What new developments have taken place in Abu Dhabiâ€™s healthcare sector?
STANIFER: The healthcare market here continues to evolve. It has been evolving for years, but the pace of that evolution and acceleration has increased dramatically in the last 3 to 5 years. In recent months, I have seen a much more active role in the private sector. There are some new hospitals getting ready to come online. They appear to be ready now to take a much broader role in the provision of healthcare services here. Technology continues to be deployed, especially in SEHA. We have invested a tremendous amount in medical technology, medical equipment, diagnostic equipment, as well as technology such as electronic medical records. Within SEHA, we have an electronic medical record that runs across our entire health system. No matter where you are in our health system, you have one record so we can see what has transpired over your experience with us. That is a big advantage to patient safety.
Will telemedicine play a role in healthcare here in the UAE?
STANIFER: Telemedicine is fairly new throughout the world and it is even more new to Abu Dhabi. Some of the proven telemedicine opportunities, for instance, tele-radiology, are here now. All of our imaging films are digital in a central storage archive available through pack software. We do not have to have the radiologist on site anymore; we can use telemedicine for that. We have just recently done an exhaustive study on the state of telemedicine throughout the world, and which applications are ready for mature use and which applications have a more leading edge and have not matured yet. We have shared that study with the Health Authority of Abu Dhabi, with Daman the primary payer here, and there is a conscious effort among all the major players including the private sector to begin to adopt more telemedicine technology. For that adoption to occur, we have to look at the regulations that exist here because regulations are going to have to be amended and new regulations are going to have to be added. We are going to have to protect patient safety and patient confidentiality. There are licensing issues because there may be issues regarding an offsite professional rendering care and whether his license covers that or not. There are also issues around payment and whether a telemedicine version of care can be paid for in the same way that traditional brick and mortar healthcare is applied. What is important and what is encouraging to me is that Abu Dhabi is now looking at this very seriously at a very high level. Homework has been done and we are now on a path to create opportunity for innovators and entrepreneurs to come here and really move in the area of telemedicine. It is very important, and I think it is critical for a market like this where far too much of our reliance is based on foreign labor, for clinical work to be in play. So the solution is a combination of supplementing that with telemedicine. I am very optimistic that we are going in the right direction with this.
To what extent are we seeing a coordinated approach to healthcare across the UAE?
STANIFER: I think more can be done. There is coordination across the UAE on some very important issues such as certain licensure requirements and the approval of drugs for importation into the country. But more could be done. I am not involved in the regulatory process directly myself, so part of what I share might be anecdotal, but I do know there is continued communication between the regulatory groups and bodies among the 7 emirates as the federal umbrella, which is the glue that holds this together and that is the Ministry of Health. I would like to see more coordination and I expect we will see more coordination. Again, it is an evolution. I think each of us, and us being the 7 emirates, are experimenting with certain models, how best to fund care, how best to regulate, and that is good because we can each test certain models and then share with one another and eventually create a more common platform.
Where do you see the best investment opportunities today in healthcare in the UAE?
STANIFER: We have talked a little bit about telemedicine and I think there are some opportunities there. But if I were an investor I would want to wait until some of the issues such as licensure, regulation, and payment get sorted out and then look at opportunities there. In more traditional medicine, there are opportunities in home healthcare and in that instance, many of the regulatory and funding issues have already been sorted out. Long-term care and skilled nursing facilities, we have zero in Abu Dhabi now and there is a crying need for that. Rehab and psychiatric care are also a fairly urgent need. In acute care, and the number of beds, if you look at long-term projections by the Health Authority, I would not be too optimistic as an investor to come in and greenfield a bunch of new hospitals. We have several already under development both within SEHA and in the private sector and within Mubadala. Looking at the demand curves that HAAD projects, I think the bed need is close to being met. So there may not be as many opportunities in that sector, but there are many other opportunities.
How is the culture of healthcare in the UAE evolving?
STANIFER: There are many factors that influence projecting healthcare bed need. I think that population growth is obviously one and the ageing of the population is another. These are a little easy to get your head around when looking at projections. But there are other factors that have a bigger impact. One of those is increasing the efficiency in the way we deliver care. I mentioned earlier about some of the needs including home healthcare, long-term care, rehab, and psychiatric care. This will remove patients from existing acute care beds and put them into a more appropriate and less expensive care path. It is a lot cheaper to do it that way than to go and open up another hospital. Additionally, length of stay, there has not been a huge focus on case management or care management or length of stay management. The reimbursement systems here now in Abu Dhabi are evolving through diagnosis based reimbursement as opposed to per day based reimbursement.Â Health providers like SEHA are now paying a lot more attention to managing length of stay. There are cultural issues because often people do not want to move into an alternative care stay like home healthcare because they feel more comfortable in the traditional setting, large brick and mortar, plenty of specialist doctors and lots of equipment. But the fact is, if that care is not appropriate and not needed, we are really doubling up the cost to provide it. So it is a cultural change as well. But, you have to have the processes in place and theÂ effectiveÂ places to transfer patients to in order to change the culture. It is not a chicken and the egg situation, you have to have an alternative to show people and right now we do not have enough of that.
What healthcare indicators are the most interesting for the UAE?
STANIFER: Macro healthcare indicators are important and they really provide an overarching guide as to whether Abu Dhabi is moving in the right direction and getting value for money in terms of its healthcare expenditure. On a percentage of GDP basis, I believe we are under 4%. Compare that to the US, which is at 17%. If you just look at that one indicator, we are getting a great deal. But here the GDP is inflated because of the oil economy. This is something that has to be taken account when looking at GDP expansion and the expenditure on health. Another, and I think an easier method to compare, is the per capita spend on GDP. Again, we are far below the US. Our per capita spend on GDP varies greatly depending on which market you are in within our population. The blue-collar market is mostly male, they are mostly young, and they are mostly healthy. So they are not going to be consuming much healthcare and so we may be looking at maybe AED 2000 ($545) a year per capita spend for that segment of the market compared to maybe AED 8000 ($2178) to AED 9000 ($2450), I do not know the number in the States, but my guess is AED 8000 to AED 9000 maybe more per capita spend. If we look at the national population here in Abu Dhabi, the per capita spend goes up quite a bit. Chronic disease is driving that as well as the continually aging population. So I like to look at the per capita spend as a benchmark against other nations.
How are lifestyle diseases among the national population being addressed?
STANIFER: I think it is important to identify among the national population health status and put programs in place to better manage the health and well being of the national population. That is the portion of the population where we have serious issues regarding chronic diseases. A lot is being done to set the stage and make tremendous improvements in this area. It began with a massive national screening program 2 or 3 years ago, which was initiated by the Health Authority. SEHA did the screening in our clinics. That created a health status database for the nationals. That database is managed by the Health Authority. Daman has access to it through disease management programs. The target now is to take this data and begin a more intense lifestyle education, a more intense disease management program, a more intense program to ensure that individuals with chronic disease are complying with doctorâ€™s orders, taking drugs when they need to be taken, and coming in for follow up visits. It is important that we continue this work and use the data we have because the hard work has been done, which is getting the data. Now we have to find ways to use that data and we are. I think it is a huge benefit to the national population to have someone as interested and focused on monitoring their health status and helping them to improve their health status as we have the capability to do here.
On a percentage of GDP basis, I believe we are under 4%. Compare that to the US, which is at 17%. If you just look at that one indicator, we are getting a great deal. But here the GDP is inflated because of the oil economy. This is something that has to be taken account when looking at GDP expansion and the expenditure on health.
Which international healthcare management companies has SEHA brought to the UAE and why is this important for a nascent healthcare market?
STANIFER: We have turned to many international partners to help us develop the health system in Abu Dhabi further. Once SEHA was formed, and this was only 4 and a half years ago, we had a huge task to dramatically change the way healthcare was delivered, to improve quality, and to improve patient perception. We knew we could leverage the know-how of worldwide experts and shorten our time frame from what might have taken 10 years to maybe 3 to 5 years. We ended up partnering with Johns Hopkins, Cleveland Clinic, the Medical University of Vienna, Fresenius Healthcare, and Bumrungrad. These partnerships have given us the opportunity to tap into know-how that we wouldnâ€™t have been able to have access to before and we are primarily talking about clinical capability. So we can learn from them and apply it here under their supervision. This goes a long way to positioning SEHA toward the same level of world class healthcare that is available in some of the more developed countries.
What are the biggest challenges to healthcare in the UAE faces going forward?
STANIFER: There are many challenges moving forward. I think the biggest, and this should not come as a surprise, is the labour market. I mentioned earlier that we rely extensively on foreign workers in the clinical area. So most of our doctors, 98% to 99% if you do not count student and resident programs, are non-nationals and that is the same in the nursing area. This is almost as dramatic in the areas of pharmacy, lab, radiology and so forth.Â There is a worldwide shortage in all of these fields, so to remain competitive financially, in terms of quality of life, offering new opportunities in research and training, and so many other aspects of creating an environment where professionals want to come here and work and contribute, is never ending. Because people come here on 2 year and 3 year contracts with limitations on visas, you never fill the pipeline because people leave. So you have to continually work on the pipeline. So that is by far the biggest challenge we face in delivering healthcare here.
What role does healthcare play in Abu Dhabiâ€™s Vision 2030?
STANIFER: Abu Dhabi has great ambitions for healthcare and the state of healthcare here. It is simply stated in their 2030 plan with a few words. Those are to bring world-class healthcare to Abu Dhabi. That is hard to execute on and easy to say. It is my job and the 17,000 employees of SEHA, the private sector, the Health Authority, Daman, and other insurance companies, it is our collective job to deliver on this promise for the future.Â World-class healthcare involves a lot of things, not just clinical quality. It also deals with access. We now have over 99% of the people who live here with insurance. So we have access from that standpoint, they have the capability to pay. But do we have enough services, do we have enough beds, doctors, surgical capabilities, etc. So we have gaps there and we need to do better jobs with that. Part of world-class healthcare is access, so if you need to see a surgeon or a specialist, we can get you in to see that individual in a matter of days, not weeks or months. Cost is another aspect of the quality of healthcare or the achievement of world-class healthcare. It has to be affordable and yet on the quality side, it has to be the top. It is very difficult, as you can imagine, to balance all three of those, but if the three are not kept in balance, you just do not have world class healthcare. It is a big job and I think we are doing a good job but I also do not think we are quite there yet.