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Investment and PPP
Department
2020
Overview of PPP Opportunities and Projects
for Dubai
On Jan 4th 2019 the 50 year charter was announced by
HH Shk. Mohammed bin Rashid Al Maktoum
The Vice President and Prime Minister of the UAE, and ruler of
Dubai
Article 5: A Doctor to Every Citizen
We aim to provide citizens with medical consultations 247/ through hundreds of thousands of
doctors, specialists and medical consultants across the globe.
This will be facilitated by smart government application.
Our goal is to transform the medical system to bring doctors closer to individuals, enhance
awareness, and
utilize top medical minds globally to serve the health of our citizens.
2
Dubai is a vibrant city of opportunity for professionals, investors
and
entrepreneurs
The Dubai Advantage
Dubai is a gateway to growth markets with recognized quality of
life and ability to retain talent
88% of GDP is from
Financial Corporation
4th most visited city
in the world
THE HUB
Investor friendly destination
Quality of life and talent
retention
THE CITY
Over 200 Nationalities
15.8 million tourists in 2017
84% of population is between 15
and 64 Yrs.
THE GATEWAY
Open economyStrategic location
Dubai
International
Airport
8 hrs flights
to 2/3rd of
the world
140 airlines
260 destinations
Ranks #1 in the word Bank’s
logistics performance index
for MENA region
Number 1 city for quality
of living across the Middle
east and Africa for 5 yrs in
a row
Top 10 financial hubs in
the Bank2017 IFC ranking
3
Dubai Health Authority oversees the healthcare sector in the Emirate of Dubai,
and the health sector has witnessed significant growth in the past decade
CAGR 14-17
+8.1%
30.6 38.5
2014 2017
2.8
3.
1
2014 2017
CAGR 14-17
+3.9%
208 263
2012 2017
CAGR 12-17
+4.8%
Number of hospitals, per type of setting (2017, in no. of facilities)
6
201
0
2017
+10 Hospitals
2737
Public
Private
FacilitiesTotal number of
licensed facilities by
DHA (2014- 2017, in
thousands)
ProfessionalsTotal number of licensed
professional by DHA
(2014-2017, in thousands)
MO HAP
DHCC
(Private)
Snapshot of the Key Figures of Dubai’s Healthcare Sector
The number of outpatients, inpatients as well as the number of healthcare
facilities and professionals licensed by DHA have seen significant growth in recent
years
OutpatientsOP Volumes (2012-2017, in
millions)
7.3 9.
8
2012 2017
HospitalsEvolution of the no. of
Hospitals (2012-2017,
in no. of facilities)
CAGR 12-17
+6.0%
InpatientsIP Volumes (2012-2017, in
thousands)
Private
Regulate
d by
DHA
Public
Regulatory Bodies
4
6 3121
Health spending in Dubai has risen by 12% p.a. from 2012 to 2017, and there
exists opportunities for investment and growth in the health sector
Health spending has risen from AED 9.9 billion in 2012 to 17.5 billion in
2017, and this is estimated to reach AED 24 billion in 2020, supported by
health insurance reforms…
Source of funds
Evolution of healthcare expenses, by Source of
funds (2012-2017, in AED)
Use of funds
Hospitals 47%
Clinics 22%
Ancillary 2%
Pharmacies 9%
Outbound
medical tourism
14%
Admin & Finance
6%
Curative care 59%
Rehabilitative care 1%
Ancillary services 15%
Medical goods 14%
Preventive care 5%
Admin & Finance 6%
Healthcare expenses, by type of
provider (2014, in % of total healthcare
expenses)
Healthcare expenses, by type of care
(2014, in % of total healthcare
expenses)
…however, despite years of positive development,
there exists potential for growth in the health sector
…and the UAE is one of the top 10 economies
with the most efficient healthcare sector, and
ranked on top of Middle East countries...
#1 #2 #7 #8 #10 #11
#12Source: Bloomberg Health-Efficiency Index, 2018
Ho
ng
Ko
ng
Sin
ga
po
re
Jap
an
Au
str
alia
UA
E
No
rwa
y
Sw
itze
rla
nd
3.6% 3.4%
Healthcare expenditure in Dubai vs. GCC and OECD
countries (2014, in % of the GDP)
10.0%
Dubai GCC OECD
Governmen
t
Insurance &
Corporation
s
38%
Source: Dubai Health Investment Guide 2018, Health Accounts System of Dubai 2013-
20145
34%35% 32%
41%
42%
52%
60%
22%
25%
12.8 billion13%
8%
2012 201
4
201
6
2017
Out of
Pocke
t
9.9
billion
17.5 billion
16.0 billion
Health Investments Strategy is important to Dubai (Health Investment Strategy
2017-20)Projected Capacity Gaps in the Dubai Healthcare
Infrastructure
By 2030, DHA foresees a gap of ~1,590 inpatient beds, mostly in specialties such as orthopedics, respiratory medicine, pediatric
medicine, cardiology, long term care and obstetrics
90 96 89
225 241 227
Obstetric
s
Orthopedic
s
Pediatric
medicin
e2025
203
0
8,00
0
6,00
0
4,00
0
2,00
0
0
2020 2025 2030
Suppl
y
Deman
d
Evolution of Supply-Demand Gap in Inpatient Beds in Dubai, 2020-
2030
Gap:
~1,590
beds
Specialties with the Largest Inpatient BedGaps, 2025-2030
In # of
beds
Gap by Specialty in
2030– Orthopedics
– Respiratory
medicine
– Pediatric medicine
– Obstetrics
– Gastroenterology
– Psychiatry
– Cardiology &
Cardiothoraci
c
– General surgery
High
Mediu
m
Capacity Gap in Other Critical
HealthcareInfrastructure in Dubai in
2030
Gaps, in # of
beds
Primary care
Gap: ~726 OP rooms, by
2030
Long-term care
Gap: ~192 beds, by
2030
Gap:
~311
beds
Oversupply
: ~654
beds
6 Note: (*) Ultrasound, X-ray, Computed tomography, Mammography, Magnetic resonance, PETscan, etc.. Source: Dubai Clinical Services Capacity Plan 2018-2030.
Rehabilitation
Gap: ~192 beds, by 2030
Procedural care / Medical
imaging
• Ultrasound
Gap: ~484 units, by 2030
• Computed tomography
Gap: ~50 units, by 2030
• Mammography
Gap: ~43 units, by 2030
…leading to investment needs in certain medical specialties in terms of outpatient
rooms…
Gap analysis by specialty, in no. of outpatient rooms required (base case, 2018-
2025)
Projections are based on the following assumptions:
1.248 operational days per year
2.8 operational hours per day
3.70% planning occupancy per consultation room
4.Adjustments for National and Non-national utilisation based on current trends
5.Nursing demand has been split between adult and paediatric Hospital modes, no
supply captured but absorbed by other consultation rooms
Specialty Gaps (base
case)Specialty Gaps (base
case)
Source: Dubai Health Investment Guide 2018, Preliminary results from Dubai Clinical Services Capacity
Plan 2018-2030, developed by TAHPI7
Primary Care 524 696 1,218
Orthopaedics and
Rheumatology
77 31 75
Respiratory Medicine 10 20 37
Immunology & Infections 11 15 26
Endocrinology 33 21 13
Oncology 8 4 11
Haematology 1 3 7
Gastroenterology 47 35 0
Nursing care &
Allied health
357 463 761
Trauma and Injury 27 32 44
Neurology 1 12 35
Vascular Surgery 4 7 16
Urology 41 27 12
Renal Medicine 2 3 11
Neonatology 3 4 6
Dentistry 26 19 4
… As well as acute inpatient beds in 2020 and 2025 across certain specialties and
services
Gaps by specialty, in no. of additional acute inpatient beds required (basecase)
2020
Onco-
Psychiatry logy
Neuro- Cardio. &
Plastic surger
y
Gastroen- Renal
terologymedicine
Gyneaec
Neona- tolog
y
General Obste- ENT,
Headtrics
Resp.
medicin
e
& neck
Urology
Cardiot.
surger
y
Ortho.
&
Rheum.
Oversupply Optimum
coverag
e
Undersupply
(investment
needs)
2025
General
medicin
e
olog
y
Neuro-
Endocrin
surgery ology
surger
y10
87843
10101
71623273540517281
10
016
9208
log
y
Cardio. &
Onco- Cardiot.
logy
surgery
Plastic
surger
y
Renal
medicin
e
Obste-
Ortho.trics &
Rheum.
Resp.
medicin
e
Psychiatry
ENT,
Head
&
neck
Gastroen-
terology
Oversupply Optimum
coverag
e
Undersupply
(investment
needs)
General
medicin
e
Gyneae
c
ology
Neuro-
surger
y
Endocri
n
ology
Genera
l
surger
y
167
10
8969077675543
4118
6303233
6475
13
514
8
Urolog
y
Neona-
tology
Neuro-
logy
8 Source: Dubai Health Investment Guide 2018
Health Investments Strategy is important to Dubai (Health Investment Strategy 2017-
20)
Priority Investment Areas for Dubai Healthcare Infrastructure
for Diabetes,
Cardiology
and
Oncology
As part of its Investment Strategy 2017-2020, DHA has started identification of highest priority investment areas to fulfil its objective of
promotion and facilitation…
Focus of next 2-3 years… Focus for 3-5 years…
11Innovations
in
Primary Care
Ambulatory
Care
Urgent
Care
Clinics
Mental
Health
Chronic
Disease
Manageme
nt
Tertiary Care
Diagnostic Health
& Remote
Monitoring
Rehabilitation and
Physical Therapy
Home-based
care
Long-term Care
and Extended
care
Preventive Care &
Pharmacy
beyond- the-pill
Precision
Medicine
and Genetics
Population
Health
Management
Nursing
Homes and
Palliative Care
1
2
3
4
5
6
7
8
9
10
12
13
14
9 Source: DHA Investment Strategy 2017-2020,Advention
The Dubai Investment Guide maps the investment journey for different types of facilities / projects for healthcare services
e.g.New facility
licensing
process map
Source: Dubai Health Investment Guide 2019
10
Key Features of a PPP ModelPPP’s are unique in helping create value and transfer of risks to Private Sector
Public Private Participation (PPP) model is a partnershipstructured between the Public Sector/ Government andthe Private Sector to develop infrastructure or provideservices to the population based on an agreedallocation of risks and reward to the Private Sector.
The Key Components of a PPP Model are the following –
1. Financing – Identifying and selecting acceptablemodes of public and private funding for the project
2. Distribution of risks – assessing and designing a riskdistribution model across public and private sectorpartners
3. Business case – develop a business case that isbeneficial and feasible to the public and privatesector
11 Source: DHA Investments &PPP’s
PPP Models in Healthcare - ExamplesPPP models have been implemented across developed and developing regions of the
world helping drive lower capital costs, more efficiency, improved access and investment
in health
• $ 352 mn Joseph
Brant Hospital with
172 beds. Design,
Build and Finance
(DBF)
• 1.1 bn GBP Bart’s
Health Trust NHS
hospital and 430mn GBP
Bristol Trust NHS
• $ 460 mn Women’s
College Hospital –
Design, Build, Finance
and Maintain (DBFM)
Hospitals in
Canada
Hospitals in
Canada
Hospital Trusts
in UK
Hospitals in
Spain
• Hospital de La Ribera in
Alzira region for $ 91
mn. Payment through
capitation fees
• Eur 360 mn 1,000 bed
hospital in Elaziğ. 26
PPP’s planned
Hospitals in
Turkey
• $ 215 mn Burwood
Hospital in Christchurch
with 230 beds
Bumrungrad
Intl. Hospital
• $365 mn Royal
Women’s Hospital in
Victoria, Australia
Hospitals in New
Zealand
Tele-radiology in
Kenya
• GE partnership with
Kenya to deliver
teleradiology to 46 mn
people across 98
hospitals
Imaging
Diagnostics in
Brazil
• $ 40 mn project in the
State of Bahia to set up
and operate 45 new
equipment across 12
hospitals
Hospitals in
Australia
12 Source: DHA Investments &PPP’s
13
PPP Law and Guidelines in DubaiDubai has a PPP Law and PPP Guidelines developed by the Dept. of Finance (DoF) to support investments in healthcare, transport and other infrastructure projects for the Emirate
DHA is very focused on implementingmodels that are suited and tailored toDubai’s needs and that are within theframework of the PPP Law no 22 of 2015.PPP Guidelines issued by DoF governsdifferent models of PPP’s for bothgreenfield and brownfield facilities and weare reviewing and proposing differenttypes of models that are suited to differentprojects provided these allow for risksharing and risk transfer to the privatesector
Focus of PPP Law and Guidelines inDubai–1. Description of the different types of
PPP’s allowed and level of investment2. Evaluation and approval of PPP’s3. The process for development and
approval of a PPP project4. Payment Mechanisms and Risk
Allocation and transfer
Dubai PPP Law and Guidelines
DHA is implementing a PPP Project for Cardiology CoEThe Cardiology CoE is the first healthcare PPP project to be implemented in the Emirate of Dubai and aims to bring world-class cardiology services in partnership with private sector
Objectives of the Cardiology CoE*Highlights of CCoE and PPP Model
• The Cardiology CoE is expected to be a 100-120 bed
dedicated cardiology hospital focusing on cardiac ER, OP
and IP services;
• DHA aims to implement a DBFM PPP Model with the below
stated sharing of responsibilities between the Public & Pvt.
Sectors with the term of the PPP agreement of 25 years
• The CoE will be co-located within the Rashid Hospital
Complex
One –stop-
shop approach
with integrated
care continuum
Evidence based
international best
practice with focus on
screening and early
detection
Physician access
to clinical affiliation,
research &
technology
innovation
Sustainable
and predictable
costs with
access to
financially
vulnerable
segments
It will be flexible and
adaptable to support
remote patient
monitoring
Focus on physician
training, development
and education in Dubai
ResponsibilitySelected PPP Model - DBFM
(Design-Build-Finance-and Maintain, “DBFM”) with clinical affiliation
Revenues DHA
Capex Private Sector
Opex Private Sector (excl. Clinical Salaries paid by DHA)
Clinical StaffSelected medical and nursing positions by DHA
(40-50% of clinical staff), Clinical Affiliation partner to support recruitment & development
Non-ClinicalStaff
Private Sector is free to recruit and deploy staff for the suited positions
Availability Payment
DHA PPP CoReflects capex and opex incurred by PPP Co, along
with cost of funding (debt & equity)
14
DHA is also evaluating opportunities for PPP in 2020-24
Other PPP projects range from developing new infrastructure to enhancing
existing DHA services and improving access to care for the patient
population
Imaging Diagnostics
Dialysis
Spine
Diabetes
DHA is keen to improve utilization of equipment, quality and efficiency of services and
training of staff
Possibility of a risk – share partnership to manage radiology services of 3 hospitals (retaining
DHA staff) to reduce waiting times and increase revenues
Training and upskilling DHA staff will be a key component
Operating Agreement for managed services model to manage dialysis services for patients in
Dubai
To focus on efficiency, patient convenience and quality of outcomes (incl. access to care)
Needs to interface with primary care
Operating Agreement for managed services model to manage spine services in Dubai
Hospital for patients in Dubai
To focus on cost of care, patient trust and quality of outcomes (incl. access to care)
Objective is to bring best in class, highly qualified and experienced surgeons to Dubai
through this
Service enhancement and clinical affiliation for Dubai patients in diabetes care
To focus on cost of care, efficiency and quality of outcomes (incl. access to care)
In future it could include take over and turnaround of an existing center focused on UAE
National
patients
Improved
Efficiencies
Sustainability of
Services
Better Quality
Outcomes
Improved Access
to Specialized Care
Cost
Reduction and
Control
Increase
in
Revenue
Grow PatientVolumes
Overview of other proposed PPP projects in service enhancement and improvement
Concession Model or Operator Agreement for managed services model to manage LTC
services for
patients in Dubai
To focus on efficiency, patient experience and quality of outcomes (incl. access to care)
Expected to free up beds and critical care units in Rashid and Dubai Hospitals
Long Term
Care
15
Thank You
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