It can be said without a doubt that the GCC governments have made substantial investments in infrastructure and resources to improve health services for the patient community, leading to significant improvements of regional health. While the conversation has historically revolved around the unmet needs and gaps in clinical infrastructure, the narrative has shifted over the past few years towards improving the quality of services, attracting and retaining clinical talent, and encouraging private sector participation in the delivery of health services. In 2016 especially, there was a lot of talk about developing and shaping an efficient and sustainable healthcare system in GCC countries at an affordable cost. Efficiency, sustainability and affordability are especially important to overcome challenges of today such as the pressure on budgets resulting from a continued lowered oil price, the rising utilization of health services driven in part by changing demographics (towards an older and sicker national population coupled with a sizeable segment of a younger pediatric age group that has a higher utilization of health services), the rise in burden of chronic diseases, and also in some part by health insurance reform which has increased the demand for health services in the major economic hubs in the GCC.
Despite increases in the efficiency of regional health care delivery, payers including GCC governments and insurance companies, find the increase in healthcare costs (ranging from 8-12 percent per year across GCC countries over the past three years) to be unsustainable in the current economic environment. While some GCC governments have reduced budgetary spend or capped their budget to previous year’s spending, the insurance companies are investing in cost containment efforts to limit spending and curb overutilization of health services.
Public sector hospitals and clinics in the GCC could consider the following reform initiatives to stabilize their spending while addressing and serving the needs of their patient population. The following top 6 most important reform initiatives will enable the GCC public health sector to provide world class, efficient, affordable and sustainable health care when needed by patients:
- Redesign the care-model and improve primary care services
The past two decades has seen governments invest significantly in building and operating secondary and tertiary care hospitals. This has helped improve the quality of health services as well as create a situation where the infrastructure delivers ‘sick care’ and not preventative healthcare services. More efforts can be made at various touchpoints, and more particularly partnering with the private health sector to provide newer, technology enabled primary care services that are focused on preventative services, check-ups, monitoring chronic conditions, and developing intermediate care services, long term care facilities and home healthcare services. This needs to be done in a way that the services are delivered efficiently, providing the patients with multidisciplinary care across the care continuum. Redesigning the model of care could be an effective step for GCC governments to not just bring critical investment needed at this point through the private sector, but it could help check the spiraling healthcare costs and help address the challenges that accompany the rise of the burden of diabetes, stoke, cardiac diseases and obesity.
- Leverage specialization and concentration of services
It is not uncommon to see duplication of clinical services among public hospitals that are in close proximity. Efforts can be made to consolidate inpatient services to treat complex and serious medical conditions in a single center of excellence equipped with the best doctors, technology and resources. Most minor, elective procedures can be moved out of hospitals to be delivered in day care centers or in ambulatory care, thus reducing the need for unnecessary hospitalization. Denmark has made significant progress in their optimization of health services delivery across the care continuum. This has resulted in close to 94% of all services being delivered in an ambulatory care setting or at the patient’s home through telehealth enabled services. However, moving towards this requires a shift in the mindset of clinical and administrative leadership in the public sector health facilities, to embrace e-health and push towards the implementation of electronic medical records. It is encouraging to note that the emirates of Dubai and Abu Dhabi are making a bold push towards electronic medical records. This is a critical step in helping deliver high quality, efficient and coordinated care while allowing patients to seamlessly access the best available resources in the health system.
- Outsource non-core clinical support services
While most public hospitals in the GCC outsource non-clinical support services like catering, security and facilities management, much more can be done to engage with the private sector and foster mutually beneficial partnerships that are geared towards reducing the cost per unit of the service delivered, improve quality and deliver a higher volume of services with the same resources. Outsourcing the management of pathology laboratories, imaging diagnostics, laundry and sterilization services could be effective steps to further reduce costs. This also optimizes and frees up latent capacity and brings down the waiting list for certain services, as the tried and tested processes of a private sector partners can bring efficiency and cost containment. This could also be a revenue stream for the public sector hospitals as capacity freed up can be used to deliver services to private sector clinics at a fee for service.
- Re-assess the cost structure
Most public hospitals in the GCC don’t measure the cost of delivering care to the patient in real time. The biggest cost components in hospitals or clinics are the cost of staff and the cost of medical consumables. While for medical consumables strategic sourcing, centralized purchasing, optimizing order cycles and shifting from branded formulations to generics where possible can bring great results– opportunities exist to further reap results through implementation of global best-practice processes and productivity measures. Public sector hospitals and clinics can benefit from lessons learned across Europe over the last two decades to bring down average length of stay, improve productivity and shut down non-functional beds, which has helped slow down the rise in healthcare costs despite a sizable aging population. In the GCC however, efforts over the past decade have been to create more capacity and build more hospitals and clinics to meet the rising demand for services. While much of this was justified in the past to address unmet needs and improve access, going forward what is needed is to considerably improve the productivity of resources (particularly the clinical staff) in public health facilities which will free up capacity to see a higher volume of patients, and avoid unnecessary capital outlays to expand inefficient services. It would help decision makers to implement performance management systems and push towards a daily, weekly and monthly (where possible) reporting of key performance indicators such as lengths of stay, bed utilization, waiting time for specialist consultation or elective surgeries etc.. Through the right set of key performance indicators, health providers can strive towards exceeding performance standards.
- Re-purpose certain health facilities
Within the public health system it has often been observed that few hospitals have a very low utilization of inpatient beds capacity, while most of the patient needs are oriented towards outpatient services. Meanwhile, in certain cases, particularly in small distant towns with a larger proportion of elderly national population, the general hospitals are seen to observe a high bed utilization and lengths of stay that average from 15-20 days, which indicates a need to create infrastructure for nursing homes, long term care services and extend home care services. Efforts can be made to re-purpose some of the existing hospitals based on the utilization of services and the patient communities they serve, into ambulatory care centers, nursing homes or long term care centers which are in acute shortage in the GCC countries and this could be done by making minimal investments to optimize the patient flow to health services in these communities.
- Overhaul and improve patient experience
While it is commonly known that many public hospitals across the GCC pick up the most complex cases and treat the more serious health conditions and also serve the most vulnerable segments of society, the general patient experience and level of responsiveness offers opportunities for improvement. Patients from a higher income segment or with access to health insurance flock to the private hospitals for most of their needs or travel abroad for overseas treatment in some cases. Often the reasons why patients do this are the long waiting time for appointments or tests, poor coordination of care or ineffective follow up treatment. This creates a dual problem for the governments – on one hand, a significant investment in the most technologically advanced equipment and highly paid clinicians, and on the other hand, meeting the burden of costs in the private sector or being faced with the flow of money outside the country to treat conditions or provide health services that are available at home. Public facilities can significantly improve the use of technology to make appointments, co-ordinate care within the health system and put in place patient-centric case management processes and staff to effectively serve the needs of the patient community.
The capacity constraints within the public health sector and the limited budget to meet rising healthcare demand create an unprecedented opportunity and urgency to assess, re-design, optimize and improve performance and the delivery of care within public health facilities in the GCC. While the road may be arduous, the timing to push through much needed reform couldn’t be better and there is hope that with persistence and commitment to the cause, the sustainability of the health system could improve in the region.
Ahmed Faiyaz is a strategy consultant and health sector expert with AT Kearney. He is a prolific speaker and has extensive experience in health sector transformation in the GCC