Demand for health services rises in Qatar

 

Through a healthy stream of public investment and support, modern facilities and an innovative medical technology (medtech) segment, Qatar has established itself as a global leader for health care. In the 2019 Legatum Prosperity Index produced by the Legatum Institute, a UK-based think tank, Qatar ranked 48th out of 167 countries for health, with a score of 76.07 out of 100, the third highest in the MENA region. The country’s per capita health spending is also among the highest in the Middle East, which has ensured that the population remains one of the healthiest in the region and has also led to a growing market for medical tourism.

In this context, the outlook for Qatar’s health sector remains promising. Despite its small size, the country’s medtech industry is pursuing various research and development (R&D) initiatives, and stakeholders across the sector are continuing to face up to new challenges, such as the rise of non-communicable diseases (NCDs). In addition, like the rest of the world, Qatar’s health sector was under pressure as of early April 2020 due to the Covid-19 crisis, with the authorities taking steps to limit the health and economic impact of the virus.

Structure & Oversight

The main government body responsible for overall policy and strategy formulation is the Ministry of Public Health (MoPH). Under Qatar National Vision 2030, the country’s development plan launched in 2008, the ministry is charged with establishing a modern health care system based on global standards of research and education programmes, and high-quality practitioners and facilities.

The sector is also guided by the National Health Strategy (NHS), which runs from 2018 until 2022 and seeks to build on the achievements of previous initiatives, with a focus on promoting the sharing of information among health care providers, as well as combatting the rise of NCDs through public health campaigns and expanding care in areas such as the treatment of mental illnesses.

Key entities operating within the MoPH include the Healthcare Quality and Patient Safety (HQPS) department and the Medical Commission Department (MCD). The HQPS oversees the quality and effectiveness of health services, and enforces various standards such as the Patient Safety and Risk Management, Infection Prevention and Control, and Antimicrobial Resistance initiatives. The MCD is responsible for screening all individuals entering Qatar for infectious diseases including HIV/AIDS, hepatitis B and C, syphilis and tuberculosis. The MoPH also operates a number of preventive health and health education programmes for the public, including the National Immunisation Programme and tobacco control programmes. The Qatar Council for Healthcare Practitioners (QCHP), which was established in 2013, retains sole authority for regulating all health care practitioners and facilities in both the public and private sectors. Lastly, the MoPH’s Pharmacy and Drug Control Department regulates the manufacturing and marketing of drugs.

General Indicators

According to the most recent data from the World Bank, life expectancy in Qatar reached 78.2 years in 2016, the highest rate in the GCC and almost on a par with the US average of 78.6 years. At $1827, Qatar has the highest health expenditure per capita in the GCC, comfortably ahead of the UAE ($1323), Saudi Arabia ($1147), Bahrain ($1099) and Kuwait ($1068). However, Qatar allocated 3.1% of GDP to health expenditure in 2016, below the global average of 10%, but above its 2014 level, which stood at 2.4%.

Maternal and child health indicators have also improved significantly. The infant mortality rate in the country decreased from 17.7 per 1000 live births in 1990 to 5.8 in 2018, according to the UN Inter-Agency Group for Child Mortality Estimation. The under-five mortality rate fell steeply over the same period, from 20.8 per 1000 live births to 6.8.

Increased investment in health care has already had a tangible effect on infrastructure and access to facilities. The most recent health indicators published by the Ministry of Development Planning and Statistics found that in 2018 there were approximately 3535 hospital beds in Qatar, up from 3011 in 2017 and 2627 in 2016. Although this is a considerable increase, this equates to a ratio of 13 beds per 10,000 people, which is still much lower than the OECD average of 47.9 beds.

NCD

In line with the country’s economic development, modernisation and urbanisation, many Qataris have adopted a more sedentary and car-centred lifestyle, which has resulted in a rapid rise in preventable diseases such as diabetes and hypertension.

While increased investment has enabled the sector to expand in terms of its capacity and infrastructure, efforts have been primarily focused on treatment rather than preventive care, which has allowed these diseases to become more prevalent. According to the most recent data from the World Health Organisation (WHO), NCDs were responsible for approximately 69% of all deaths in Qatar in 2016, with cardiovascular diseases and cancer accounting for 27% and 16%, respectively. While around 9% of deaths were caused by diabetes – much lower than rates in other GCC countries such as the UAE (18.7%), Saudi Arabia (16.8%) and Oman (13.4%) – it is still above the global average of 6.4%.

The economic costs of NCDs on Qatar’s health sector are high and expected to rise as current lifestyle trends continue. A study from the World Economic Forum and Harvard University’s School of Public Health in 2015 estimated that the cost of NCDs in the country is set to reach around $2778 per capita. This figure is noteworthy as the OECD average for total health care spending per capita in 2017 stood at approximately $3857.

Covid-19

Like the rest of the world, Qatar has also had to contend with the Covid-19 outbreak, which has placed considerable pressure on the health sector. As of late March 2020 approximately 700 cases of Covid-19 were registered in Qatar. The authorities have responded quickly to reduce the spread of the virus, closing the country’s borders to non-residents on March 18, 2020. On March 30, 2020 the Hazm Mebaireek General Hospital (HMGH), a 118-bed facility in Doha operated by Hamad Medical Corporation (HMC), was rapidly transformed into a Covid-19 treatment facility. The government has also implemented measures to limit the economic impact of the virus, unveiling a Dh75bn ($20.8bn) financial incentive package to protect the country’s private businesses.

Public Sector

Two government-owned entities are responsible for providing public health care in Qatar: HMC, a non-profit organisation; and the Primary Health Care Corporation (PHCC), an independent body established in 2012, which has its own budget. Together HMC and the PHCC serve over 90% of the country’s population, although private health care providers are becoming increasingly popular. The PHCC covers most primary care services while HMC provides inpatient care. HMC has 12 hospitals in its portfolio – nine specialist facilities and three community hospitals – with around 2500 beds altogether. It also manages the national ambulance service, as well as at-home and residential care services.

HMC has seen a significant expansion of its infrastructure and the range of services offered to patients. Between 2016 and 2019 HMC increased the total number of inpatient beds by 25%, opening five new hospitals over the period. The most recent addition to HMC’s portfolio is the HMGH, which was inaugurated in December 2018. In July 2019 the first phase of its surgical services programme was completed, which saw the opening of two operating theatres for general surgery and urology, where more than 15 surgeries are expected to be performed per week.

Meanwhile, the PHCC has 27 health centres located across the country, after opening four new facilities in 2018 and the Qatar University Health Centre (QUHC) in 2019. Based in Doha, QUHC is home to 23 doctors and 44 nurses, in addition to laboratory technicians and pharmacy staff. The centre is designed to cater for 35,000 people, with an initial capacity of 10,000 visitors registered upon its opening in January 2019. QUHC offers a range of services including family medicine, walk-ins and specialist clinics such as ophthalmology. “The growth of the population has led to rapid development and expansion of existing facilities, which requires that PHCC acquire and maintain the highest level of staff to run these facilities,” Mariam Ali Abdul Malik, managing director of PHCC, told OBG.

In recent years both HMC and the PHCC have taken steps to integrate their services as part of the NHS. Since 2017 the two entities have combined patient data through shared clinical information systems, and are increasingly collaborating in areas such as mental health. A key aim of the NHS is to shift the provision of mental health services from secondary care to primary care, under the authority of the PHCC, to reduce waiting times and increase capacity.

To this end, in February 2019 the PHCC launched the Integrated Mental Health Service, a pilot project to provide diagnosis, treatment and follow-up plans for patients who were previously referred to HMC’s Psychiatry Hospital. In October 2019 the MoPH launched a two-month campaign to raise awareness of mental health issues in partnership with the PHCC, HMC and private health care providers.

Public Spending

In 2019 the government allocated QR22.7bn ($6.23bn) to the health sector, representing 11% of its total budget. This remained largely unchanged for 2020, with QR22.6bn ($6.2bn) allocated to health. According to a report from regional investment bank Alpen Capital, Qatar’s health spending is expected to grow by an average of 2.2% per year until 2022. This relatively slow growth was attributed to an anticipated increase in the country’s population size.

Major public sector projects in progress in 2020 include an expansion of HMC facilities and the establishment of several new health centres. Additionally, the 2020 budget will build on existing plans to construct new laboratories and the ongoing development of five health centres in Al Wakrah, Al Mashaf, Al Saad, Al Khor and Ain Khaled. However, the progress of some projects may be halted as government revenue is impacted by the drop in oil prices in early 2020, and resources are directed to the treatment and prevention of Covid-19.

Private Sector

As the rising prevalence of NCDs has exerted increased pressure on the public sector, private health care operators have taken on a more important role in keeping up with the country’s growing demand for services. The country has the highest per capita income in the world, which affords Qataris the opportunity to seek private specialist treatments.

As of 2019 there were six private hospitals in the country and more than 200 private polyclinics, as well as a range of clinics, laboratories, pharmacies, and medical centres. In June 2019 Hanan Mohamed Al Kuwari, the minister of public health and managing director of public provider Hamad Medical Corporation, announced that the MoPH was looking to expand the role of private health care providers in order to achieve its ambitious expansion plans. By 2022 the MoPH aims to increase the number of private hospital beds by 25% (see analysis).

Some of the major private providers in Qatar include the International Medical Centre, American Hospital Clinics, Al Ahli Hospital, Doha Clinic Hospital, and Sidra Medical and Research Centre (SMRC). Although many of these hospitals and clinics refer patients to HMC facilities if specialist treatment is required, SMRC is taking on an increasingly prominent role in providing tertiary care. The facility opened in 2018 and has 400 beds, with the capacity to treat 275,000 patients per year.

Insurance

Qatar offers free universal health coverage (UHC) to citizens and residents at all public health facilities, which only charge nominal fees for medication. In the WHO’s most recent UHC Service Coverage Index, released in 2017, Qatar scored 68 out of 100, placing it above the global average of 65.69. Though health services in the country are sound, the high costs associated with operating a UHC system have come at a significant financial cost for the Qatari government.

In 2013 the country introduced a public national health insurance scheme known as Seha, which aimed to shift the burden of health care costs to the private sector. Seha was operated by the National Health Insurance Company, a joint-stock company wholly owned by the government. The scheme was expected to eventually cover all Qatari nationals, expatriates and tourists, but it was discontinued in 2015 due to mounting expenses and growing criticism about resource management. Since then, the government has relied on private sector insurers to fill the gap while efforts to develop a new national insurance law continue. In June 2019 the MoPH announced that a draft law to create a new health insurance system would be launched soon. While few details about the law had been made public as of March 2020, it is expected to mandate that visitors to Qatar have medical insurance, in order to reduce the current pressure on health services. At a weekly meeting of the Advisory Council in June 2019, the board urged the government to reintroduce citizens’ health insurance, and suggested that the private sector be permitted to participate in its implementation.

Medical Staff

With approximately 77.4 physicians per 10,000 people, Qatar has one of the highest health workforce densities in the world. However, the country still faces a shortage of locals studying and working in the health sector, as is the case across the GCC. As of early 2020 more than 90% of nurses were expatriates, and around 69% of doctors in the public and private sectors were sourced from abroad. A number of medical centres, such as the Cuban Hospital in Dukhan, are staffed entirely by foreign nationals. “Qatar’s local population is small, and currently there are few locally trained doctors, and even less who choose to work in family medicine or primary care,” Steven Emery, assistant managing director of the PHCC, told OBG. “It is extremely difficult to recruit Qataris, so we have to look regionally and globally.”

The distribution of foreign health care professionals also reveals a public-private dichotomy. “Private hospitals usually recruit personnel internationally, mainly in order to maintain healthy levels of local competition. Because the market is relatively small, local recruitment often translates to poaching employees, so most private institutions recruit expatriate staff,” Jassim bin Mohamed bin Hamad Al Thani, vice-chairman of Mohamed bin Hamad Holding, told OBG. According to Egon Toft, dean of the College of Medicine at Qatar University (QU), the country will need around 250-300 additional physicians each year in order to keep up with demand for medical services. Although Qatari medical graduates currently only make up a small proportion of the graduate doctors entering the workforce every year, the number is rising. QU’s College of Medicine and the Weill Cornell Medical College of Qatar (WCM-Q) are the only two universities that offer medical degrees in the country. WCM-Q has produced 384 new doctors since its first graduation ceremony in 2008, with an increasing number of Qataris. The year 2019 saw Qatari graduates, one fewer than in 2018.

Pharmaceuticals

With only a few local manufacturers, Qatar’s pharmaceuticals market is highly dependent on imports. There are no controls over the pricing of medicines in Qatar, which has meant that pharmaceuticals prices are among some of the highest in the region, although costs differ for Qatari nationals and foreign patients in public facilities.

The industry was valued at $537.4m in 2018, with branded medicines comprising around 80% of all pharmaceuticals sold, and generics accounting for the remaining 20%. Although the MoPH promotes the use of generic medicines, branded pharmaceuticals remain extremely popular as they are often more trusted by both pharmacists and consumers.

Most medication is imported by dedicated air service Pharma Express, operated by Qatar Airways Cargo; there is only one local manufacturer, Qatar Pharma, which focuses on producing intravenous solutions.

The disruption of some supply routes in June 2017 caused by the regional blockade against Qatar has seen the country shift away from importing generics from neighbours such as Saudi Arabia, UAE and Bahrain, instead looking to other markets and brands to fill the gap. This has resulted in higher costs for Qataris and calls for the country to manufacture medicine locally. While this may take some time to achieve given challenges such as skills shortages, a lack of raw materials and stringent regulations, local pharmaceutical companies, such as QL ife Pharma, have already signed several promising collaboration agreements with overseas firms. In May 2018 the company inked a deal with Poland to develop medications in QL ife facilities.

R&D

Although Qatar’s pharmaceuticals industry is still in the early stages of development, various start-ups and research projects are helping to establish the country as a centre for medtech R&D. For example, Meddy, an online platform that helps patients find and book appointments with medical practitioners best suited to their needs, has 120,000 active monthly users. The platform has helped increase profitability for medical service providers and improve patient experience. In November 2019 it was awarded QR9m ($2.5m) in funding from various venture capital firms to scale up its operations and expand into other GCC countries.

Another major initiative is the Qatar Genome Programme (QGP), a population-based project that aims to pave the way for precision medicine and personalised care. “Qatar is one of the few countries with a national genome programme, and so far we have sequenced 10,000 genomes,” Said Ismail, director of the QGP, told OBG. “In 2020 our target is to complete genomic characterisation of 10% of the population and finalise plans to open the Qatar Precision Medicine Institute.”

Outlook

The development of new facilities is set to continue in the coming years, with a raft of new hospitals and clinics under way across the country in order to meet growing demand for medical services. A key focus in 2020 will be the government’s ongoing plans to develop a national health insurance scheme. The role that this new law envisions for private sector operators will be a determinant of investment and growth potential, particularly as pressure on the public sector continues to rise with the growing incidence of NCDs and the more recent threat posed by Covid-19.

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The Report: Qatar 2020

Health chapter from The Report: Qatar 2020

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