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THE GCC – OPPORTUNITIES IN HEALTH FUNDING AND MEDICAL TOURISM
6th Arab German Health Forum 2013
2
Demographic Changes and Future Population Trends
GCC Population has grown considerably over the past 5 years
3
37.4
38.2
39.1
40.0
40.8
41.6
35.0
36.0
37.0
38.0
39.0
40.0
41.0
42.0
2008 2009 2010 2011 2012 2013
Popu
latio
n (M
illio
n)
Years
Population, GCC (2008-2013)
Source: International Database- Census bureau
CAGR:2.2%
38%
61%
25%
70%
25%
75%
49%
62%
39%
75%
30%
75%
25%
51%
0%
20%
40%
60%
80%
100%
120%
Bahrain Kuwait Oman Qatar Saudi Arabia UAE GCC
Popu
latio
n
Countries
Percentage of National and Expatriates, GCC,2009
Nationals
Expatriates
• The GCC population expanded at CAGR of 2.2% to 41.6 million during 2008-2013.
• The expatriates make up to 49% of the region’s population.
• UAE has the highest expatriate population
and Saudi Arabia has the lowest.
Source: Frost & Sullivan 2012,report
GCC Population is expected to rise to over 50 mn in 2025
4
39.1 41.6 43.2 45.4 46.9 50.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
2010 2013 2015 2018 2020 2025
Popu
latio
n (m
illio
ns)
Years
Population Projections,GCC,2010-2025
Source: International Database-Census bureau
1.2 2.5 3.0 1.7
25.7
5.0 1.3 2.8 3.3 2.2
27.8
5.8
1.6 3.2 4.0 2.6
31.9
7.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Bahrain Kuwait Oman Qatar Saudi Arabia United Arab Emirates
Popu
latio
n(m
illio
n)
Country
Population Projections by Country,GCC,2010,2015 and 2025 2010 2015 2025
• By 2025, the population in GCC will reach 50 million. The vast majority will be under the age of 25.
• Growth in GCC is largely due to increasing number of expatriates in the region’s developing economies.
• GCC is expected to be a major importer of foreign labor in future as well.
Source: International Database- Census bureau
Overall population is set to rise, the +65 population is set to grow significantly 5
39.1 43.1
46.9 50.2
53.1 55.1
58.0 60.1 61.9
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
2010 2015 2020 2025 2030 2035 2040 2045 2050
Popu
latio
n (m
illio
ns)
Years
Population Projection, GCC (2010-2050)
65+
15-64
0-14
0-14 age
15-64 age
65+ age
Source: International Database- Census bureau
• Population growth in GCC is heavily driven by immigration trends in the region.
• In addition, improvement in life expectancy over past quarter of a century have lead to the expansion of over 65 age group segment.
• The elderly population in the region is expected to grow leading to increase demand in healthcare in future
12.9 mn
46.5 mn
11.1 mn
6
Health Indicators, Spending and Risk Factors in the GCC – A snapshot
NCD’s a % of total for cause of mortality
% Overweight out of total population
% Obesity out of total population
% at risk from raised blood pressure
66%
71% 56% 69% 72% 79%
33%
28%
83% 71% 69% 76%
21% 33% 33% 42%
35% 33% 34% 29%
GCC – Health Indicators and Risk Factors
71%
79%
33%
37%
WHO: Non communicable diseases country profiles 2011
Overweight Prevalence – A global snapshot
8
GCC – ranges from 51-60% to over 71%
Rising Prevalence of Diabetes in the GCC, a leading risk factor for CVD
9
7%
8%
10%
12%
12%
52%
6%
7%
7%
11%
24%
44%
0% 20% 40% 60%
Genitourinary diseases
Digestive diseases
Maternal and perinatal conditions
Infectious diseases
Cardiovascular disease
Others
Projected burden of cardiology – 2006 vs 2025 (est.)
2025 2006
Source: McKinsey & Co. Research
Source: IDF 2011
▪ Diabetes prevalence is over 25% of the GCC population.
▪ 5 of the 6 GCC countries in the top 10 countries in the world in terms of % prevalence of Diabetes (2011 Diabetes Atlas).
▪ Lifestyle disease such as diabetes, Hypertension, Heart diseases accounts to 50% of deaths in Gulf region.
Comparative Prevalence of Diabetes (2011, MENA Region)
Per Capita Total Expenditure on Health in the region is reasonable but lower than OECD Avg.
Source: Global Health Expenditure Database, WHO 2012 and OECD Health Data 2012
However, the healthcare spending is significantly higher than rest of Middle East where the current spending is grossly inadequate to meet healthcare demand in a number of the countries
A large portion of the health spending in the GCC is financed by the Government
Source: Global Health Expenditure Database, WHO 2012 and OECD Health Data 2012
Efforts are being made by many Gulf States to shift the burden of spending from the Government and OOP to health insurance
There has been an Increase in spending on Healthcare(per capita) since 2005
12
0
200
400
600
800
1000
1200
1400
2005 2006 2007 2008 2009 2010
Hea
lth e
xpen
ditu
re($
)
Years
Average per capita expenditure on Health,GCC,2005-2010
CAGR:8.7%(2005-2010)
Source: World bank
0
500
1,000
1,500
2,000
2,500
Oman Saudi Arabia
Bahrain Kuwait Qatar United Arab
Emirates
Per
capi
ta e
xpen
ditu
re($
)
Country
Per capita Health expenditure by Country, GCC
2005
2010
Source: World bank, IDB-census bureau
• During 2005-2010,per capita health spending in GCC has grown in tandem with rise in income.
• The growth is quite significant in UAE compared to other GCC countries.
13
Health Spending in the GCC – Future trends
• The healthcare services market in GCC expanded at a CAGR of 18.8% since 2004 and reached around USD23.1 billion in 2009.
• It is projected to grow at an annual rate of 11.4% to USD43.9 billion by 2015 from an estimated USD25.6 billion in 2010
• Some experts estimate spending to grow to USD 60 billion in 2025 with growth in inpatient and outpatient market due to increased disease prevalence coupled with rising healthcare cost/inflation
Source: Alpen Capital GCC Healthcare Report 2011, Mc Kinsey & Co. GCC Healthcare Outlook
14
Health Market Growth in the GCC
Saudi Arabia and the UAE are the largest markets together accounting for 75% of health spending in 2015 and are expected to be the fastest growing markets in GCC over 2010–15 growing at over 12%
Source: Alpen Capital GCC Healthcare Report 2011
Country-wise healthcare market growth over 2010-15 Country-wise healthcare market within GCC (%)
15
Overview of Future Health Investments in the GCC
Upcoming Healthcare Projects in GCC
Some of the major projects in the region (this is not an exhaustive list)
16
Country Project Status Value
Kuwait Jaber Al Ahmed Al Sabah hospital
Construction $1057 m
Razi Hospital Construction $ 1200 m
Sidra Medical & research Design $ 2300 m
Oman Medical City Oman Concept Stage $1000m
Saudi Arabia 10 Specialized hospitals in Saudi Arabia
Concept Stage $1,350m
Prince Nayef Specialization Medical city
Concept Stage $1,000m
King Abdullah Medical City Design $1,200m
UAE New Hospital for Sheikh Khalifa Medical City
Design $2,000m
Cleveland Clinic in Al Maryah Island
Construction $1,300m
Source : Frost& Sullivan Report 2012, Alpen GCC Healthcare Report 2011, Contructionweekonline.com
Upcoming Healthcare Projects in Dubai
17
Project No. of Beds
Public
Al Jalila Pediatric Hospital 200
Al Makhtoum Trauma Hospital 400
Private
University Hospital (DHCC) 400
Al Jord Orthopedic Specialty Hospital 53
Suliman Al Habib Hospital expansion 200
Aster(DM Healthcare) Dubai 300
The City Hospital expansion (Oncology) 200
Lifeline – Umm Hurrair Hospital 94
Al Zahra Hospital 200
Source : Dubai Health Authority/ DHCC
18
Financial Challenges in the GCC Health System
Financial challenges facing the region
Increase “pre-payments” through health insurance, levies and/ or taxes
Reduce government burden on health expenditure
Reduce Out-of-Pocket expenditure by increasing health insurance
coverage
Complexity projecting future health spending, which requires;
Current expenditure on hospitalization, doctor visits, pharma.
Demographic factors: population structure
Health factors: burden of diseases
Economic and social factors: income, new technologies
Public policy factors: health promotion, health regulation
Health Insurance can play a role in promoting investments & reducing the prevalence of lifestyle diseases
Benefits of future Health Insurance packages
Primary prevention –They include immunization, smoking cessation, regular physical activity, good nutrition etc.
Secondary prevention - It includes Pap smears, blood pressure check-ups, mammograms, and other forms of screening.
Tertiary prevention - Tertiary prevention may include both drug treatments and actions like physical activity and good nutrition that can help control heart disease and hypertension.
Booz & Co’s GCC’s Insurance Mandate
Insurance industry can design and implement innovative health coverage packages that have varied benefits and have a specific focus on prevention
GCC Employers are likely to adopt health insurance schemes that are aimed at reducing cost. Specific Programs focusing on wellness & prevention could be an innovative approach e.g Weight loss or smoking cessation.
Medical Tourism – Overview and Opportunities
Industry Drivers: Factors that have lead to the rise of Medical tourism
Source: Healthcare Special report - EIU 2011)
Government policy - Around 50 countries have now identified medical tourism as a strategic national industry. In Asia, one impetus came from the Asian crisis of 1997, when some countries seized on medical tourism as a way to increase foreign currency earnings.
Developments in information technology - The Internet has enabled patients to research options beyond national borders, and has expanded international marketing opportunities. It has also broken down cultural barriers.
Lower air fares -The advent of budget airlines and a drop in airline fares have made foreign travel-and therefore medical tourism- more affordable.
Trade liberalization - The General Agreement on Trade in Services, agreed by the World Trade Organization (WTO) in 1996, paved the way for trade in medical and other services.
Increasing foreign investment - The relaxation of restrictions on foreign ownership in many emerging-market economies has channeled FDI into provision of healthcare services, leading to improvements in quality and efficiency.
Internationalization of the medical workforce - As healthcare systems have expanded, developed countries have recruited more immigrant healthcare workers. This has given medical staff valuable international experience, and has allowed Western patients to become familiar with dealing with foreign medical staff.
Internationalization of medical training and accreditation - The vast majority of IMGs in the US trained in developing countries, which originally led to concern over standards. This prompted some harmonization of medical training, which, combined with the spread of English as an international language, has made medical skills more portable.
The rise of facilitator firms - Thousands of agencies now offer medical tourism services to healthcare travelers, such as arranging accommodation and acting as a mediator with the hospitals. These agencies also act as a channel for governments and hospitals to promote medical services.
Drivers demand for Outbound Medical Tourism from GCC
Drivers of demand for
outbound tourism
Medical tourism provides an opportunity to reduce costs
for blue collared workers and those without insurance
coverage.
People with health insurance opting to travel abroad for quality or value as they pay
out of pocket for elective surgery and
“pre-existing conditions”
Patients travelling to centers of excellence for critical care.
Singapore and Germany attract a lot of Gulf patients
for Oncology
Growing incidence of lifestyle diseases like CVD, Cancer, Diabetes is encouraging
health and wellness procedures abroad
Lack of availability of certain health and wellness treatments encourage the outbound travel
for e.g. fertility, sports medicine, cosmetics
Very often, patients tend to travel for better quality of
care which can be offered in a more mature and evolved
health system such as Germany, France, UK
The reasons behind a decision to travel for healthcare
Source: Healthcare Special report - EIU 2011 and DHA Overseas Treatment Survey 2012
The factors that could affect each patient’s choice of location are:
Expertise of the doctors or surgeons involved, and the quality of aftercare;
Ease of travel, including the possibility of combining treatment with a holiday;
Familiarity with the country, the language and the healthcare system;
Risks for the patient, which range from quality concerns in the healthcare system to general risks, such as terrorism;
Cost, both for the treatment and for the stay.
The perceived value from treatment abroad considering the quality of health system in the home country and malpractice by clinicians.
The waiting time for the procedure in the home country compared with the location they consider for medical travel.
The availability of after care services post surgery
The availability of information on quality and experience of surgeons and on the costs
Perceptual Mapping of leading destinations in Medical Tourism
Clinical Quality Focus
Tourism Focus
Bulgaria Romania
Dubai Greece
South Africa
Turkey Spain
Thailand
Czech Rep.
Malaysia
Costa Rica India
Jordan
Switzerland
Canada
UK Germany
Singapore
US
Korea
All destinations for medical tourism are positioned to compete based on either the clinical quality and the strength of their health system or on the strength of their tourism brand and infrastructure
A well developed medical tourism offering focusing on certain specialties and treatments. Although expensive, Germany is
respected for high quality care and its technological edge and innovation in clinical services
Developing a brand on the strength of its tourism and hospitality sector. Focus on
elective procedures
France Belgium
Poland
Hungary
Hungary and Czech Republic – growing popular, good quality care with 30-50% cheaper prices than UK, Germany for cosmetic, dental, fertility, spas. Tourists from Austria, Germany, Russia, UK
Value Focus
Costa Rica is very successful with US patients seeking elective
procedures. India for cardiac and orthopedic globally
Factors limiting the growth of outbound medical tourism in the GCC
Limiting factors for outbound tourism
from GCC
Considerable investments in public and private sectors
are being made to expand services and keep patients at
home.
Bad experiences and poor word of mouth at some destinations lead to a
spillover effect, limiting medical tourism growth
At times patients have faced difficulties in getting follow
up treatment which is difficult to co-ordinate for some procedures at the home
country.
Most medical tourism destinations are developing
countries with limited legislation on malpractices in
case of errors or complications
Lack of transparency on costs, volumes and other information on clinical practitioners in some countries as well as cultural and
language barriers.
Patients face difficulty in getting follow-up treatment in
their home country after receiving medical treatment abroad
Germany, UK, US, India and Thailand are leading destinations for GCC medical tourists
• Providers seeking and receiving accreditation from organizations such as JCI in order to alleviate concerns about quality of care. Hospitals are also getting accredited as certified medical tourism facilities from MTA and Temos.
• Reputed medical institutions and providers collaborating with institutions abroad to create brand recognition for organizations and for the destination.
• State health providers, ministries of health and big companies have recently launched plans that reimburse treatment costs in foreign locations, alleviating concerns about follow up care and coverage once back at home
• Destinations like Thailand, US, India and Germany are providing concierge services and a cultural environment.
• Destinations such as Turkey, Korea, Jordan & Malaysia are growing in popularity.
…appears to be having an effect on patient sentiment Multiple surveys of patients’ experiences at facilities abroad suggest that most feel satisfied with the quality of care and would encourage friends and relatives to travel abroad for medical care Germany has an 87% satisfaction based on a recently concluded survey with 90% of patients who’ve sought treatment in Germany would recommend it to friends & family.
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