By Ahmed Faiyaz, Advisor, Health Investment & PPP’s Office, DHA
The GCC region is seeing a rise in investor interest and participation by international healthcare providers to set up health facilities or partner with public or existing private sector providers to deliver healthcare services to the population. While much of the investment in the past decade has been focused on building hospitals and primary care centers to address the growing healthcare needs of a rising population, there is a growing acceptance among healthcare regulators, investors and providers to look at models of care beyond curative services delivered in the hospital, and to focus particularly on preventative care, disease management and extended care which includes home-based health services. Much of the change in mindset is supported by evolving trends in delivery of health services in Europe, North America and South East Asia (more specifically Japan, Singapore and South Korea) which are seeing a rise in chronic disease prevalence, and a rapidly aging population, that has led to developing and implementing innovative models of care and changes in the care pathway which significantly reduces hospital admission, lengths of stay and thus the need for increase in hospitals. It has also helped many economies, particularly Germany and the Nordic countries in maintaining a less than 2% increase in health spending annually despite demographic changes and rising chronic disease prevalence.
The following three propositions could see rise investment within the next 4-5 years to help address the health services capacity gaps and improve access to highly efficient, coordinated care –
- Urgent Care Clinics – Within the US and parts of Europe the urgent care clinics or walk-in clinics are a growing trend, and this model has remained popular in many developing countries in Asia and South America. They offer the advantage of being accessible, as the patient does not require a prior appointment, and are usually located in busy residential and shopping areas which is in close proximity to the patient population. The cost of treatment is inexpensive compared to a hospital setting or a specialized facility (between 40-70% cheaper based on various estimates), and these clinics are effective at treating injuries and illnesses that require an immediate attention (common colds, flu, minor respiratory ailments, minor cuts and wounds etc.), but do not warrant a visit to the emergency center. Growth in investment to set up walk-in clinics could help reduce the pressure on ER’s in acute hospitals and also help address the utilization of health services in more – expensive settings often leading to over – utilization of services and consultation with specialists which could be delayed and lead to higher costs. In the recent years, many large hospital systems and integrated health networks (IHN’s) in the US have set up urgent care clinics in communities they serve.
- Ambulatory Care Centers – Ambulatory care is provided in an outpatient setting, with more advanced patient infrastructure compared to smaller urgent care clinics/ walk-in clinics, and is seeing growing attention and investment in Western economies particularly supported by innovation and advancements in health technology. The services at an ambulatory care center includes diagnosis, short stay observations, consultation, intervention (including day surgeries and minor procedures), and rehabilitation services. Ambulatory care centers are often equipped with advanced diagnostic infrastructure and laboratory services, and can perform procedures with the use of advanced medical technology. The NHS in the UK has moved a number of day surgeries and procedures out of the hospital, to be performed in an ambulatory care setting which improves access to patients, reduces waiting times and lowers costs. Cleveland Clinic and Mayo Clinic have set up ambulatory care centers, with some of these focusing on a specific condition or disease (e.g. respiratory or pulmonary conditions, obesity management, internal medicine etc) close to the catchment population they provide services to. They require lower capital investment, and can be adopted both in big cities served by large hospitals as well as smaller towns and remote areas, as the services in these facilities can be connected and supported by larger hospitals through telehealth solutions and applications. From the experiences in many countries, it has been seen that effective ambulatory care could help prevent the onset of chronic diseases (such as diabetes and CVD), control an acute episode, or can better manage a chronic disease or condition, and this could deliver a significant impact in the GCC region which is seeing a high prevalence and rising mortality from chronic diseases.
- Beyond the Pill initiatives – Pharma companies and payers, driven by rising healthcare costs, disease burden and health technologies are embracing partnerships across the health ecosystem to deliver innovative solutions to patients which are aimed at better outcomes. The decades old business model which saw massive investment in drug development and sale of drugs by persuading physicians to prescribe their products, is beginning to see a considerable shift supported by a disruptive breed of innovators, who are developing applications and solutions that help improve coordination of care for chronic diseases and improve patient outcomes. Examples of this include, Livongo Health, who have developed a device which is the size of a mobile phone fitted with a cellular chip which monitors blood sugar levels for diabetes patients. Glooko is another application to support diabetes patients, and partners closely with Novo Nordisk, a leading pharmaceutical company, and IBM Watson, to gather data about patient compliance to medications and the impact of insulin medications. The health ecosystem continues to be reshaped by these health technology companies that use big data, sensors and AI for real – time remote monitoring of the patient’s conditions and trigger notifications and physician intervention where required to help manage risk factors. These could be particularly successful in the GCC region which has a high prevalence of diabetes and CVD patients, whose condition needs constant monitoring and coordination between specialists, nutritionists and fitness counselors, and this could help reduce the rising pressure on costs and health spending for health insurers and the governments.
While innovative and disruptive models need proactive investment facilitation support by regulators, it is imperative for the regulators to review policies and legislations that could enable the licensing of these facilities and applications, and encourage their roll out and set up to improve access to patient services for the community, also supported by health insurance coverage and inclusion in health insurers’ networks for facilities and applications providing these health services.