap of 2593 based on current provision.
This is an issue across all three regions of Abu Dhabi. The CMP estimates demand for outpatient consultation rooms in Al Ain will grow from 243 in 2015 to 374 in 2025 and 547 in 2035, while in Al Dhafra it projects an increase from 104 to 182 and 298. In Abu Dhabi itself, the anticipated need is 553 in 2015, 887 in 2025 and 1381 in 2035. The report breaks down data in specific districts of each region and details where it sees the largest supply gaps in 2015, and those it anticipates over 20 years. A primary care task force has been established to seek ways to more clearly define and license primary care roles, and to create quality metrics to help evaluate the subsector’s performance.
The CMP found that in 2014, 89% of acute overnight mental health episodes and 59% of outpatient episodes were dealt with by public facilities. It anticipates growth of 15% per year in acute overnight mental health beds in 2015-35, and a shortfall rising from 62 to 1097 beds over the period. There were 218 of these beds in 2015. This picture is mirrored by the shortage of outpatient consulting rooms offering mental health care, with anticipated demand rising from 65 in 2015 to 115 in 2025.
There were 29 outpatient consulting rooms for mental health patients in 2015 against demand for 94. The shortage in facilities is similarly reflected in the availability of qualified staff. There were 131 psychiatrists in 2014 compared to demand for 274. Factored into the CMP’s mental health projections are growth in the elderly population and a sustained demographic bias towards working-age men, with both groups identified as having a high prevalence of mental illness internationally. The report notes that there is “an urgent and growing need” for investment in mental health services in Abu Dhabi, and that HAAD is working closely with investors to address the issue.
The study also identified a shortfall in complex emergency and trauma care. The international triage system for emergency care has five classifications, with class one representing immediate life threat, class two for imminent and class three for potential, while class four cases are serious and class five less urgent. The demand for levels of care one, two and three is increasing rapidly. The CMP anticipates demand for class three care growing at 9% per year up to 2035. The CMP notes there is a current demand for 273 emergency physicians in Abu Dhabi, but just 196 FTEs were employed in 2015. It forecasts demand will rise to 363 in 2020, 465 in 2025 and 682 in 2035. The plan says investment is already needed in complex emergency care in Abu Dhabi and anticipates similar investment will be required in Al Dhafra by 2025. Using digital mapping and international models for trauma centre requirements by population groups, the CMP proposes that the Mafraq Hospital, Madinat Zayed Hospital, Sheikh Khalifa Medical City and Al Ain Hospital be designated as complex emergency care centres, reachable in 45 minutes by ambulance or medevac.
Using comparisons of the data it has collected with international best practices, the CMP identified the need to develop a specialist children’s hospital with 250 beds, scaling up to 300 beds by 2025 and 375 by 2035. The plan suggests this could be achieved by expanding or redeveloping Sheikh Khalifa Medical City or by working with a leading provider, as Mubadala Healthcare did with Cleveland Clinic Abu Dhabi, to develop a new paediatric centre.
The CMP envisages a strong compound annual growth rate between 2015 and 2035 in demand for other services, including 7% in non-acute and long-term care (LTC), 6.5% in acute same-day care, 6% in specialist outpatient care and 3.8% in acute overnight care. However, the supply-demand landscape is mixed in some cases. There are examples of existing or anticipated oversupply, such as in acute overnight care in Abu Dhabi and Al Ain, even while the same kind of care is deemed inadequate and is an urgent priority in Al Dhafra.
There was a shortfall in Al Ain and Al Dhafra in the provision of specialities such as orthopaedics, cardiology, neurology, rheumatology and respiratory medicine, and a worsening undersupply of non-acute beds and home care. The plan identifies an oversupply of more junior medical staff and a shortage of consultants, particularly in primary medicine, psychiatry and emergency medicine, which is matched by a shortage of nurses and midwives. To address gaps in the clinical workforce, HAAD is to establish a workforce planning and delivery body, while also developing a suite of initiatives to strengthen residency programmes and encourage more Emiratis to join medical professions.
When it comes to managing the provision of facilities, HAAD plans to use its regulatory powers through the licensing of new and existing facilities, the allocation of land, and the introduction of new metrics to assess the proportion of medical or surgical procedures taking place in hospitals or clinics that meet with CMP objectives. According to the CMP, HAAD and the national insurer Daman will develop a methodology “that links reimbursement and the provision of facility or specialist coverage together in order to incentivise provision”. This may be particularly relevant to non-acute and LTC, where 85% of capacity has been provided by private providers, whereas 98% of patients are covered under the Thiqa insurance programme for nationals. Abu Dhabi has been a trailblazer in the introduction of universal insurance and the use of public-private partnerships in health care, which suggests creative solutions may be developed.
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