Private sector investment becomes the focus of Qatar's second six-year health plan

The large-scale investments of the past half-decade look set to continue driving Qatar’s health sector in 2016 in the final year of its six-year industry blueprint, National Health Strategy (NHS) 2011-16. With the population rising rapidly and household incomes well above the developed-world average – Qatar’s per capita GDP exceeded $100,000 in 2015, according to data from the Ministry of Development Planning and Statistics – public and private sector outlays are on track to keep ticking upwards alongside a state-led push to raise quality and expand services. Significantly, as the public sector enters a new cost-optimisation phase in the wake of the oil price drop that has squeezed state revenues – a policy shift signalled by the emir in late 2015 – the government is increasingly looking to the private sector to fill areas of need. This is opening new opportunities for foreign investors and private companies.

Challenges certainly remain. The very affluence that drives high health spending in Qatar is also contributing to the rise of lifestyle-related diseases, such as diabetes and cancer. On the supply side, a government push to upgrade services at public hospitals and invest in high-end research is helping push up health costs, thus increasing the bill for the state – which accounts for about 86% of health expenditure in the country, according to the World Bank. Furthermore, a long-standing skills gap in recruitment of medical personnel remains a key obstacle.

Main Indicators

On most measures of public health Qatar mirrors developed countries. As of 2015 life expectancy at birth was 77 years for males and 80 for females, according to the World Health Organisation (WHO). Infectious diseases such as HIV and tuberculosis are virtually non-existent.

The big health challenge lies rather with non-communicable diseases (NCDs), which cause some 69% of mortalities. The most fatal NCD is cardiovascular disease, at 24% of total deaths in the country, followed by cancer (18%), diabetes (9%) and lung disease (1%), with another 17% coming from other NCDs. All told, the WHO reckons that the probability of dying in Qatar from one of these four main ailments for those aged 30-70 is about 1:7. As for adult risk factors, as of 2014 some 19.8% of the population had diabetes, according to the International Diabetes Federation, while WHO data shows that 42.3% were obese. A 2013 survey by the WHO and state authorities showed tobacco use at 12.1% among adults.

Spending

Qatar spends around 2.2% of GDP on health, according to the World Bank, with the government contributing by far the largest chunk of outlays at 85.7% of the total in 2014, the latest year for which data was available. Of private spending on health, 48.1% was out-of-pocket. In per capita terms, Qatar spent the most in the GCC that year at $2106, above the UAE’s $1611 and Kuwait’s $1386, but below that of developed countries like Singapore ($2752), the UK ($3935) and the US ($9403).

This, however, likely understates the spending power of Qatari nationals, since most of Qatar’s 2.56m people are expatriates who are not as yet entitled to free public health care and for whom employer-provided insurance is not widespread and disposable incomes tend to be lower.

In Qatar’s 2016 budget health spending hit QR20.9bn ($5.7bn) up from QR15.7bn ($4.3bn) in the previous budget. Alpen Capital’s “GCC Healthcare Industry” report published in February 2016 forecast that the Qatari health care market would clock a compound annual growth rate of 12.7% in the five years to 2020. Of the total reached in 2020, 67% would be for outpatient care.

Regulatory Bodies

The highest authority in the health sector is the Ministry of Public Health (MoPH), established in January 2016, headed by Hanan Mohamed Al Kuwari. Previously, the Supreme Council of Health (SCH) had been the main regulatory body; however, by emiri decree the SCH was disbanded and its responsibilities taken over by the MoPH.

Under the human development pillar of the overarching development plan, Qatar National Vision 2030, issued in 2008, the goal for the ministry is a “comprehensive world-class health care system whose services are accessible to the whole population”. To carry out this enormous, multi-faceted endeavour, the MoPH is vested with several powers and functions: regulating and monitoring the sector, supervising and funding HMC and PHCC, conducting public health testing and commissioning research. It also funds specialised on-site care for labourers in highrisk occupations through five health centres run by the private sector – activities that account for 2% of outpatient care in the country. Another important regulatory body, which is also funded by MoPH, is the Qatar Council for Healthcare Practitioners, which licenses hospitals and doctors, and has been a member of the International Association of Medical Regulatory Authorities since 2013.

Facilities & Staff

Health care in Qatar is provided free of charge to nationals at public facilities, which deliver the bulk of provision. The main provider, HMC, was established in 1979 by emiri decree and now runs eight hospitals that account for 75% of inpatient and 27% of outpatient care. Among the largest are Hamad General Hospital, Rumailah Hospital, Women’s Hospital and Al Wakra Hospital. HMC is accredited by Joint Commission International, a US-based non-governmental organisation whose standard is widely respected as demonstrating quality, and it has plans to obtain a separate certification for its nursing services. As part of government efforts to steer provision from hospitals towards primary care facilities – a core theme in the government health strategy – in 2012 the SCH spun off a new company, PHCC, which now runs 21 primary care centres across the peninsula that together account for 39% of outpatient care.

The public health sector employed 30,303 professionals as of end-2014, up 16% on the previous year, according to the latest available data from the MoPH. The private sector employs some 1150 doctors who work across 166 clinics and medical complexes, 131 dental clinics and four general hospitals (Al Emadi, Al Ahli, Doha Clinic Hospital and American Hospital), according to the Public Works Authority (Ashghal). In all, for every 10,000 people in the country there are 77.4 doctors, 118.7 nurses and midwives, and 0.3 psychiatrists, according to the WHO’s “World Health Statistics 2015”, which did not include data for the number of dentists or hospitals in Qatar that year. WHO statistics for 2013 show that the number of hospital beds per 10,000 was about 12, while the number of dentists was 5.8 per 10,000 people.

Strategy 

To meet burgeoning demand for health services, in April 2011 the SCH launched the NHS 2011-16 – the health component of the broader six-year National Development Strategy 2011-16 – and promptly set about building new infrastructure and expanding services. The plan has seven themes: comprehensiveness, systems integration, prevention, skilled personnel, inclusive regulation, cost effectiveness and research. These are laid out in specific sub-goals, with outcomes spread over the six-year period. In recent years the government has also published specific strategies in areas such as cancer (2011) mental health (2013), facilities development (2014), tobacco cessation (2015) and diabetes (2015).

Capital Projects

The scale of investment is significant. According to the SCH annual report for 2014, the number of hospitals and medical centres is set to nearly double from 35 in that year to 66 by 2022, while the number of hospital beds will more than double from 2100 to 4701 in that period. These new builds will include seven medical care facilities; five health centres and three new hospitals for single male labourers; eight HMC hospitals; a behavioural disorder centre; and 13 specialised units for paediatric therapy, blood donation and outpatient services.

Progress on this list intensified in 2014, with the number of facilities under construction rising to 32, up from 22 a year earlier. In that year three new facilities were also opened: the Abu Samra branch of the Central Food Laboratory, which studies public health risks by examining food consumed in the country for contamination; the Enaya Specialised Care Centre, an 80-bed long-term care unit for chronic illnesses; and the Interim Translational Research Institute, which does DNA extraction, cell culturing, genomics and proteomics. In 2014 expansion work was also completed on the heart Hospital’s emergency department to 700 sq metres, adding a congestive heart failure unit and three new bays for recliner beds. Equipment upgrades in 2014 included new chromatography systems at the Drug Quality Control Laboratory, computerised maintenance systems at the Al Ghuwairiya health centre and new security systems at the Al Karaana health centre.

Pipeline Progress

Such progress continued in 2015 even as new dimensions have been added to the NHS. Since 2011 the SCH, and now the MoPH, has grafted three new components (diabetes, oral health and cancer) and 29 new outputs onto the original blueprint. In March 2015 the SCH announced that the proportion of completed NHS outputs (weighted by significance and labour required) had reached 61%. “The size and scale of the NHS programme continues to increase,” Abdullah bin Khalid Al Qahtani, then Minister of Public Health, told local press in mid-2015. Completions in 2015 included a build-out of HMC’s Enaya centre to 156 beds and the opening of its 40-bed Bayt Al Dhiyafah patient recovery centre.

The Leabaib, the first health and wellness centre in Qatar, was opened in December 2015. The 10,000-sq-metre centre has over 65 clinics and treatment rooms, 26 consultant clinics, 10 dental clinics, six maternal and child clinics, and three physiotherapy clinics. Authorities confirmed that two similar health centres of Al Thumama were also opened in June 2016, and the inauguration of Rawdat Al Khail Health Centre and Umm Slal Health Centre are planned to be held in July 2016, and a number of other health centres are to be opened in the near future.

Meanwhile, construction continues on HMC’s QR2.4bn ($658.6m) Hamad bin Khalifa Medical City, a 227,000-sq-metre site including separate hospitals for women, minimally invasive surgery and rehabilitation, as well as a research centre. Construction on these facilities began in 2011 and reached 80% completion in 2015, according to Ashghal. Local media reported in May 2016 that Ashghal had finished the construction and equipping works for three of the project’s hospitals – the Ambulatory Care Centre, Qatar Rehabilitation Institute, and the Women’s Wellness and Research Centre – and expected them to be handed over to the MoPH by June 2016.

Also in the pipeline are three 120-bed hospitals dedicated to male labourers, in Doha Industrial Area, Mesaieed Industrial City and Ras Laffan.

A further large-scale project under way is the Sidra Medical and Research Centre, a $7.9bn hospital in Education City with a three-fold mission of health care provision, medical education and biomedical research. Contracts to build Sidra – funded by Qatar Foundation, a government-affiliated non-profit – were awarded in 2008 but reassigned in mid-2014. The first clinics in Sidra’s outpatient department opened in May 2016. By the end of 2016 the outpatient clinic will be operating at full capacity, treating up to 5000 patients per week, according to Sidra’s CEO, Peter Morris.

By October 2016 the paediatric surgery unit will be open, and by June 2017 the IVF-reproductive unit will be completed. The hospital section of the clinic is planned for early 2018.

Private Sector

The private health care sector, though smaller than the public sector – at 33% of outpatient and 25% of inpatient care – plays a substantial role. In 2014 the SCH outsourced the operation of its five labourers’ care centres to a private organisation, the Qatar Red Crescent Society (QRCS), and it plans to do the same with 10 others by 2016. “In 2010 we took on the challenge of overseeing the Industrial Area Labour Centre,” Saleh Ali Al Muhannadi, secretary-general of the QRCS, told OBG. “We were then tasked with overseeing and regulating the health care sector for blue-collar workers in Qatar. In total, we have five medical centres and three health commissions in operation for labourers with the new medical centre in Mesaimeer and a new commission in Ras Laffan, both of which recently opened. The ultimate aim is to reach seven centres in total.”

Private participation is especially strong in staff procurement: in 2014 the number of partnerships between the SCH and recruitment agencies rose by 40%. Of the 2344 new licences issued to medical practitioners in 2014, two-thirds were in the private sector. Private companies also play a role providing supplies – for example, Doha-based Qatari German Medical Devices produces safety syringes and filtration products and distributes these to HMC and the QRCS, and throughout the Middle East.

The private sector is likely to play a larger role in the sector in the near future, from operations and management to supplies and infrastructure building, though local participation will remain crucial. “There is certainly space for a well-constructed proposition, but it is important to find a good local partner,” Roger Phillips, legal director at the Qatar branch of global law firm Pinsent Masons, told OBG.

Insurance

A core component of the ambitious plans to continue to transform health care in Qatar is the creation of a new national health insurance scheme, which is currently being developed by the MoPH. Early indications suggest the new scheme will include the provision of a comprehensive health care system with a full range of high-quality health care services, as well as ensuring easy access to these services by providing the patients with multiple options of health care providers. Qatari nationals will be able to access the new health insurance scheme in 2017, after the new programme is fully approved and its first phase is implemented.

New Initiatives

A range of initiatives under way stand to help transform health care services in Qatar qualitatively. In May 2015, as part of the national cancer programme for which it is responsible, PHCC announced three new contracts to advance cancer screening: with Japan’s FujiFilm, to provide equipment and IT support; with US-based RadNet, to run clinical services; and with Doha-based Specialised Medical Solutions, for administrative support.

This was followed in July by the start of a “Screen for Life” public awareness campaign, which began airing television programmes on the benefits of early detection. Then, in November, PHCC launched a new informational website, www.screenforlife.qa. PHCC also announced a children’s oral health scheme in March 2015, including plans for “beautiful smile” clinics that will treat all children under age five, and signed a deal with the Ministry of ICT to expand its Hayyak 107 helpline hours. Designed to make it easier for the public to seek medical aid, Hayyak 107’s new operating hours will extend from 7am-11pm on weekdays to 24 hours a day, seven days a week.

Perhaps the most significant initiative, however, is the Clinical Information System (CIS), an electronic patient records database that was launched in 2012 and is being rolled out in phases. As of May 2016 CIS had been implemented in eight HMC hospitals, paediatric emergency centres, dialysis centres, a bone and joint centre, and a number of PHCC health centres across the country, with HMC’s home health care service implementing it in mid-May 2016.

CIS forms part of a comprehensive, integrated eHealth system, which could be fully operational in the next few years. “Personalised medicine is the key medical advance of the 21st century,” Robert Moorhead, director of the NHS programme management office at the MoPH, told OBG. “With CIS and robust clinical coding in place, we can plug a patient’s medical history into advanced data analytics to identify causal relationships and better understand and thus treat their ailments.” The next steps, he said, will be to integrate this information on a national level, which can be syndicated between different facilities to support patient care, and eventually used – anonymously – to conduct targeted research on health issues that are specific to Qatar.

Outlook 

High disposable incomes, free public health care for Qataris and an expanding expatriate population mean that the health sector is likely to continue on a path of growth and transformation, with the most crucial change in care provision expected to involve significant private participation.

In late 2015 the SCH began drafting a second plan, NHS 2017-22. Its themes include quality and access built on patient empowerment, an emphasis on preventing ill health, service integration and increased capacity in the public and private sectors. “Our focus for the next NHS is to consolidate our progress and finish what we have started,” Faleh Mohamed Hussain Ali, assistant secretary-general for policy affairs at the SCH, told OBG. “We are on target to complete our NHS outputs by the end of 2016, and we plan to continue this achievement by ensuring our future plans remain achievable, measurable and affordable.”