e 3 a s h i g R E F L E C T I O N S

Top Quality Stuff (For Real!)

I came accross the Abu Dhabi Agenda for 2007-2008 which covers quite alot of areas. Naturaly, I was interested in the section about healthcare. This is a top quality document that I think all health professionals would greatly benefit from. The full document (88 pages) is available from Gulfnews website, I extracted the healthcare section which covers the policy drivers and structured strategy for change. Its a lot of text so instead of cluttering the main page with it, I included it as an extended entry. Click on this entrys’ title to read it.

Objectives
Healthcare delivery in Abu Dhabi is undergoing a significant transition that will affect the entire spectrum of stakeholders: patients (Nationals and Non-Nationals), providers and those responsible for planning, assuring the quality of services and financing the health system. Key objectives for the Health Authority in Abu Dhabi are to:

• Improve quality of care, always the primary consideration, to be promoted through application of rigorous service standards and performance targets for all.
• Expand access to services, giving all residents access to the same standard of care with the power to choose healthcare services thus promoting excellence through free-market competition.
• Shift from public to private providers safely and efficiently so that private providers, rather than government, services healthcare needs, with the role of government restricted to the development and enforcement of new, world-class healthcare standards.
• Implement a new financing model through a new system of mandatory health insurance.

Contribution to Abu Dhabi Vision
Under the leadership of His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the United Arab Emirates and Ruler of Abu Dhabi, the Executive Council has set a goal to deliver a standard of healthcare equal to the best systems across the world. The new approach seeks to provide more choice and greater access to higher quality healthcare services, facilities and professionals in the Emirate.

By implementing the new policy, the Health Authority is also contributing to the delivery of key components of the Executive Council’s broader vision for the Emirate. Specifically, mobilizing a large and empowered private sector to fulfil roles once provided by the Government, diversifying the economy, and building greater capacities and job opportunities for the Emirate’s people.

Policy Drivers
A range of factors drives the need delivery. Specifically, there are five policymakers seek to address:

1. The cost of healthcare is not sustainable
Current funding arrangements have developed in a time of rapid social and economic change. They have served Abu Dhabi well. However, as the population of Abu Dhabi and the UAE continues to grow and age, the funding forecasts are unsustainable. For example, historically the Government has generously funded overseas treatment for patients with severe medical conditions. By 2004, this practice was consuming a quarter of total healthcare expenditure.

In addition, the aging of the population and changed lifestyles have led to an increase in incidence of a range of diseases requiring extensive treatment and care, including cancer, afflictions of the respiratory system and cardiovascular disease. For example, according to international statistics, the UAE now has one of the world’s highest prevalence levels of type II diabetes in adults. Equally alarming is the high prevalence of asthma and obesity in children. Treating these diseases is expensive, and if future incidence of disease is not reduced through preventative measures, the cost of treatment and the loss of human capital through disease will continue to adversely impact economic growth.

2. Facilities and institutions need upgrading to meet expected demand
As the healthcare needs of the population change, facilities and institutions must change as well. Aging facilities need updating. New, world-class institutions are required. The professional workforce, in particular, needs to grow. In 2005, Abu Dhabi had an estimated 4.7 oncology specialists for every million residents. This is significantly lower than the UK (8.1), Germany (8.7) and the similarly sized US state of Oregon (26). Depending on the average age of a population, between 6 and 12 oncology specialists per million residents are needed to deliver appropriate services without waiting times that could negatively affect outcomes. The number of acute hospital beds available for every thousand residents in Abu Dhabi is equal to Singapore, but well below international benchmarks across Europe, the USA and Australia.

An analysis of current demand for speciality treatment centres has identified need for:

• One cancer centre
• One cardiovascular centre
• One paediatrics and high risk pregnancy centre
• One plastic surgery and burns unit
• One forensic psychiatric hospital
• Two elective orthopaedic centres
• Two poly-trauma centres
• Two molecular imaging departments or centres
• Two long-term nursing homes
• Four dialysis centres
• Four cataract centres
• Five rehabilitation centres

3. Access and standards are inconsistent
Every resident of Abu Dhabi should be able to rely on consistent, high quality care within the Emirate. The Abu Dhabi Health Authority will address both access and quality standards to increase choice and address any inequities that currently exist. Recent estimates suggested up to 25 percent of healthcare facilities may not meet all of the Government’s healthcare regulations and this situation is being remedied as a matter of urgency.

A more holistic approach is required to produce consistent outcomes across all institutions in the healthcare system, and deliver certainty to patients and their caregivers. Specifically, this requires genuine accreditation standards and a rigorous system of inspection and quality control across all institutions, to lift the overall standard of healthcare in the Emirate. Moreover, these measures need to be accompanied by programmes to upgrade the qualifications of doctors, nurses and paramedics, as well as intensified and mandated continuous medical education.

4. Focussing on primary care and prevention will make a tangible difference
There is evidence that many patients rely on hospital facilities when a health problem becomes acute, rather than seeing a GP in the first instance or during early stages. For example, according to recent studies 85 percent of all breast cancer cases are diagnosed and first treated at a very late stage, when the chance for a cure is low, compared to only 20 percent in the USA and 30 percent in Europe. Steps need to be taken to expand health awareness and preventative programmes as well as to improve the accessibility and delivery of primary health centres to overcome residents’ impressions that hospitals provide the best care.

5. Public institutions have dominated healthcare service delivery
Public institutions have traditionally dominated the delivery of healthcare facilities and services. Currently fewer than 800 of the 3,900 hospital beds in the Emirate of Abu Dhabi are in private hospitals. Despite the already significant government investment and subsidies, Abu Dhabi faces significant shortages in qualified health professionals to provide for the Emirate’s primary health care needs. In addition, only 10 percent of doctors in the Emirate are actually UAE Nationals. By shifting health delivery responsibilities to private hands and partnering with the private sector to upgrade existing public facilities, the Government can focus on critical public health matters such as prevention, public education and awareness. Going forward, the Health Authority has prioritized and set ambitious improvement targets in 12 key areas including, diabetes, breast cancer, infectious disease and road death prevention. The Emirate will continue to form new partnerships with international organizations to develop and implement these campaigns.

6. International experience will be leveraged more effectively
Abu Dhabi possesses strong economic and diplomatic relationships with many countries around the world. While these relationships have been leveraged successfully to draw on international expertise and access cutting edge technology in areas such as energy and business, the same opportunities are now emerging in the healthcare sector. Historically, Abu Dhabi has primarily drawn on international expertise in healthcare by funding overseas treatment for Emirati Nationals. While international treatment is an appropriate interim solution for patients, continuing this initiative over the longer term would represent a missed opportunity to attract the world’s best institutions and healthcare professionals to Abu Dhabi. The Government believes it is simply not practical to rely on international institutions that are based overseas when many of the world’s best institutions are keen to establish a presence in the region.

Strategy
As of March 1st 2007 the Health Authority – Abu Dhabi became the sole policy and regulatory authority for health management in the Emirate. The Authority will adopt, monitor and enforce internationally recognized quality and service standards. To ensure independence within this new framework, the Authority will cease its dominant role in both provision and financing of health services, with exceptions for healthcare in remote areas and preventive medicine. Policy initiatives to reform the delivery and administration of healthcare in Abu Dhabi based on systematically identified trends, challenges and opportunities will create a well regulated health system in which Residents will have access to world-class services and the providers of these services will be adequately rewarded.

Key initiatives are as follows:

Health Insurance Reform for Nationals and Expatriates
A new, mandatory health insurance scheme was introduced in 2006 for foreign residents and their families. In the second half of 2007, a comprehensive health insurance scheme for Nationals is due to be established. Hallmarks of the new system include a clear and transparent reimbursemment process, affordable access for foreign and national residents, and reliable funding for quality healthcare in Abu Dhabi. Importantly, the new insurance scheme is an investment in sustainability for the future of healthcare in the Emirate.

Under the law, employers must enrol and fund insurance for all eligible Non-National employees in the scheme, covering spouses and up to three children under 18 for each employee. To standardize access, authorised public and private healthcare facilities are required to provide the following medical treatments to individuals with insurance:

• Check up and primary care by general practitioners and specialist doctors at clinics and health centres
• Laboratory tests and X-rays
• Medicines
• Emergency care and treatment
• In-patient treatment
• Expenses of an escort in critical cases
• Dental and gum treatment, excluding orthodontics and dentures

The Health Authority – Abu Dhabi will conduct the licensing and monitoring of all health insurance activities. An independent not-for-profit body (the Third Party Administrator) will manage all billing and claims. Employers will meet the insurance costs of expatriates and their families.

In the case of Abu Dhabi Nationals, the Emirate will meet insurance costs. A capitalisation fund has been established to allow for the future health costs in the Emirate, predicted for Nationals to be five times higher than today in 2025. A charitable fund will continue to operate for underinsured expatriates and also cover more serious medical conditions such as cancer, dialysis, poly trauma and disability.

A new Government owned entity, known as the Abu Dhabi Health Services Company will be established, independent of the Health Authority, to partner in public-private partnerships and oversee public sector healthcare provision assets, as well as to manage preventive programs and health services in remote regions (e.g., the Western Region of the Emirate).

Upgrading Facilities to Meet Current and Projected Demand
The Abu Dhabi Government has announced the following major investment projects to improve healthcare provision in the Emirate:

• New Hospital at Al Mafraq AED 300,000,000
• New Hospital at Al Ain AED 300,000,000
• Oncology Centre of Excellence AED 300,000,000
• Western Region Infrastructure AED 230,000,000
• Grant to Oasis Hospital AED 150,000,000
• Health Information System (HIS) AED 140,000,000
• Renovation of Al Jazirah Facility AED 100,000,000
• New wards Al Ain Hospital AED 25,000,000
• The SKMC Cardiac Program AED 25,000,000

As part of the effort to enforce higher standards, the Authority recently closed 25 primary health care (PHC) clinics and will establish new facilities to include additional services, including dentistry. The redefinition of PHCs will include a strengthened role for General Practitioners to serve as more effective gatekeepers for hospital care and will make PHCs more attractive to consumers who have resisted these institutions in the past.

Groundbreaking International Partnerships
A key component of the Government’s healthcare strategy is to develop beneficial partnerships with select international healthcare institutions. In line with this strategy, a number of significant partnerships have already been announced between Abu Dhabi and leading international healthcare institutions, resulting in new world-class healthcare facilities, top-level training and improved quality standards across the sector as a whole.

In March 2006, a ten-year agreement came into force between the Health Authority and Johns Hopkins Medicine of the United States. Under this agreement, Johns Hopkins Medicine will assume managerial and operational oversight of the 469-bed Tawam Hospital, one of the UAE’s largest and most prestigious.

The agreement encompasses:

• A nine-month assessment of the hospital’s needs.
• Implementation of management systems.
• Establishment of Centres of Excellence in a range of specialist clinical areas, e.g., an oncology Centre of Excellence to treat the most prevalent types of cancer in the Emirate and the region (lung, prostate and breast cancer).
• Access by healthcare professionals and patients to the latest information from The Johns Hopkins Hospital in Baltimore, consistently voted ‘best hospital’ in the USA by US News and World Report.
• Training of local medical staff.

Also in 2006, the Imperial College London Diabetes Centre opened in Abu Dhabi. The first initiative of a partnership between Mubadala Development Company and Imperial College London, this state-of-the-art centre is expected to become the leading diabetes resource in the region.

• Treatment will include the highest level of specialized patient care from first diagnosis to management of diabetes and its associated complications. Comprehhensive diagnostic facilities include digital retinal photography and retinal laser machines, as well as state-of-the-art echocardiograph imaging and stress testing to detect the earliest signs of heart disease.
• Research is expected to encompass epidemiological, basic, clinical and genetic research focused on diabetes in the UAE.
• The Centre will also have a responsibility to provide continuing education to healthcare professionals and the community.

Furthermore, an agreement was reached in September 2006 with the Cleveland Clinic—one of the top three hospitals in the United States—to establish, manage and operate a brand new hospital in Abu Dhabi. The Cleveland Clinic partnership will deliver unrivalled service provision, unprecedented medical and administrative training opportunities and world-class research, as well as important impulses for the overall improvement of the health system of the Emirate.

In June 2007, Cleveland Clinic signed a further agreement with the Health Authority - Abu Dhabi which will see Cleveland Clinic take over the management of the 550-bed Sheikh Khalifa Hospital, the 120-bed Abu Dhabi Behaviour Sciences Pavilion, and the 100-bed Abu Dhabi Rehabilitation Centre, as well as more than 12 specialized out-patient clinics and 9 primary healthcare centres in various parts of Abu Dhabi city.

Delivering Consistency: A Rigorous Licensing and Inspection Regime
The Government is revising existing laws relating to healthcare quality and standards, creating new laws to maintain and improve standards in the future, and will provide a more reliable system of accreditation.

Key initiatives include:

• A comprehensive audit of the privileges, qualifications and credentials of all healthcare professionals in Abu Dhabi.
• Requesting appropriate continuing education credits for each healthcare professional based on credentials and years of experience.
• Creating qualified inspection teams to rigorously monitor facilities and healthcare professionals.
• Enforcing strict licensing standards for all healthcare facilities, based on minimum standards, quality reform and certified accreditation.
• Ranking and accrediting all healthcare facilities in Abu Dhabi through a partnership with the Joint Commission on International Accreditation (JCIA).
• Working with an international partner to standardize healthcare examinations in Abu Dhabi.
• Working with a technical partner to create a world-class, integrated Health Information System.

Coordination
The Authority coordinates its activities with the Federal Ministry of Health and its advisory council. In addition, within Abu Dhabi, the Authority must coordinate with:

• The department which will be responsible for financing Nationals’ healthcare insurance and services.
• The Department of Municipal Affairs.
• The departments and authorities conducting health-related public education campaigns, such as the Food Authority.
• The various education entities on health and physical education in schools, and on the attraction and retention of new healthcare professionals.