Disruptive innovations such as telehealth and telemedicine were highlighted as areas of investment interest in Dubai’s healthcare sector ahead of the launch of a Dubai Health Authority investment guide.

The use of technology was marked out as a major potential cost-saver in Dubai’s healthcare system by the DHA - preventing unnecessary clinic visits and prescriptions for patients.

As well as identifying the areas of medicine where Dubai is currently experiencing undersupply, policy changes to create reimbursement frameworks for telehealth services are on the agenda for Dubai Health Authority to support cost-saving technology in the healthcare sector.

What is needed?

Inpatient beds for psychiatry, orthopaedics, obstetrics, respiratory medicine and gastroenterology are the areas of greatest undersupply in Dubai. Dubai’s Health Investment Guide 2018, which has been published on Thursday, states that the areas that are expected to witness the greatest levels undersupply by 2025 are orthopaedics and rheumatology – at 317 beds.

Undersupply is also predicted in the inpatient sector by 2025 in 18 different inpatient medical disciplines, with the next greatest being respiratory medicine at 248 beds, psychiatry at 231 beds and gastroenterology at 208 beds.

In the out-patient room segment, primary care will see the greatest undersupply by 2025, at 1,218 rooms, followed by nursing care and allied health at 761, with orthopaedics and rheumatology at 75 rooms. 

At a launch event held for the guide on Wednesday, officials told Zawya that cost-saving measures, improvements in efficiency and working towards increasing patient trust in the system were all part of a five-year strategy for the sector.

Ahmed Faiyaz Sait, advisor, investments and PPPs, Dubai Health Authority, said health spending in Dubai had increased significantly in five years, from 10 billion UAE dirhams to 17.5 billion, with 10 new hospitals opening in the emirate in the past seven years.

However, the health authority’s focus is moving away from the building of general hospitals to meet specialist demand, and also finding cost-savings by making policy changes towards telehealth or telemedicine to reduce ‘over utilisation’ of clinics.

In addition, the landscape is changing, with a growing older population, meaning long-term extended care will become increasingly important. At present, the number of people over 60 in Dubai’s overall population, including expats and UAE nationals, stands at between 1.6 and 1.7 per cent, according to Sait, and estimates suggest this will rise to 3.2 or 3.3 per cent by 2030.

The percentage of people aged 60 or over in the UAE national population in Dubai is expected to reach eight per cent by 2030.

“When you look at where investment is needed, we’ve got a lot of gaps across healthcare – mental health is clearly one of them. We have also got a population that is going to age over the next decade or so, therefore long term extended care is very important.

“You also have a growing burden of disease, cardiovascular, oncology, you see a growing prevalence and need for these services and we need a more integrated ecosystem to address the needs of the population, and the chronic disease management programmes,” said Sait.

PPP cardiology centre of excellence

Public-private partnerships (PPPs) will be important in attracting investors to the emirate’s healthcare, sector according to Dr Ibtesam Al Bastaki, director, investments and PPPs for the DHA. A good example is a new Cardiology Centre of Excellence, with between 100-120 beds, which is to be built within the vicinity of Dubai’s Rashid Hospital, with most of Rashid Hospital’s cardiology services to be moved to the new centre.

“The aim of this PPP is to encourage investors. Sometimes investors will feel more comfortable when they are linking themselves with the government because we can guarantee volumes, because we do have a lot of patients,” she said.

According to the report preview, the UAE experiences a mortality rate of 147.9 per 100,000 inhabitants due to cardiovascular diseases, three times higher than in the United Kingdom or Australia. 

“[The centre will not be restricted to certain categories of population, we will accept the restricted [insurance] network as well as the general network, as being as a part of a Dubai Health Authority, it’s a government entity, but despite that it will be built as a partnership with the private sector, but the service will be given to everyone equally,” said Dr Al Bastaki.

“[The centre] will be designed, built, financed, operated and maintained project for 25 years, the private sector will do all this, the government will pay them through a payment where you will have [key performance indicators] KPIs across the medical operations,” said Sait.

 Medics on call via tech

Telemedicine companies could tie up with insurance companies to allow patients to receive an online triage consultation within minutes of putting in a request, said Sait, and for simple cases such as influenza, could receive advice at home to negate the need to attend a clinic. In the space of a year, nine licences for tele providers had been issued in the emirate, he added.

“Where this is has already, happened, the cost savings are in double digits, it is possible to bring down costs by 20-30 per cent, without any impact on the clinical impact,” he said.  

The technology has potential to change the way healthcare is provided, moving towards a less hospital focused and more home-based model.

“Healthcare systems all over the world are being disrupted by technology,” said Sait. “You have remote disease monitoring, a lot of home-based care, your support services are offered in fiscal infrastructures through technology, treating patients at home, monitoring their condition, bringing in interventions when needed. These are areas in which we are developing policies and focusing a lot of our initiators to drive investment.”

An area in which the home-based care model could be effective was for diabetes, which the report preview shows is at a 17.3 per cent prevalence ratio in the UAE’s population aged 20 to 79, between two and four times higher than the UK and Australia.

“We are supporting value-based remote patient monitoring programmes, we are partnering with the existing providers for solutions where these diabetes patients are constantly monitored, reducing the number of complications that come up in these cases. The complications are when the costs come up,” said Sait.

“When the patient is hospitalised because they are in a coma, the costs skyrocket - 60 or 70 per cent of the cost is spent on 5-10 per cent of the sickest of the population, and we want to try to change that in the future.”

 Price caps

 In addition, a price capping system, similar to one already in existence in Abu Dhabi, is to be introduced, meaning that providers will have to agree maximum prices for procedures, depending on the quality of care available.

‘Outcome-driven’ costs are to become the norm, meaning providers will have to charge based on the success of procedures, rather than the duration of hospital stays or treatment provided, Sait explained.  

For example, if a knee replacement patient stays five days in hospital, then is released, but readmitted due to complications because the surgery has gone wrong, the provider will not be paid, said Sait.

“You’re moving it away from the model that the longer the patient stays, the more you get paid,” he said.

While some very specialised conditions will still lead to patients travelling abroad, due to low volumes, the new policies are designed to build trust in the health system in Dubai to encourage more to stay in the emirate for treatment, said Sait.

“For many tertiary care systems, there is still a lack of trust in the system, where some patients in many segments, prefer to go abroad, either because cost-wise they don’t have the access or they don’t have the same quality service perception in Dubai. We want to try to change that,” said Sait. 

Asked if ‘cost-saving’ measures, such as encouraging the use of telemedicine and telehealth – in which patients can use online consultations and wearable tech for health monitoring purposes for chronic conditions such as diabetes, might be off-putting to investors, Sait said he thought there was already a lot of interest in healthcare tech and innovation.

“I think there is a lot of interest, particularly on the innovation side, telemedicine side, it’s for us to support that with policy change and reimbursement mechanisms that can really support those technologies,” he said.

Further reading:

(Reporting by Imogen Lillywhite; Editing by Michael Fahy)

(imogen.lillywhite@refinitiv.com)

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