Preventative medicine, private investment to lead Qatar's health sector to the next phase

First established in 1954, Qatar’s health care sector has emerged as the highest-ranked system out of 20 countries surveyed in the MENA region, according to the Legatum Prosperity Index 2018, which measures a country’s performance on basic physical and mental health, infrastructure and preventive care. The past 10 years have seen particularly quick improvement with Qatar rising from 27th place globally in 2008 to fifth in 2018 out of 148 countries. This has been attributed to increased investment in new facilities, services and technologies to meet the demands of the growing population. To further its progress, Qatar has launched the second phase of its ambitious National Health Strategy (NHS) covering the 2018-22 period. The plan will focus on preventive health care in hopes of addressing the rising prevalence of non-communicable diseases (NCDs) in the country. Meanwhile, ongoing efforts to develop the private care sector have seen Qatar loosen regulations of foreign investment.

In addition, the country has heavily invested in education and research. “The reputation of the country as a centre for research and development is growing significantly,” Omar El Agnaf, executive director of the Qatar Biomedical Research Institute, told OBG. “This has attracted the interest and investments from international health and research institutions and will continue to do so in the near future,” he said.

Structure & Oversight

The Ministry of Public Health (MoPH) is charged with setting the country’s national health strategy, as well as developing its plan to achieve the strategic health goals set out in Qatar National Vision 2030 (QNV 2030). Regulation of practitioners falls to the Qatar Council for Healthcare Practitioners (QCHP), established in 2013 by Amiri Decree No. 7 to function as an independent council rather than a department within the MoPH. The QCHP retains sole authority for regulating all health care practitioners and facilities in both government and private health care sectors through the QCHP Accreditation Department.

While the National Health Authority in Qatar controls the manufacturing and marketing of drugs, all pharmacists must be licensed by the QCHP. The MoPH’s Healthcare Quality and Patient Safety department (HQPS) oversees the quality and effectiveness of health care services delivered in Qatar. The department is responsible for the development and implementation of standards, policies and guidelines to steer provision and monitor performance. Various programmes fall under the remit of the HQPS, including the Patient Safety and Risk Management, Infection Prevention and Control, and Antimicrobial Resistance initiatives.

Meanwhile, the Medical Commission Department of the MoPH is tasked with screening all those who enter Qatar to live or work for infectious diseases including HIV/AIDS, hepatitis B and C, syphilis and tuberculosis. The MoPH also runs various health initiatives for the public, including the National Immunisation Programme and pre-marital medical examinations. “The public’s relationship and perception of regulators is very important,” Samar Aboulsoud, the acting CEO of the QCHP, told OBG. “There has been a tangible growth in the public’s trust of the health sector’s regulating bodies.”

Public Providers

The MoPH does not provide clinical services, but instead entrusts the responsibility for care to the hands of public institutions, such as non-profit provider Hamad Medical Corporation (HMC), as well as the private sector. HMC has seen significant expansion in its infrastructure and the range of services offered to patients with the opening of seven new hospitals and numerous specialist facilities since 2011. Amiri Decree No. 15 was issued in February 2012 to establish the Primary Health Care Corporation (PHCC) as an independent entity with its own budget. According to its website, the PHCC manages 27 primary health care centres. Of these facilities, 17 are located in Doha and the rest are in other populated areas across the country. HMC and the PHCC both operate as the principal public health care providers under the MoPH.

Public Spending

Overall spending in 2018 increased by 4.1% to reach QR22.7bn ($6.2bn), accounting for 3.7% of Qatar’s GDP. This increase reflected the major developments in health care facilities with the December 2018 opening of the Hazm Mebaireek General Hospital for male expat workers, expansions at the Hamad Bin Khalifa Medical City, and the expansion of the Trauma and Emergency Department at Hamad General Hospital, which is scheduled for completion in 2019.

Budget statements for 2019 indicate that government spending on health care will remain at 2018 levels; in line with broader goals of addressing the budget deficit, which reached QR28.1bn ($7.7bn) in 2018, and an emphasis on private sector participation. Despite this, 2019 funds will go towards the completion of four new health centres in Al Wajbah, Muaither, Al Waab and Doha at Qatar University, as well as the start of construction on five new health centres in Al Mashaf, Al Saad, Al Khor, Ain Khaled and Al Wakrah, according to the Ministry of Finance.

Financing

Taking into account slowing population growth, health care expenditure is expected to grow by 2.2% per year to reach $6.6bn in 2022, according to a report issued by investment bank Alpen Capital. Inpatient and outpatient care expenditure is set to grow at a compound annual growth rate of 2.8%, to $3.1bn and $1.7bn, respectively. Currently, the inpatient market accounts for just under half of health care spending in Qatar. As a majority of the goals set out in the NHS 2011-16 were achieved, public spending over the next five years will focus mainly on preventive measures, combating NCDs and promoting an overall healthy lifestyle in line with the NHS 2018-22.

Health Care Access

All Qataris have access to free or heavily subsidised health care via HMC, though private provision is increasing in popularity due to rising demand for specialised or higher-quality services. Some companies provide full or subsidised private medical coverage for their employees though this can be limited to employees in the banking and oil and gas sectors, and often does not extend to family members. For the long-term care of family members, the country has noted the importance of a family doctor.

“The national strategy sets out a clear model based on patients having a primary care home to ensure the continuity of care through their family doctor,” Mariam Abdul Malik, managing director of Primary Health Care Corporation, told OBG. “The family practitioner is a specialist who knows the patient and their family, and can ensure that family members are screened and any health problems treated much earlier.”

Qatar launched a set of new guidelines in November 2018 to inform the public on how to access health care, what services are provided and how to select the right services in accordance with their needs. As Qatar’s health care service has undergone significant expansion over the past few years, the public’s understanding of the scope and access of services provided has posed a challenge, with many people, especially in rural areas, unaware of the benefits available to them. The guidelines are available in Arabic and English and are being translated into Urdu, Tagalog, Nepali and Malayalam, to ensure migrant workers are able to understand the services accessible to them.

Qatar Red Crescent Society (QRCS), established in 1978 as the nation’s first volunteering charitable organisation, deals mostly with providing support and treatment to labourers, and provides a range of relief and development services. It also provides social support to vulnerable communities, emergency medical services – with a fleet of 50 cars and ambulances, expanding to 70 by 2021 – and covers most government and sporting events. “New initiatives launched by QRCS aim to improve the standards of health care and general awareness among labourers in Qatar. Through organising specific health education sessions for workers, we are trying to raise awareness in areas such as personal hygiene, mental health and ways of combating seasonal conditions. We are also improving specialised programmes, including working with local doctors to improve identification of diseases and training patients with chronic conditions, for example diabetes, on how to use their medication,” Ali Hassan Al Hammadi, secretary-general of QRCS, told OBG.

Major Health Indicators

Life expectancy in the country reached 78.2 years in 2016, the highest in the GCC, and around the same as the US average of 78.7 years, according to the latest available data from the World Bank. However, as is the trend in the region, NCDs are observed to be the top causes of death in the country. Some 70.1% of Qatari nationals are overweight or obese, and 43.9% reported doing little or no physical activity, according to MoPH data. Qatar also faces issues posed by having a high population of guest workers, many of whom arrive from countries that lack an equally robust health service.

However, maternal and child health is improving. In 1993 there were 14.7 infant deaths per 1000 live births, which fell to 6.5 in 2017, according to the World Bank. While UNICEF data shows that Qatar’s under-five mortality rate declined from 17.1 per 1000 live births to 7.6 during the same period.

NCDS

Increasingly sedentary lifestyles and risk factors stemming from a modern diet have led to a spike in the incidence of diabetes, hypertension, obesity, cancer, heart conditions and other lifestyle-related diseases over the past 10 years. According to the MoPH, cardiovascular disease, cancer and diabetes together are responsible for 49% of all deaths. As the high cost and length of treating such diseases has placed a growing financial burden on the country, allocating government spending to preventive care and lifestyle changes is a priority and area of increased spending and investment.

Public Health Facilities

HMC has expanded its services and infrastructure significantly over the past seven years and has ambitious plans to expand capacity through to 2030. The group manages nine specialist and three community hospitals providing a range of general and specialised care. These include the Women’s Wellness and Research Centre, which opened in November 2017 and a number of facilities focusing on helping Qataris lead healthier lives, such as the Hamad Tobacco Control Centre and the National Obesity Treatment Centre. HMC also runs a national ambulance service and home care services.

In 2016 HMC became the first system globally to have all its hospitals accredited by the Joint Commission International under the Academic Medical Centre Hospital Accreditation programme. With a capacity of 603 beds, Hamad General Hospital is HMC’s largest facility. It provides inpatient care and has a large outpatient department offering over 65 speciality clinics, an emergency department, five intensive care units, eight operating theatres and a pharmacy. Recognised by the World Health Organisation, the Hamad Trauma Centre is currently working towards receiving accreditation status as a Level-1 facility. The hospital also manages the Fahad Bin Jassim Kidney Centre, which opened in 2010, and the National Centre for Diabetes Treatment, opened in 2013. It is estimated around 13% of the Qatari population is affected by kidney disease, with diabetes and hypertension being the leading causes.

Community hospitals are key to the provision of health care in the country, and HMC currently operates: Al Wakra Hospital, Al Khor Hospital and the Cuban Hospital in Dukhan. These facilities play an important role in relieving pressure on Doha’s hospitals and providing a full range of secondary health care services closer to many patients’ homes.

Private Care

As the prevalence of chronic diseases rises and health care costs increase for an ageing population, the current offering of government services that are nearly free will increasingly become unsustainable, resulting in the need for greater private sector engagement. There is also growing demand for private health care as patients seek a wider range of options and facilities. Qatar is home to 219 private complexes and clinics and four multi-specialty hospitals. The most recent addition was the $7.9bn Qatar Foundation-funded Sidra Medical and Research Centre (SMRC), a specialist women and children’s hospital and medical education and biomedical research centre. While the 400-bed facility welcomed its first patients in January 2018, its grand opening occurred the following November. There are over 50 clinics offering services for a number of specialities, including complicated cases in paediatrics, obstetrics and gynaecology. In its first 10 months of operation, the hospital provided care for some 120,000 people and performed 2700 surgeries and 3000 procedures. The hospital also recently launched the Sidra Medicine Simulation Centre and robotic-enabled surgery in July 2018. Other key private facilities include, the 80-bedDoha Clinic Hospital, offering multiple specialties and a dialysis centre and laboratory, and the 250-bed Al Ahli private general hospital, providing inpatient and outpatient care services. Looking ahead, a new 200-bed Al Emadi Hospital is due to be completed in 2020 near Doha Festival City in Umm Salal. Preliminary construction work was completed on the multi-specialty facility in November 2017. The first Al Emadi Hospital opened 13 years ago in Al Hilal West in Doha.

Health Insurance Schemes

Private hospitals accept a wide range of insurance policies, as well as cash-paying patients. Currently, there is no national health insurance scheme in Qatar. In 2013 the state introduced a short-lived public national health insurance scheme known as Seha. For two years, Seha was run by the National Health Insurance Company, a jointstock company wholly owned by the government in a single national payer system and was ultimately only rolled out in its initial phases to nationals. This was expected to be extended to all residents in 2015, with employers tackling most of the cost for expatriates and the government paying for Qataris’ health care. As expenses began to rise and criticism mounted over resource management, the programme was paused to take time to reconsider the strategy. The insurance scheme was dismantled in December 2015 because the country found it lacked the experience of managing a complex health system and wished instead to rely more heavily on the private sector’s expertise. “The Seha insurance scheme failed due to its inability to price treatment plans correctly,” Mohammed Robin Alami, CEO at Gulf Dental Centre, told OBG. “With dental treatments, for example, prices were not in line with market values, making the scheme a costly and unsustainable,” he added. There could be many advantages in implementing mandatory universal insurance coverage, including growth in health expenditure, the higher use of medical services at private facilities, and significant business and investment opportunities. However, doing so remains a complex task involving cooperation between a range of sector stakeholders, including insurance firms, medical services providers, employers and a number of other intermediaries.

Pharmaceuticals

The pharmaceutical market remains dominated by multinationals working with local partners that make up nearly 100% of the 260-270 pharmaceutical companies in Qatar. Nearly all medication is imported by dedicated air service Pharma Express, operated by Qatar Airways Cargo, with only one local manufacturer – Qatar Pharma – focused on intravenous solutions. However, the disruption of some supply routes beginning in June 2017 caused by the regional blockade, which saw Saudi Arabia, the UAE, Bahrain and Egypt sever diplomatic ties with Qatar, presented temporary challenges. While the effects of the blockade were minimal for the health sector, it highlighted the need for Qatar to manufacture more medicines domestically. Dr Yousef Al Maslamani, the medical director at HMC, told local media in June 2018 that during the blockade, health care services remained unaffected, new suppliers were sourced and a number of local manufacturers had prospered. In line with Qatar’s goals of becoming more self-reliant, in 2018 Washington-based US-Qatar Business Council reported that US firms were interested in exploring investment opportunities in Qatar’s pharmaceutical sector.

Attracting Investment

The blockade has presented opportunities to further develop Qatar’s health care offerings beyond pharmaceuticals. The Qatari German Company for Medical Devices and Shifa Al Jazeera Healthcare Group, one of HMC’s primary suppliers, signed an agreement in November 2018 to cooperate on the manufacture and sterilisation of medical devices in Qatar. The products were expected to be readily available on the market in the first quarter of 2019. To further such efforts the Ministry of Commerce and Industry passed Law No. 1 of 2019, regulating the investment of foreign capital in economic activities.

The amended foreign direct investment (FDI) law is aimed at promoting economic development by attracting global capital to local economic and commercial activities. It will provide foreign firms with the incentives Qatari companies currently enjoy, including the permission to participate in government contracts. Health care is one of 12 sectors expected to be specifically targeted for FDI. “There are a lot of opportunities for foreign investment and collaboration,” Christof von Kalle, chief research officer at SMRC, told OBG. “Especially in the fields of research, new technologies and in developing hospital capacity as additional medical services and research programmes are established in the future.”

Digitalisation

Qatar was the first country to employ a clinical information system (CIS) across its public health system in 2016. The implementation of CIS, which produces an electronic medical record for each patient at HMC and PHCC hospitals, was seen as an integral part of developing Qatar’s health service. Leveraging IT should increase efficiency, reduce paperwork and transform the health care system. Qatar continued its digitalisation project by launching the MyHealth patient portal in 2018 to provide HMC patients with access to their medical records, test results and medication.

The next phase of the portal will enable patients to send and receive messages to and from their physician, as well as manage appointment schedules.“The health care sector has heavily invested in technology in recent years,” Malik told OBG. ”An integrated electronic medical record has been fully deployed in governmental health facilities, and now we can realise the benefits in terms of improved patient safety in medication management, shared results of investigations and care plans, electronic appointment booking, and electronic referrals between primary and secondary care.”

Outlook

Qatar has prioritised the health sector as a key area of development and investment. Growth is set to continue, albeit at a more modest pace. Both the QNV 2030 and the NHS 2018-22 have placed the sector at centre stage of the government’s plans over the next 10 years, with consistently increasing FDI expected to continue furthering those efforts.

The focus on preventive care and NCDs has heralded in expansion as a number of specialist hospitals and clinics have opened across the country. The main concern, however, will be in ensuring that there are enough practitioners and resources to meet increasing demand. “By continuing to improve and innovate, operators are strengthening the quality and accessibility of domestic health care,” Peter Morris, CEO at SMRC, told OBG. “This will also contribute to the long-term development of local capabilities, human resources and research.”