By Inga Louisa Stevens, Contributing Writer
A report by Alpen Capital has estimated that the hospital bed density in the region averages 17 beds per 10,000 people – much lower than the 54 per 1,000 seen in high-income countries. And as the United Arab Emirates continues to grapple with this shortage of hospital beds, a number of much-needed healthcare infrastructure projects are expected to enter the market in the next few years.
Arab Health Magazine sat down with King’s College Hospital (KCH) UAE Chief Operating Officer Neil Buckley to get an update on the UK-based hospital group’s plans for expansion into the UAE and his views on the increasing cost of medical care in the country.
- King’s is expanding its footprint within the UAE. Can you give us a progress update?
We are delighted to be delivering on our promise of bringing the best of British evidence-based healthcare to the UAE and enhancing patient journeys across more than 10 specialties, including paediatrics, foetal medicine, diabetes, and endocrinology. We’ve been in Abu Dhabi since 2014, with our flagship medical and surgical centre based in the capital. We also launched our second medical centre in September last year, this time in Dubai, specifically in Jumeirah. We are full steam ahead and on track to introduce two additional facilities in Dubai — another medical centre in Dubai Marina this year, plus our highly anticipated 100-bed hospital in Dubai Hills in Q1 2019.
All our facilities are directly connected to King’s College Hospital in London and we are committed to delivering and transferring its 175 years of world-leading expertise to the UAE and enhancing patient journeys so people don’t have to travel overseas, even for the most complex procedures.
Once all facilities are operational, come 2019, King’s will be serving a catchment area of hundreds of thousands of patients every year. In addition, we will be creating jobs for UAE-based healthcare professionals as well as for international doctors wishing to come to the UAE and be part of King’s expanding footprint.
We already have a stellar line up of world leading experts from King’s in London and its partner hospitals, who will visit patients in the UAE every four to six weeks as part of our unique ‘London Faculty Programme’. During the intervening period, their day-to-day involvement with our UAE-based doctors and patients is maintained through telemedicine and through our local clinicians.
- King’s is really championing primary healthcare in the UAE and the role of the Family Medicine Consultant. Why is this?
We believe that primary healthcare is the answer to some central problems that affect the UAE healthcare industry. Family Medicine Consultants can significantly help improve patient care outcomes and reduce medical inflation.
Often, when UAE residents have common medical ailments, they prefer to visit a specialist, rather than first visit a Family Medicine Consultant, also known as a general practitioner (GP). The common misconception is that by going to a specialist first, people will save themselves the time and money of an extra visit paid to the Family Medicine Consultant, and will get to the treatment quicker. However, in order to determine which specialist to visit, people self diagnose themselves.
Research shows that 72% of people self-diagnose, yet the chances of getting the diagnosis right are fairly low. In the eventuality of a misdiagnosis, patients don’t get the right treatment as early as possible, delaying recovery. Also, a patient’s condition could worsen, and their recovery may be slower, making the patient experience complicated and unpleasant.
An extra visit is, after all, not all that time-consuming; especially as the Family Medicine Consultant is the most qualified clinician within a clinical setting, fit to triage and refer the concerned patient to the right specialist, making a patient’s journey to better health much quicker and smoother. People should think of their Family Medicine Consultant as their health champion. Not only will he or she be able to coordinate the care the patient needs across specialists and help them make the right decisions following specialist visits, but he or she will also help manage their condition from a holistic point of view.
A Family Medicine Consultant will also educate patients about prevention and remind them of important health screenings and vaccinations. He or she is also the clinician who will know a patient’s full medical history (and his or her family’s history if they also visit them), and will help them make better informed decisions when prescribing a treatment.
Last but not least, patients’ medical choices affect the whole health ecosystem. Visiting multiple specialists for the same medical ailment leads to unnecessary costs for insurance companies, who find themselves having to increase medical premiums and decrease benefits. According to the Health Authority Abu Dhabi (HAAD), in Abu Dhabi people undertake - on average - 14 visits to solve a common health problem. We estimate that if this number was reduced by one visit, it could save insurance companies AED600 million.
- What is driving up medical inflation?
The UAE’s medical inflation rate generally ranges between 13% - 20%. There are many contributing factors, such as science and innovation, as ground-breaking developments come at a high price due to the investment needed in research, development and training. You also have a soaring prevalence of lifestyle diseases – diabetes, cardiovascular diseases, obesity and so on – the burden of which add enormously to medical expenditures.
Then you have over-utilisation. There is a tendency for some UAE providers to over treat and over prescribe, with a massive impact on inflation. On the other side of the coin, there is often a patient mind-set that, unless you walk out of a doctor’s appointment with a big bag of medication, then you have not been treated properly. Often, quite the contrary is true.
This is where evidence-based medicine can help. King’s is a fantastic example of placing evidence-based medicine at the core of its business model. We follow strict governance guidelines working closely with King’s in London, adhering to evidence based NICE (National Institute for Health and Care Excellence) treatment protocols that form the framework of our patient care. That means that we only treat patients using best practice for what is presented in front of us and nothing more. We refuse to over prescribe, which seems to be the fashion of the day. According to our research, 32% of UAE residents feel their doctors over prescribe. At King’s, only one in four patients will be prescribed medication compared to the industry average of four in four, and what’s more interesting is that over 50% of what we prescribe are generics.
We take all measures to maximise the chances of successful outcomes, fewer complications and fewer corrective procedures, and this practice is being extremely well received by insurers, brokers and most importantly, patients. What’s best is that by the efficient use of healthcare providers that practice evidence-based healthcare, individuals, companies and the government can and are taking control of their medical costs.
Without this, we need to recognise that ultimately, there is only one loser in the end and unfortunately, that is the patient. Medical inflation comes at the price of higher renewal rates and often employers find themselves having to downgrade their employees’ health coverage, or even changing insurance providers, often resulting in stripped out health benefits for employees.
In order to stop this, we need change on many levels: regulator, provider, corporate and the patients themselves. By doing this, the end result is enhanced patient care and a more effective and efficient system with the flexibility to redirect funding towards other public health priorities, such as cancer treatment and research, awareness campaigns for obesity or diabetes, upskilling local talent or more medical infrastructure.
- With rising medical inflation costs, how can providers, like yourselves, help control costs?
Again, this is where evidence-based healthcare really comes to the fore. More importance needs to be placed on practicing evidence-based healthcare across the UAE. I’d like to give you a few examples of how evidence-based healthcare can help with cost containment and combating medical inflation.
Let’s start with upper respiratory tract treatment protocols. King’s estimates that if all uncomplicated upper respiratory tract infections are treated using the same protocol guidelines that we use, then the savings to the economy could be above AED1 billion given the prevalence of these conditions.
I’d like to give an example of how reducing elective procedures can help. King’s encourages natural births. King’s in London has a 17% elective C-section rate compared to the current industry average rate of 25% in the UAE; our target is 18-20%. The expectation is that there will be approximately 77,000 babies born in the UAE in the year 2020. If all providers took the same approach to reduce their percentage of C-sections to 18-20% while considering the wishes of the mother, this would represent an estimated cost saving to the economy of AED 305 million in 2020 alone.
Aside from evidence-based healthcare, there are many ways providers can help. Advocating for better use of primary care systems and educating patients on the importance of the Family Medicine Consultant as your ‘health champion’ are key changes I’d like to see across the industry. Ultimately, if we all do our part, when extrapolated out, these changes can make a big difference and add up to great wins for the UAE’s health and economy.