A clear road map has been laid out for improvements to the health care sector. By consulting both public and private providers, Dubai Health Strategy ( 2016-21) has outlined the Dubai Health Authority’s (DHA) core vision of a healthier community. With 15 strategic programmes and 100 initiatives to be applied by 2021, authorities are working to reshape what it describes as the “health ecosystem”.
While these measures are intended to facilitate systemic reforms, absolute control over delivery of these intended outcomes is tempered by Dubai’s resolute adherence to a free market approach, with the private sector expected to provide approximately 70% of the emirate’s health care needs.
Health & Efficiency
The first programme stresses the importance of ensuring patients have access to continuous quality care, with an emphasis on innovation and efficiency in filling existing gaps. The strategy outlines 10 initiatives to deliver solutions to long-term care, rehabilitation, home and remote care, telemedicine and new medical technologies and pharmaceuticals.
Further initiatives grouped under the prevention and healthy lifestyle programme, including enhanced school health campaigns, the development of health awareness in the community and a greater emphasis on health education in the school curriculum. There will also be a drive to improve vaccination campaigns and awareness of communicable diseases, as well as the introduction of personalised genetic profiling.
Under the public health and safety programme there are campaigns to improve food hygiene, road safety, occupational health, environmental health and disaster management. Primary care will also be a key focus with the aim being to make more efficient use of resources by promoting clinics rather than hospitals and the development of innovative models of primary care and family health delivery, accompanied by the introduction of performance measures.
Where dental health is concerned, the strategy calls for better awareness campaigns about oral hygiene, increased screening programmes, and the creation of a dental health protocol and innovative solutions for the delivery of dental care.
Other initiatives focus on the development and delivery of specialist respiratory disease clinics; centres of excellence in oncology, orthopaedics, sports medicine, ophthalmology and neurosurgery; treatment for cardiovascular conditions; a mental health strategy; medical tourism initiatives; and chronic-disease management programmes, including treatment for diabetes and the establishment of more renal dialysis clinics. There are also programmes covering governance, medical education, informatics and technology, insurance and financing, and investment, including plans for an emirate-wide health care investment strategy.
These strategic programmes are geared towards helping private providers identify gaps in the market – for instance in informatics and mental health or long-term palliative care.
Indeed, insurance companies are likely to have a significant role to play with the introduction of the International Refined Diagnosis-Related Group payment system. This system uses statistics to classify inpatient hospital stays into groups for payment purposes. In 2017 DHA introduced it for hospital accommodation only, but over a three-year period it will be rolled out to outpatient clinics as well.
The system, which was evaluated and subsequently adopted after consultations with insurance companies, is designed to ensure fair prices are charged for treatments, tests and diagnostic consultations. It may also curb the use of referral fees, which are ultimately paid by medical insurance companies. Mark Adams, the founder and former CEO of Anglo-Arabian Healthcare, told local media in May 2016 that doctors in the UAE are paid between Dh350m ($95.3m) and Dh400m ($108.9m) in annual fees by pharmaceuticals or diagnostic companies for the use of branded medicines or specific tests, which results in higher charges than might be incurred were generic drugs prescribed or scans and laboratory tests used more sparingly. “If you remove the kickback payments and use generics instead of branded medicines, as most health services in the US or Europe do, then you could save 25% of the claims fee, which would bring corporate contracts for insurance companies close to break even,” Adams told OBG.
Although several new hospitals and health facilities are being built, there were indications that some private hospitals were operating at below capacity in 2016. DHA data shows its own hospitals had a total bed occupancy rate (BOR) of 76.9% compared to optimal usage of 75% during the year. However, the BOR at private hospitals was just 44.6%, leaving Dubai with an overall rate of 48.1%. While there may be some provision gaps in treatment availability at DHS hospitals, the low-occupancy rate at some private facilities suggests there may also be considerable overlap among a growing number of competing facilities.
Another concern for some health care experts is that certain private facilities are focusing their attention at the high end of a stratified market. The result could be a significant mismatch between supply and demand with an oversupply of beds at the top of the market but a gap in provision for the majority of patients in the emirate who cannot afford to pay the highest prices, according to industry players.
“My estimate is that the true level of demand in the private sector is for 100,000 bed days a year, but with new hospitals being built, capacity could soon pass 1m bed days per year,” Adams told OBG.
Unless the population rapidly increases or medical and wellness tourism expands exponentially, this could lead to significant oversupply in the sector.
Despite these concerns for the future, DHA data on the private sector in 2016 point to strong annual growth in the numbers of patients using both outpatient clinics and inpatient beds. The 6000 doctors working in private centres treated more then 7m outpatients and just under 200,000 inpatients in 2016, increases of 9.1% and 18.9%, respectively, over 2015. In keeping with the demographic divide between citizens and expatriates in Dubai, non-nationals accounted for 83.6% of inpatients, 83.9% of outpatients and 85% of patients receiving surgery.
Some hospitals and clinics have begun concentrating on cosmetic procedures with DHA data showing there was particularly strong growth in skin care treatments performed in private facilities, with over 226,300 procedures completed, 71% more than in the previous year.
The International Modern Hospital (IMH) specialises in key-hole surgery, but its casualty room is also open to accident and emergency cases. Dr Kishan Pakkal, CEO of IMH, told OBG, “Generally, private hospitals prefer not to accept code-red or medico-legal cases. At IMH, we are open to accepting such cases.” IMH accepts cases transferred from DHA facilities through public-private partnerships, so that government centres can manage the overload and keep beds free for more critical cases. “We also work very closely with the Dubai Corporation for Ambulance Services in attending to such cases. This has led to more cases being directed to us,” Pakkal told OBG. DHA data shows the 78-bed hospital dealt with 9325 emergency cases in 2016.
At the other end of the care spectrum are medical tourists in search of detox, diet or day-spa treatments. When Dubai announced its target of attracting 500,000 medical tourists annually by 2020 in 2014, wellness was a core component of this target. That year the region’s oil-producing countries were selling crude at more than $100 per barrel. Dubai Holdings revealed a detailed master plan for the Dh25bn ($6.8bn) Mall of the World project, a 4.5m-sq-metre, temperature-controlled retail, hospitality and entertainment complex that was to include a 278,700-sq-metre wellness district giving visitors access to high-quality medical procedures and treatments. However, by 2017 falling energy prices saw austerity measures implemented in certain GCC nations, and the Mall of the World project was replaced by Jumeirah Central, a mixed-use development without a wellness component. In October 2017 it was announced that even this project was being put on hold to prioritise projects for Expo 2020.
Despite these setbacks, wellness has remained a key concept in the Dh5bn ($1.4bn), 1.8m-sq-metre phase 2 of Dubai Healthcare City. Indeed, by the end of 2017, 40% of phase 2 of the master plan has been realised in committed projects, the latest of which is a residential real estate development with a wellness theme. Swiss Property will build 230 homes with access to exercise tracks, pools and fitness centres. The project is scheduled for completion in 2019.
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