To what extent was healthcare neglected during the economic boom here in Dubai? To what extent does the lag that neglect created in the sector create more opportunity in healthcare today? Where do you identify the best investment opportunities today in healthcare?
CANNING: It is true to say that during the boom time there was not a lot of investment in healthcare. When we started 5 years ago, the healthcare market was still not as mature as it is now, and even now, we have a long way to go. There are a lot of companies that did a lot of work here, and some of them are still here and some of them are not. There are many different models that were tried here, some have worked and some have not. The key is what organizations are actually bringing to the market. Do you want to bring solely a high value clinical service, or do you want to bring more. We believe that along with high value clinical service, teaching and research are also key components of the healthcare industry. Unfortunately, the emphasis on teaching and research is just not there in this part of the world. The drive, the need, the desire and the recognition that you have to provide is just not there. It is a strategic benefit to the country to provide its own doctors and that is something that has just not taken hold yet here.
Clearly the growth market is in clinical service. As the population grows and as the healthcare needs of the population grow, and expectations of the population grow, and we are going to see more and more need for clinical service. Although we are going to need more clinical service, it is still uncertain what the model employed is going to look like. A lot of it has to do with the insurance market here because a majority of the money for clinical care is going to be coming in from insurers in various forms and that is a flexible animal in itself at the moment. There is still a debate about what the fundamental principal of paying for healthcare in this part of the world is, and I think each emirate takes a different approach. There are very big differences on how the different emirates supply healthcare.
Over the next 20 years, treatment demand in the GCC will rise by 240 per cent and the total number of hospital beds will need to more than double to 162,000 to meet the needs of an ailing populace, according to consulting firm McKinsey and Company. Is the UAE currently on track to meet these growing demands? What investments is the government making in healthcare in the UAE?
CANNING: What is not discussed in this report is who these people are and there is a very marked stratification between the white collar and the blue-collar workers here, and the different groups of white-collar workers. Healthcare provision is not even, it is not a national healthcare provider scheme, as we would understand it in the UK. As mentioned there will continue to be a lot of growth in healthcare and a lot of that growth will be in the blue-collar sector. The health demands for the blue-collar sector are very different. The way that healthcare works for this sector is also partly determined by the way that employment contracts are arranged, and how residence visas work.
By and large we find that expats around the world are a healthier group of people in general. That is partly because if you have some chronic disease or serious health issue you may not be eligible to travel or you may not want to travel. Therefore, the healthcare demands for the expatriate population are very different. What is hugely noticeable is the demands for the local population, which is estimated around 15% of the population of Dubai and 25% of the UAE population as a whole. These people have a completely different set of health issues. In optomology, the key thing we see is diabetes. Diabetes affects the eyes, and very badly in some cases. With a very high prevalence of diabetes here, second highest prevalence in the world, we see a lot of patients with diabetes and diabetic eye disease at an earlier age than you would expect to see it. The demand for diabetes healthcare is huge and growing. There are some pretty innovative ways of addressing that, particularly in Abu Dhabi, where the Imperial College will be opening their second unit in May. They have a high quality model for the mass treatment of diabetes.
Experts say that the GCC suffers from a structural deficit in healthcare infrastructure and delivery. Statistics show there are 1.6 doctors per 1,000 people in the region, whereas Germany, for example, has 3.4 doctors per 1,000 people. How are providers addressing this structural deficit?
CANNING: As a country, if you are not training your own doctors to a high standard, you are then relying on expatriate doctors. Getting the right doctors from the right places will require the right incentives to get them to come here. We believe thoroughly in research and training because if you are only providing clinical service it is only a matter of time before you are not providing it very well. The structural deficit I see is in the lack of commitment to teaching and research. Provision of doctors basically comes down to lifestyle and money; if you get those two right, then you have your doctors. There are enough doctors out there, if you pay them they will come. Dubai also provides a very high quality of living, so it is not too difficult to bring people here.
Clearly the growth market is in clinical service. As the population grows and as the healthcare needs of the population grow, and expectations of the population grow, and we are going to see more and more need for clinical service.
How is hospital accreditation given in the UAE? What are the licensing requirements for doctors in Dubai at the moment? Are standards the same across all emirates?
CANNING: Accrediting doctors and accrediting hospitals in the UAE is an extraordinarily labyrinthine process, which goes against the ethos of the UAE, which is to streamline and eliminate bureaucracy. It simply does not happen in healthcare and that is a major problem. In order to practice medicine across the UAE, I would need to hold four medical licenses from four medical licensing boards in a very small country. To practice medicine across the whole of Europe, I need one. The bureaucracy is extraordinarily complicated. There is a long way to go in regulating and registering doctors to practice in the UAE. From the end user in healthcare as a doctor, I can see no benefit to requiring four licenses in a country this size. Ideally, across the GCC, doctors should only need one license, that would be a good use of resources. Having four different groups verifying the same document is not a good use of resources at all.