Healthcare in the UAE
Healthcare has proven to be one of the UAE’s most resilient sectors in the face of international economic woes. The UAE’s population is made up of several different demographic groups from different cultural, geographical, and socioeconomic backgrounds. Each different demographic group has its own unique set of healthcare needs and there is a concerted effort from both the private and public sectors to address these needs.
Some of the indicators used to measure the health of a society seem to be pointing in the right direction. The overall trend in health indicators remains positive, and is expected to continue improving. Life expectancy has risen from 75.3 years in 2005 to an estimated 76.5 years in 2011, levels similar to those in Europe or the United States and infant mortality has fallen to an estimated 11.9 in 2011. According to the World Health Organization (WHO), 100% of the population uses safe drinking water sources, 97% uses clean sanitation facilities, and 92% of one-year-old children were immunized against measles.
I do believe that the United Arab Emirates is in a leading position in the region when it comes to healthcare. Our leaders at the federal level are working hard. The government is making good investments in healthcare and healthcare has always been a priority in our annual budget in the UAE.
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.
However, there are some other indicators that are showing negative trends. The GCC has some of the highest incidents of lifestyle diseases in the world. Within the national population, the UAE faces the highest prevalence of diabetes and obesity in the world and these challenges are getting progressively worse. The level of consumption of processed food is high, and lifestyles are sedentary with a lack of exercise. Diabetes, coronary problems, and other obesity-related diseases are becoming widespread. According to the WHO, over 60% of the population is overweight, 20% of the population have been diagnosed with diabetes and a further 18% are considered to be at high risk of developing the disease. These rates are among the highest in the world and it is predicted that deaths from diabetes will increase by 50% over the next ten years. There are also high rates of hypertension, cardiovascular, and kidney problems; with all of these conditions compounded due to diabetes, the obesity, and the lack of exercise.
In addition to lifestyle diseases, the availability of soft and hard infrastructure presents a challenge. The GCC as a whole suffers from a structural deficit in healthcare infrastructure and delivery. Statistics show there are 2 hospital beds and 1.6 doctors per 1,000 people in the region, with the UAE coming in at 1.9 and 1.93 respectively per 1000 people as of 2008. 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 McKinsey and Company. However, experts counter that such studies sometimes fail to take into account a more progressive and efficient approach to healthcare delivery.
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 easier to get your head around when looking at projections. But there are other factors that perhaps have a bigger impact. One of those is increasing the efficiency in the way we deliver care.
Something about these long-term surveys is, if they are based on the wrong criteria about how healthcare is going to be delivered into the future, I think you can have a tendency to require too many hospital beds versus looking at the whole delivery of healthcare into the future. For example, more outpatient surgery centers, home healthcare, and delivering healthcare to the population in the vehicle that is necessary into the future versus just looking at number of hospital beds compared to population. I think Abu Dhabi and the Abu Dhabi government recognizes that and is trying to have that balance between over building hospital beds versus really providing the healthcare that is going to be needed by the population.
Spending & Investment
With regard to investment, governments have shouldered most of the cost of developing their healthcare sectors in the GCC, with over 75% of total costs paid for by GCC governments. However, rising costs of providing a high standard of medical care has resulted in a focus to share some of this burden with the private sector. In the UAE, the private sector has focused more on elective procedures and outpatient care rather than trauma, inpatient care, and emergency services.
The UAE government spent an estimated 2.9% of GDP on healthcare in 2011. This is a lower percentage than that of regional neighbors and most developed countries. However, accounting for the high rate of GDP growth, spending has in fact more than doubled since 2005 to reach nearly $7.5bn in 2011. This level of growth is expected to continue in the coming years with healthcare spending expected to reach $12.66bn by 2014. This will represent a per capita healthcare spend of $1,963 in 2014, nearly triple the 2005 per capita figure. Additionally, private healthcare investment has played an important role in the growth and development of the sector, mitigating the potentially negative effects of lower rates of public spending and helping to bridge the gap in supply and demand.
Governance & Administration
Structurally, the administration of healthcare in the UAE is somewhat complicated with different authorities administrating across the different emirates and across the different free zones within the emirates. Hospitals throughout the emirates tend to have a high degree of autonomy.
In Abu Dhabi, the Health Authority-Abu Dhabi (HAAD) is responsible for regulating the healthcare industry and developing policies, and the Abu Dhabi Health Services Company (SEHA), manages the public healthcare facilities in the emirate. Dubai has its own health authority, the Dubai Health Authority (DHA), which is responsible for public and private healthcare facilities in Dubai. Ultimately, the Ministry of Health is responsible for public and private healthcare facilities across all seven emirates, overseeing HAAD, SEHA and the DHA, and is solely responsible for healthcare administration and both public and private facilities in the emirates of Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimah, and Fujairah.
Most of my experience here is in Dubai. What I can see more than anything else is from the insurance aspect. It seems like they are starting with a type of insurance in Abu Dhabi, using Daman as their carrier. I believe it will move throughout the emirates and the nation and that this is important. Given the fact that people do travel, they work in one emirate and may live in another, it is important to make sure we have a coordination of care and payment across the entire nation. I think this is going to be very important.
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.