Abu Dhabi boosting quality of health care

In the midst of an ongoing transformation that has seen patient outcomes and specialty care offerings significantly improve, Abu Dhabi’s health sector is poised to continue expanding rapidly, driven by growth in private sector investment. The health authority in Abu Dhabi continues to implement sector reforms, with a new seven-point health strategy that is aimed at addressing the most critical issues faced by patients and medical professionals in the emirate. An increasing emphasis on preventative care, emergency preparedness and further expansion of specialty care are expected to bolster health indicators, in the process helping to reduce outbound medical tourism and paint a positive forecast for the future of private health care development in the emirate.

Government Oversight

The Abu Dhabi government split its health supervisory arm, the General Authority for Health Care Services, into two bodies in 2007, with service provision at the emirate level now overseen by Abu Dhabi Health Services Company (SEHA) and regulation by the Health Authority - Abu Dhabi (HAAD).

SEHA currently manages and operates 12 hospitals, 37 health care centres, one occupational health centre, 10 disease prevention and screening centres, nine dialysis centres and clinics, and two blood banks. The firm treated 61% of all inpatients and 38% of all outpatients in the emirate in 2013. HAAD, conversely, is the main regulator and policy-maker, and responsible for licensing and monitoring service provision and insurance companies.

At the federal level, the Ministry of Health (MoH) develops national health care policy in collaboration with the relevant emirate-level authorities under the country’s Vision 2021 development plan, which targets the emergence of a globally competitive health care system. Similar to HAAD, the MoH has increasingly sought partnership and investment from the private sector in order to expand existing services and facilities. Health insurance laws were rolled out in Abu Dhabi in 2005, and later in Dubai in 2013.

Sector Overview

HAAD reported 14.3m patient episodes in 2013, of which 1.4%, or roughly 194,000, were inpatient episodes. Emiratis, who comprise 18% of the population, accounted for 39% of total patient episodes in 2013, while HAAD reports an additional 83.9m patient activities, of which 44% were consultations and medical procedures. Pharmaceutical prescriptions accounted for 20%, diagnostic-related group (DRG) insurance claims 21%, services 7% and dentist visits 5%. According to data published by HAAD, a total of 6864 physicians, 1220 dentists, 14,235 nurses, 5332 allied health professionals and 2396 pharmacists were working at 1626 licensed facilities in 2013, including 41 hospitals, 922 health centres and clinics, and 502 pharmacies.

SEHA reported in January 2015 that roughly 4m patients were treated at public hospitals in Abu Dhabi in 2014, including outpatients and babies born in the hospitals. According to SEHA, Tawam Hospital in Al Ain leads the pack, with 855,780 patients, followed by SKMC (781,561), Al Ain Hospital (644,363), Al Gharbia Hospital (580,628), Al Mafraq Hospital (565,155), Al Rahba Hospital (247,369) and Corniche Hospital (242,967). A total of 18,851 babies were born in SEHA-operated hospitals in 2014, excluding SKMC, while patient numbers for emergency care reached 56,673, inpatients 109,473 and outpatients 1.48m. The average occupancy rate stood at 64% across 2503 beds.

Seven-Point Strategy

HAAD has sought to improve the emirate’s health sector strategy with a previous mid-term plan, running from 2010 to 2014, emphasising 12 priority areas. These priority areas include filling critical capacity and insurance gaps, improving education for health professionals, and increasing private sector investment. Moreover, the authority recently moved to introduce a new mid-term health care strategy, which should see private sector participation in health care delivery continue to expand.

In December 2014 the government approved a seven-point health sector strategy that includes 58 separate initiatives. The new strategy targets expanding the continuum of care through specialty service offerings; improvements to the quality of health care services; improving safety standards and patient experience; attracting and retaining skilled professionals; emergency preparedness; ramping up prevention and wellness efforts; enhancing cost effectiveness and value for money; and developing a platform for e-health.

Quality Of Care

The emirate’s health care sector has seen notable improvements in recent years. According to HAAD, mortality rates have been declining steadily, while infant mortality fell from 22 to seven per 1000 live births between 1990 and 2011, and the number of available hospital beds rose by 21% between 2009 and 2013. Nonetheless, improving the quality of care is dependent on building upon these recent gains.

A HAAD survey on patient satisfaction, released in June 2015, found that the overwhelming majority of Abu Dhabi residents are happy with the treatment that they receive in the emirate’s hospitals. The authority reported that out of 38,806 survey respondents, more than 80% were satisfied with inpatient, outpatient and emergency care, although 9902 patients cited quality of care, communication and prompt service as the top-three areas in need of improvement. With this in mind, HAAD has been active in addressing existing quality control issues, and focusing on the improvement of patient safety and experience, notably through the expansion of the Jawda programme.

Patient Safety & Experience

In September 2014, HAAD expanded its quality control initiative, Jawda, to health care providers, including clinics and hospitals. Under the guideline, the first of its kind in the region and which means “quality” in Arabic, every hospital in the emirate is rated against an expanding number of quality metrics for the standard of care it provides. This covers safety, effectiveness of care, timelines of service delivery and patient-centric delivery of care, with a set of quality outcome indicators under each area. The initial aim is to establish a baseline, raise the culture of safety and quality measurement, and highlight any key areas at individual hospitals that require immediate improvement, with monitoring to be published and made available to the public.

According to HAAD officials, the number of categories in which facilities are graded will eventually expand to as many as 200, while failure to meet standards will result in inspections. Facilities that fail inspections will be closed, with HAAD reporting it carried out 421 audit visits in 2014. At the time of writing, the authority and its partners were in the process of designing a comprehensive policy to integrate incentives and sanctions, financial and non-financial, into performance monitoring. The authority also intends to make the results of monitoring available to the public, although it does not intend to do so until it is confident that the results are valid and that the system has the capabilities and the skills to deal with any consequences resulting from publication without it jeopardising other aspects of quality or access.

HAAD expects such moves to improve overall quality at individual hospitals and on a system-wide level. “The benchmark gets a little higher each year in terms of patient satisfaction and clinical outcomes,” Mazen Al Dahmani, general manager at Imperial College London Diabetes Centre, which has two centres in Abu Dhabi and Al Ain, told OBG. “Having Jawda targets keeps us on our toes, while internal key performance indicators are also monitored to make sure we are always on top,” he added.

HAAD has outlined a number of priorities for the coming year that will ensure it continues to lead the way on establishing a culture of quality and continuous improvement in Abu Dhabi and the region. One initiative entails working to expand the set of indicators that HAAD is using to measure performance of quality in hospitals to include standardised mortality, staff surveys, patient-reported outcomes and the adoption of electronic medical records. The health authority is also working to develop a new Jawda programme for primary care and polyclinics and hopes to begin working with providers to improve quality of care where there are concerns. Another strategic initiative to be pursued over the short term is the implementation of integrated digitised health care provision, which should contribute to ensuring better quality of care and pave the way for the automation of quality assurance and planning.

Emergency Preparedness

Emergency preparedness is another key priority for HAAD, with plans to improve health care sector preparedness during large-scale emergencies and disease outbreaks. HAAD will be working with key stakeholders on improving information and communication infrastructure and establishing necessary policies to govern the sector’s response to such events. Emergency preparedness and response is an important consideration for health care stakeholders, and so it forms a key element of HAAD’s 2016-20 mid-term health care strategy. In line with this, the emirate’s ambulance services are undergoing a rapid expansion (see analysis).

Continuum Of Care

Continuum of care entails the development of high-quality specialty services which have previously been lacking in the emirate, and which has lead some patients to seek medical treatment abroad. HAAD reports that ongoing capacity gaps in critical and intensive care, emergency care, neonatology, paediatrics, oncology, orthopaedics, rehabilitation and psychiatry continue to offer opportunities to private sector investors, while rising demand for inpatient services, based on current occupancy rates, will require an additional 2200 beds by 2020.

The situation has improved considerably in recent years, with 16 hospitals currently under construction and over 50% complete as of the end of 2013, according to HAAD, which will provide a further 2859 beds when ready. This compares favourably to an increase of 700 beds in 2012. Moreover, since 2013, there has been a marked reduction of existing specialty gaps. The number of emergency physicians, for example, has increased by as much as 20%, with a 41% rise in the number of neonatologists and 21% more paediatric and orthopaedic doctors. Numbers of critical care doctors have jumped by 14%, with new specialist facilities coming on stream, while at the same time significant investment is being made in primary, front-line care for the community.

Mubadala has been active in rolling out a network of new specialty care providers in order to meet the specific needs of the Abu Dhabi population, complementing the wider health care system to ensure people can be treated in world-class facilities in the emirate and not have to travel abroad for complex treatment. Through partnerships with leading international providers, such as Cleveland Clinic and Imperial College London, the network includes the 364-bed Cleveland Clinic Abu Dhabi, which opened in March 2015 on Al Maryah Island, and Imperial College London Diabetes Centre, which has been designed to function as a one-stop, state-of-the-art facility specialising in all aspects of diabetes treatment, prevention, education, awareness and research.

Other facilities include Healthpoint, a multi-specialty hospital whose offerings include comprehensive orthopaedic, spine and physio care; Abu Dhabi Telemedicine Centre, a joint venture with Swiss telemedicine provider Medgate, which gives access to 24/7 specialist, non-urgent, medical advice over the phone; and Capital Health Screening Centre, which provides medical screenings for visas and occupational health services. “ Approximately 4560 people from Abu Dhabi were sent abroad for care in 2014, but with the recent opening of Cleveland Clinic Abu Dhabi, and Health-point in particular, our services are able to cater for up to 87% of the top 15 reasons why people in Abu Dhabi travel overseas for treatment,” Suhail Al Ansari, executive director of Mubadala, told OBG.

Specialist Treatment Provision

Imperial College London Diabetes Centre, founded 10 years ago in 2006 through a partnership with Imperial College London, is a specialist one-stop shop for the treatment, prevention, research, education and awareness of diabetes. Based in two locations – Abu Dhabi and Al Ain – and with more than 60 diabetes professionals and endocrinologists on staff, it has engaged with over 1m people though its treatment and public outreach programmes, leading the fight against diabetes – not just in the UAE – but across the Gulf. It has a double accreditation from the Joint Commission International Clinical Care Programme Certification in Diabetes Management and Ambulatory Care.

Going beyond its treatment offerings, Imperial College London Diabetes Centre is also highly active as a public health community resource, through its awareness raising programmes. Rising visitor numbers to the centre can be seen as an indication of an increased understanding of the issues surrounding diabetes and of the importance of increasing patient empowerment, which is at the heart of successfully tackling the condition.

The centre covers all aspects of diabetes and its related complications through a tailored, multi-disciplinary approach to ensure that patients get the full spectrum of care they need, all in one place. Conditions covered include endocrinology, cardiovascular, eye, kidney and foot care, as well as antenatal/gestational diabetes, juvenile diabetes, nutrition education and pregnancy clinics.

The centre is also introducing new technologies and treatment options, including procedures such as thyroid nodule biopsy under ultra-sound guidance, insulin pump clinics and bariatric pre-and post-surgery services. Cutting-edge research programmes examining the prevalence of diabetes in the Middle East are also under way, as well as a programme for health care professionals and diabetes educators, which is raising the capability and capacity to manage diabetes across the region.

Meanwhile, Mubadala’s 53,000-sq-metre, 74-bed multi-specialty hospital, Healthpoint Hospital, opened at Zayed Sports City in late 2013 to help meet specific identified needs in Abu Dhabi’s health care system, particularly, but not limited to, plastic/reconstructive surgery, bariatric surgery, paediatrics, family medicine, women’s wellness, and ENT, alongside orthopaedics and spine care.

An ongoing gap in maternal medicine was also reduced with the opening of BrightPoint Royal Women’s Hospital and Danat Al Emarat Women’s and Children’s Hospital, in May and August 2015, respectively. Ongoing work at SKMC is expected to further bolster specialty care offerings (see analysis). Moving forward, HAAD intends to expand the provision of specialty services through partnership with private health care providers. The body is also putting a particular emphasis on lessening gaps in rural areas of the emirate, in particular the Al Gharbia region. This includes strengthening existing facilities, such as the expansion of services in Liwa Hospital, establishing primary care facilities, upgrading integrated care models, and improving the triage and transport of critical patients.

The authority is also working to encourage investment in the provision of local and community services in these underserved areas. Another objective is to organise regular investor conferences and workshops for information sharing and guidance related to health care needs and capacity gaps at the local, regional and centralised level. In November 2015 more than 100 investors attended a forum in the Al Gharbia region.

Research and innovation is another important dimension to the emirate’s health strategy. HAAD is collaborating with local partners such as Abu Dhabi Education Council, local and international universities, SEHA, and others, to take forward this objective. Areas that are currently being explored include the allocation of grants, implementing a well-defined framework for research, identifying research priorities and recognising efforts in innovation and research through distinction awards (see Education chapter).

Rehabilitation Focus

Specialty care expansion has also been extended to physical and psychological rehabilitation, for which there is a particular need in Abu Dhabi. Healthpoint, also a leading sports medicine provider in the region, serves as the home of Abu Dhabi Knee & Sports Medicine Centre, as well as Wooridul Spine Centre. Together, these two entities, coupled with Health-point’s 1000-sq-metre advanced physiotherapy and rehabilitation centre, offer comprehensive sports medicine care, as well as every day care for the community. “There is a strong demand among all segments of the population in Abu Dhabi and the UAE for specific orthopaedics and spine-related services, which is an area we have really focused on,” Dr Ihsan Almarzouqi, associate director of Mubadala Health care and board member of Healthpoint, told OBG. “By partnering with some of the world’s leading specialists we can now deliver this highly specialised care right here in our state-of-the-art facilities.”

The Cambridge Medical Rehabilitation centre has established two new specialist rehabilitation facilities in Abu Dhabi and Al Ain which, together, are expected to retain patients seeking medical treatment in the emirate. Each 90-bed centre employs 200 medical professionals and offers physiotherapy and cognitive services. The centre in Abu Dhabi opened in Khalifa City B in March 2014, while the Al Ain facility opened in October 2014. Both facilities are operated in partnership with Boston’s Spaulding Rehabilitation Network, a Harvard Medical School teaching hospital.

The NRC

Rehabilitation services for drug and alcohol addiction have also become much improved in Abu Dhabi in response to a sharp rise in substance abuse that has affected the entire region. In 2002 the government-owned National Rehabilitation Centre (NRC) – the emirate’s first comprehensive drug treatment and rehabilitation centre – was established and has since developed a reputation as a model for substance abuse treatment, so much so that it has been asked to create a similar facility in Ajman in the Northern Emirates. As well as providing in-patient treatment, the centre also conducts counselling services for individuals and families and other support activities.

NRC announced recently that its current 72-bed in-patient treatment facility is to expand with the construction of a new Dh285m ($77.6m) centre, which will offer an additional 169 beds. Although NRC is tasked in the main with providing support and treatment to victims of substance abuse, it is also taking on an equally important role, that of promoting awareness of the risk of drugs, as part of a broader campaign amongst young people.

According to Dr Hamad Al Ghaferi, the director-general of the NRC, the project has experts working with educators in the school system to provide tools that will encourage healthier lifestyles among pupils. “The goal is that the programme will eventually help students stay away from drugs, alcohol, prescription medicines and other forms of addictive substances,” he told OBG.

In 2015 NRC signed a memorandum of understanding with the Abu Dhabi Tawteen Council – the state agency charged with identifying employment opportunities for Emiratis seeking work – to help develop labour market opportunities for recovering substance abuse patients across the country. Al Ghaferi pointed out that by offering avenues back into the workforce, and through training programmes intended to boost patients’ skills and self-esteem, NRC and the Abu Dhabi Tawteen Council hope to be able to ease the social pressures that contribute to addiction. “It will support them to effectively reintegrate into society, making them positive drivers in the UAE’s continued economic development,” Al Ghaferi stated.

Qualified Professionals

Although HAAD has made significant strides in attracting and retaining qualified health professionals in recent years, particularly at flagship developments such as Cleveland Clinic Abu Dhabi, a human resource gap remains a significant challenge to expanding health care services, particularly long term. While the number of licensed physicians and dentists in the emirate grew by 22% and 11%, respectively, between December 2012 and December 2013, it is projected that by 2022 up to 4800 additional doctors and 13,000 nurses will need to be in recruitment to meet rising demand. Should industry turnover maintain current trends, up to 1700 doctors and 2900 nurses will need to be recruited annually, according to HAAD.

In a bid to meet the shortfall and improve Emiratisation within the health care sector, HAAD is currently working on a comprehensive plan aimed at increasing the number of Emirati health care workers, while ongoing partnerships with the private sector are also bolstering professional training for existing staff. In October 2015, for example, SEHA and the Dubai Health Authority launched the Diabetes Nurse Educator Programme in collaboration with Denmark’s Aarhus University, which trains nurses in techniques to manage diabetes and secondary health issues. The Imperial College London Diabetes Centre is also offering a training programme for nurses, dieticians, pharmacists and other health care professionals in the basic concepts of diabetes self-management education.

Wellness & Prevention

Given the rising incidence of preventable, lifestyle-related illness in Abu Dhabi, wellness and prevention also play a critical role in the sector’s ongoing development.

A number of UAE residents suffer from non-communicable diseases, many of which are related to lifestyle, including heart disease, diabetes and obesity. A January 2015 survey released by the internet-based market research group YouGov found that 32% of Abu Dhabi residents said they or a family member suffer from a heart problem, with 27% reporting the same for cardiovascular disease. According to data published in the International Diabetes Federation’s “Diabetes Atlas” report of 2016, Saudi Arabia, Bahrain, Kuwait and the UAE ranked among the top-16 countries in the world for diabetes prevalence.

Increasing levels of obesity, diabetes and heart disease have impacted mortality rates significantly in the emirate, with HAAD citing cardiovascular disease as the leading cause of death in 2014, causing 36.7% of total deaths in Abu Dhabi. This was followed by injuries (19.6%) and cancer (12.9%). “Wellness and prevention have to be at the top of everyone’s agenda, with chronic conditions ranging from diabetes to cardiovascular disease costing health authorities in the country billions of dollars,” Dr Michael Bitzer, CEO of National Health Insurance Company – Daman, told OBG.

Screening

The emirate has been increasingly active in rolling out new screening programmes. HAAD’s pioneer, mandatory national screening initiative, Weqaya, for example, was launched in 2008 with the aim of early intervention to identify cardiovascular risk factors among UAE nationals, with individuals over the age of 18 years old screened every three years. According to HAAD, a total of 175,000 people were screened during the first round of the programme from 2008 to 2010, of whom 71% had at least one cardiovascular disease risk factor. Another 61,926 people were then screened in the second wave from 2011 to 2015.

A total of 56 Weqaya health care facilities are located across the emirate, in Abu Dhabi, Al Ain and Al Gharbia. The programme is also focused on food labelling to raise awareness of nutrition, with the HAAD Weqaya healthy eating logo already used by 21 food outlets in the emirate. Further focus areas include tobacco control and smoking cessation, among others. It was reported in November 2014 by HAAD that mammogram screenings rose by 77% between 2010 and 2013, with the total number of patients tested annually going up to 16,800.

Value For Money

The growing incidence of medical inflation and overuse of emergency facilities have become significant health care challenges in the UAE in recent years. A January 2014 report published in the International Journal of Emergency Medicine found that as much as 75% of emergency visits in the UAE are unnecessary, while Booz & Co, now part of Strategy&, reported in March 2014 that medical inflation has been rising between 5% and 10% per annum, driving up the cost of insurance premiums.

At The Telegraph’s Middle East Congress 2015 hosted in London in February 2015, Haidar Al Yousuf, head of funding at the Dubai Health Authority, told the audience that 50% of the estimated $80bn of annual health care expenditure in the Arab world is being wasted due to widespread inefficiencies, including the over-prescription of pharmaceutical drugs and unnecessary medical tests. Although Al Yousuf noted that the problem was less pronounced in Abu Dhabi, where mandatory insurance coverage legislation has been in place for a decade, medical inflation remains a challenge in the emirate, with the authorities considering insurance reforms and privatisation as strategies to mitigate the problem.

Other regulatory directives by HAAD include pre-approving some services that are costly or liable to potential abuse, investigating of suspected cases of fraud, and for insurance firms to report abuse. “Efficiencies and smarter ways of working are at the heart of reducing escalating costs across the health care sector,” Al Ansari told OBG. “As well as continuing to build a network approach to health care and treat more conditions here in Abu Dhabi rather than people having to travel abroad, digital health developments offer an important way of redesigning health care around the needs of the patient. All of our providers use the latest digital health technologies with Cleveland Clinic Abu Dhabi recently receiving a HIMMS Level 6 IT in health care award for its digital achievements, which allows for greater collaboration and reduced redundancies across the campus.”

Insurance

Abu Dhabi was the first emirate to implement mandatory health insurance legislation, under Law No. 23 of 2005, which made health coverage compulsory for all citizens as of 2006. The law also established the National Health Insurance Company – Daman, which is the country’s first specialised health insurance company. HAAD estimates that there were a total of 3.3m insurance contracts in the emirate in 2013, with 50% of the competitive, enhanced health insurance market held by three companies: Daman (34%), the Abu Dhabi National Insurance Company (15%) and Oman Insurance Company (7.5%).

There are two options for health insurance cover in Abu Dhabi. The first is the Thiqa programme, offered to Emiratis, for which Daman is the third-party administrator. The second is the Abu Dhabi (Basic) Plan, for expatriate workers. The basic plan is managed by Daman and subsidised by the Abu Dhabi government. Uniform prices for basic health coverage is set by HAAD, while customers can choose to enhance their cover through the purchase of optional products. Providers negotiate with payers for enhanced plans, generally as a multiple of basic product rates. The Thiqa programme’s rates are equivalent to Daman’s most enhanced plan. According to HAAD, average enhanced premiums per member jumped by some 10% in 2013 to Dh3380 ($920), although claims per member have simultaneously increased over the past four years, from 4.6% in 2009 to 6.5% in 2013.

Reform Potential

In 2012 all hospitals and insurers in the emirate were required to adopt a DRG system, which pays out a specific amount for each illness diagnosed at hospital. However, stakeholders have recently pushed for a results-based reimbursement system that takes into account the duration of care and patient outcomes. HAAD noted in its 2013 statistical report that additional outpatient payments were needed, based on the evaluation and management codes, and where payments better reflect the severity of the patient’s condition, rather than the grade of the doctor who visited them. Should the emirate adopt such a system, it could have a significant impact on government expenditure, inflation and unnecessary emergency visits, as well as overall efficiency within the health industry. In addition, HAAD is working to produce quality indicator results, and arrange with payers to use the results for the pay-for-quality programme to incentivise higher quality investors.

Private Investment

HAAD has identified increased private sector investment and service provision as the best method to streamline costs, curb medical inflation and reduce emergency visits. Indeed, private sector investment has risen quickly to become the driving force behind health care development in the emirate, with HAAD reporting in 2013 that the 74% increase in physician numbers, as well as the majority of new facilities, were private-sector driven.

“There are a number of opportunities for investment within Abu Dhabi and the UAE’s health care sector, particularly a variety of sub-sectors in the industry. The health sector offers a clear pipeline for merger and acquisition activity, as well as for greenfield developments,” Salem Al Noaimi, CEO and managing director of Waha Capital, a local publicly listed investment firm, told OBG.

A host of opportunities exist for private investors, in particular ongoing plans for privatisation of public health assets. At present, land subject to private investment for the purpose of health care development is dealt with in accordance to community facility planning standards set by Abu Dhabi Urban Planning Council (UPC) and developed in collaboration with HAAD. These standards outline the process by which land and health care facilities are to be provided in all residential and mixed-use developments within the emirate.

In order to streamline this process to support investors, the health care facility requirements for any new development are identified based on the community’s needs both at concept and at every subsequent stage in the planning process. HAAD also provides recommendations and approvals related to the provision of the required facilities, which are binding upon the developer.

In addition, the authority is in the process of changing its land allocation process for land it administers, from one of a waiting list to one whereby the land is allocated based on Abu Dhabi’s needs. Furthermore HAAD’s recently developed health care facility guidelines, also available as an app for mobile devices, provides clear and detailed information to developers and investors with regard to facility development.

Private Hospitals

The private sector has assumed a leading role in the delivery of new hospital beds in recent years, and today the emirate is able to offer a diverse portfolio of health care providers, with the private health landscape dominated by Al Noor Hospitals Group, NMC Healthcare, Mediclinic and VPS Healthcare.

Al Noor owns and operates three hospitals on Khalifa Street, Airport Road, and in Al Ain, as well as 17 medical clinics and health centres. Its facilities include specialty care and surgical support in cardiology, oncology, orthopaedics, neurology, paediatrics, obstetrics and gynaecology. The group announced plans in October 2014 to spend $200m in acquisitions in 2015, after acquiring the Gulf International Cancer Centre for $21.8m.

NMC Healthcare, part of the London-listed NMC Group, owns and operates 13 hospitals and clinics across the UAE, and opened BrightPoint Royal Women’s Hospital in May 2015, while the $200m, 250-bed NMC Royal Hospital opened in 2016, nearly doubling the total number of beds.

VPS Healthcare, the emirate’s third major private provider, owns four hospitals in Abu Dhabi, with the company announcing a new $1.5bn expansion plan in July 2014, which will add four hospitals, five specialty clinics and 15 medical centres to its portfolio. The plan will see the creation of Burjeel Medical Centre, offering 400 new beds and doubling the company’s capacity. The company employs 7500 staff and plans to recruit another 5000 by 2019.

Heating Up

Perhaps one of the most significant recent private health care developments was a three-way tussle involving South Africa’s Mediclinic International, NMC Healthcare and VPS Healthcare, over the acquisition of Al Noor, with the winner expected to establish the largest health conglomerate in the emirate. On October 14, 2015, Mediclinic, which operates 13 hospitals in the UAE, including Mediclinic Corniche in Abu Dhabi and Mediclinic Al Hili in Al Ain, announced that it had signed a deal to buy Al Noor for $2.02bn. The deal will double the group’s presence in the UAE. However, NMC Healthcare, which operates five facilities in Abu Dhabi and two in Al Ain, simultaneously vowed to continue negotiating with Al Noor.

The existing agreement has been structured as a reverse-takeover, in which Mediclinic would take on Al Noor’s London listing as its primary listing, while Mediclinic shareholders would receive 0.625 shares in the new company for each of their existing shares. Mediclinic’s CEO, Danje Meintjes, is expected to remain in charge after the deal, and told Reuters in October that the combined group will be the largest private health provider by revenue in the UAE, with an annual turnover of $4bn across a portfolio of 73 hospitals and 35 clinics.

VPS Healthcare also entered the fray, in November 2015, with an announcement that it also intended to bid on Al Noor. The company’s founder and managing director Dr Shamsheer Vayalil announced plans to build a new cancer hospital in the emirate, which would employ the latest techniques and be located within the planned Burjeel Medical Centre. However, in December 2015, it was reported that neither NMC nor VPS would be bidding for Al Noor, paving the way for Mediclinic, which subsequently had its bid accepted.

E-Health

Public facilities are also slated to become leaders in the emirate’s e-health development, in line with the roll out of HAAD’s final health pillar and through partnerships with private facilities. Imperial College London Diabetes Centre, for example, is rolling out patient-centred upgrades offering mobile and web apps, as well as instant communications access to its professionals, while Corniche Hospital is collaborating with SEHA to develop an e-records system. The emirate has already built the foundations of an e-health infrastructure, with HAAD’s website providing prevention information, a body mass index calculator, a doctor location service and a live-chat platform enabling access to representatives from a poison and drug information control centre, as well as a search engine for HAAD-approved medication.

Innovations

A number of key innovations have been initiated by HAAD that are designed to integrate technology into health care, with the aim of improving access to health services, bringing down costs and empowering the patient. First, the Health Information Exchange is being developed to allow both the health care provider and the patient secure electronic access to the patient’s medical records, allowing information sharing to become a much faster and reducing costs. Second, a mobile phone app, launched recently, will allow patients to view their historical medical transactions along with their respective costs. HAAD is also taking advantage of big data analytics in order to improve health care delivery, using predictive analytics to identify high-risk patients, implementing evidence-based protocols to reduce the impact of infections and adverse events and highlighting the importance of patient-centred care.

Telemedicine

Patients are able to call 24 hours a day for a telephone-based consultation through the emirate’s Telemedicine Centre, after which a nurse creates an electronic medical record for the call, and schedules a physician call-back. Patients in the emirate are also being encouraged to support themselves at home, creating significant opportunity for the expansion of digital innovation in at-home health care monitoring.

In addition, an e-claims system is also in place, which allows payers and providers to exchange claims data (mostly financial with some clinical information) through a HAAD-supervised application called Shafafiya. The development of the emirate’s e-health strategy, meanwhile, is expected to progress under the creation of the Health Information Exchange. SEHA is also making moves with the creation of an electronic medical records system, where all providers under the umbrella of SEHA can view and share clinical information, given that all the information resides in one central repository.

Outlook

With the level of private sector investment rising, specialty care offerings expanding and outcomes and quality of care showing considerable improvement, Abu Dhabi’s health sector has already seen remarkable successes in recent years. The government’s efforts to further bolster private sector participation in addressing ongoing gaps is expected to drive the next phase of the sector’s development and deliver services and outcomes that are comparable to the best in the world, as well as retain valuable medical revenues and enable further economic diversification in the emirate.