What role will SEHA play in the development of the healthcare system of Abu Dhabi? How is healthcare administered in Abu Dhabi?
STANIFER:Â SEHA has a significant role in the development of the healthcare system here. We are the largest provider of health services in the emirate, one of the largest in the UAE, and even in the whole of the Middle East. We have about 50% to 60% of the market share for Abu Dhabi, and we offer a full spectrum of services, everything from home healthcare to organ transplants. If it is provision of healthcare services, we are involved and in most cases have the largest market share.Â Most of the clinical staff is expatriate. We are still working hard to develop more Emiratis in the clinical positions, but historically, they have not chosen to go that way as a career path. About 85% of our employees are expats. We have hospitals, clinics, home healthcare, and are developing some post-acute care. The problem has been trying to maintain a labor force because we are importing most of our staff. All of our doctors are salaried, so they are our employees. The same applies to all of the nursing staff and administrators. We have a closed medical staff. Doctors in the private sector do not have privileges to work in our hospitals and our doctors do not have privileges to work in the private sector. This is quite a bit different from the way many other markets work.
Both the public and private sector play a significant role in the delivery of healthcare in Abu Dhabi. SEHA has, whether measuring outpatient or inpatient, or what particular type of service, generally over 50% of the market. In the areas of critical care such as ICU and neonatal intensive care, we have a much larger percentage of the market.Â The private sector is quite good here. It is a growing segment of healthcare delivery. They focus more on elective work. They do not focus on trauma and emergency services; they focus primarily on elective and outpatient care. When they do inpatient procedures, it is not usually the higher intensity procedures that involve the ICU and the neonatal ICU. But, patient satisfactory surveys show that they are as good as we are. Clinical outcomes are the same. So we have a very viable growing private sector, with the public sector as the safety net.
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? What challenges persist in recruitment of medical professionals?
STANIFER:Â There are structural deficits in healthcare provision. There are two or three different aspects. Number one is manpower, and that is the most important part. We do have lower numbers of doctors per 1,000 population than some other developed countries. The Health Authority of Abu Dhabi (HAAD) is primarily responsible for maintaining demand projections and supply projections to make sure we have the proper balance of physicians and nurses and other care providers. They predict five to ten years in the future on the numbers of clinical people needed to serve the needs of this growing community. It is a staggering amount of new clinical staff that are needed over the next five to ten years, and we have our challenges in doing so. Part of those challenges deal solely with compensation. We have recently completed some compensation surveys and we know where SEHA stands vis-Ã -vis the GCC, the USA, and other countries. It is a challenge for us to maintain competitive pay scales and to bring the right people and the top qualified people here. That is the labor side.Â The other side is the buildings and the equipment, and the numbers of beds. Again, HAAD plays a very important role in projecting the need for new infrastructure. We respond to what we see in those projections. We validate what we see and do our own due diligence. We embark on a lot of infrastructure expansion projects. We are building a new hospital to replace Al Mafraq Hospital and we have several other projects ready to present for final approval to the Executive Council of Abu Dhabi. We are expanding and renovating hospitals in the Al Gharbia Region and opening new clinics there as well. We are trying to get more capacity in the rural areas where there is a more drastic need for capacity to be developed.
The Gulf is battling the highest incidence per capita of lifestyle diseases in the world. What emphasis is placed on preventative medicine in the UAE today?
STANIFER:Â The Health Authority is primarily responsible for preventative medicine. So we have to work hand-in-hand to have an effective preventative medicine program. The Health Authority primarily identifies and publicizes the need and establishes funding mechanisms to meet that need. When the patients are being screened or being taken care of for a chronic disease, they generally are at one of our care providers.Â The population here is delineated. We have the national population and they have their own unique healthcare needs. We have what the insurance companies call the basic-plan population which is primarily the blue-collar and they have their own particular needs; and then there are the white collar expats who have a different set of needs. So when you look at gross statistics across the entire population of the UAE, it can be misleading. We do know the blue-collar market is predominantly young, predominantly male, and predominantly healthy. They have to pass a medical screen to even come here. Their health needs are quite less of a challenge. Primarily with them, it is dealing with on the job injuries and road traffic accidents. On the other hand, the national population has some serious chronic disease problems. Diabetes is at the top of that. I have seen statistics that indicate that we are at the highest prevalence of diabetes in the national population as any country in the world and the trends are not moving in the right direction. We also have obesity problems, hypertension problems, cardiovascular problems, kidney problems, and all of these are compounded because of the diabetes, the obesity, and life style lack of exercise. So a lot ofÂ the effort we make now between both HAAD and SEHA is in preventative. We focus on that cohort to identify the deficiencies in lifestyle and change lifestyle while at the same time screening and treating the diseases that are there today.
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 today?
STANIFER:Â The next twenty years are going to bring a lot of growth and demand in medical services throughout the GCC. I think that Abu Dhabi is better positioned than most of our neighbors in the GCC to meet this growing demand. This has to be balanced between private sector and public sector. As I have said before, SEHA has more than 50% of the market in most medical services. We would like to see and the government would like to see that shift a little bit more to the private sector.Â Abu Dhabi has national health insurance, which provides funding. There is land available in Abu Dhabi for healthcare projects. There are partners, venture capitalists, that are willing to invest in viable projects, and there is a need. All the ingredients are here for private investors to come and take up some of this growth and fill some of the gaps we have today, and we encourage them to do so. We have some very good private players that should be, and are, expanding their services. New players from Europe, the US, Australia, should come here and take a look at the opportunities for participating in this growth that everybody expects to happen throughout the region and specifically in Abu Dhabi.
We have national health insurance, which provides funding; there is land available in Abu Dhabi for healthcare projects; there are partners, venture capitalists that are willing to invest in viable projects; and there is a need. All the ingredients are here for private investors to come and take up some of this growth and fill some of the gaps we have today, and we encourage them to do so.
What internationally known organizations and institutions have you partnered with? Which additional institutions would you like to partner with?
STANIFER: We have partnered with Johns Hopkins in Baltimore, and they manage three of our hospitals under a management contract. We have partnered with the Cleveland Clinic from Cleveland Ohio, and they manage one of our hospitals. We have also partnered with an Austrian company, VAMED, who is in affiliation with the Medical University of Vienna, and they manage one of our hospitals. Bumrungrad, a Thai company, manages one of our hospitals. Fresenius, the largest dialysis company in the world manages our outpatient dialysis services. So we have partnered with some of the top brands and truly world-class healthcare providers around the globe, and we will continue to pursue these opportunities.
What role does SEHA play in Abu Dhabiâ€™s Vision 2030?
STANIFER:Â I think throughout the span of years that this vision covers, SEHA will still be a predominant healthcare provider for Abu Dhabi, and we will still be a safety net for people who cannot afford healthcare or are high medical risk. We will be doing research that is difficult for the private sector to do because of funding sources, we will be training Emiratis to enter the nursing field, to become physicians and pharmacists. We have physician residency programs already at many of our hospitals, and that is going to expand and grow. We have very high ambitions to drastically improve the numbers of Emiratis that are entering the field of medicine and caring for patients.Â I do not think our major role will change much; our position in that role might change slightly. We want to see more private sector involvement in elective services and growing their market share and taking more of the market in dentistry and outpatient care. For the foreseeable future, SEHA is still going to be the foundation for critical care, neonatal care, and transplants.