Health Systems

Healing the system


Are Middle East health systems prepared and ready to meet the challenge of the rapidly increasing health burden of non-communicable diseases in the future? Simon Leary, PwC’s Middle East Health Industries Leader and John Middleton, PwC’s Middle East Health Industries Account Manager, discuss the issue.

What is the issue?

Health systems across the Middle East are facing an escalating non-communicable disease time bomb without the necessary infrastructure, models of care or investment to deal with it. Non-communicable diseases, including cardio-vascular disease, cancer, diabetes and obesity, currently account for 47% of the disease burden across the Middle East, which is likely to rise to 60% by 2020 (WHO). At present, half of all deaths in the Middle East are attributable to non-communicable diseases and the burden on the system is growing. One third of all Riyadh hospital admissions is linked to diabetes.

Most Middle East health systems are in no state to meet this challenge. The prevailing health policy focus in most countries remains on building more hospitals. States are currently investing tens of billions of dollars in hospital build programmes rather than facing the burning need to invest in primary care. There are very few exceptions.

Why is the issue important?

While Middle East countries lag behind Western healthcare expenditure (with some as low as 0.5% of GDP), the pressing reason why these issues are important is cost. Caring for patients with non-communicable diseases is expensive, especially with a hospital-centred and reactive healthcare system. Responding to disease flare-ups in a hospital environment is unsustainable. In the UAE for instance, it is predicted that the cost of diabetes care will be $8.52 billion over the next 10 years alone.

Not only is it expensive and inefficient but the health outcomes of such a model of care are poor. Sufferers of non-communicable diseases generally require frequent low-impact health interventions not suited to the hospital environment.

Non-communicable diseases have far reaching impacts on individuals, their families and society as a whole. These diseases are often long term, requiring major lifestyle changes and constant management. As a result the employability of individuals and those they rely on is often affected. This is particularly relevant in the Middle East, given the lack of local and preventative care to minimise the wider impact of an individual’s disease.

The situation is only going to get worse given the common demographic profile across the region. With a very young and growing population combined with increasing life expectancies, people in the Middle East are also getting non-communicable diseases at a young age and are living longer. There is no doubt that current care models are unsustainable under such pressures.

Combined with this growing disease profile and hospital focused health systems is the problem of access to care, given income differentials and differing state financial support. Across the Middle East, a large proportion of non-communicable disease sufferers do not have the income/government support for treatment.

How has this issue contributed to recent events?

The lack of balanced, accessible and financially sustainable healthcare highlights a number of inflammatory issues common across the Middle East:

Accessibility – care is hospital based, reactive and invasive.

Affordability – differing levels of state financial assistance plus large differences in personal income means that there are those who cannot afford the required level of care, if any.

Quality – quality of care varies hugely as a result of an historic focus by states on investing in capacity building rather than capability and quality.

What does the vision of ‘better’ look like?

There is no “right” answer in terms of what the perfect health system looks like. However, global best practice shows primary-care-led health systems provide more accessible, affordable and high quality care, and specifically deliver better health outcomes in relation to noncommunicable diseases where prevention, regular and non-invasive health interventions are required.

Many countries in the Middle East are in a position to be able to learn from the mistakes made by countries around the world. The relative green-field nature of many Middle Eastern health systems means that reform does not have to contend with old and complicated healthcare systems. The Middle East has the opportunity to skip a generation and create balanced healthcare systems based on global best practices.

What are the challenges to achieving the vision?

There are a number of challenges to developing more primary care orientated systems:

Transparency – states need to understand the exact disease profile they are facing, what they are currently paying for and how much. Without this information, it is impossible to create sustainable and disease targeted health systems.

Ethnicity – many countries in the Middle East have a highly ethnically diverse and often transient population. It is important that the epidemiological problems associated with particular groups are factored in to healthcare planning and delivery.

Workforce – across the Middle East, there is a shortage of doctors and nurses. In the GCC, there are 1.7 doctors to 1,000 people as opposed to 3.2 in Western Europe. Such a manpower shortage prohibits any dissemination of doctors from hospital to primary care settings.

Regulation – regulation is at differing stages across the ME. However. It is regionally under-developed and is not providing adequate assurance of hospital and physician quality, and patient satisfaction. The issue is not helped by the widespread grouping of the state’s regulatory body and service provider into one organisation.

Cultural – the culture that hospitalised care is the future is not sustainable or desirable. But there is a wider cultural challenge in that non-communicable diseases are linked to un-healthy lifestyles. For the Middle East to deal with this time bomb, a wider cultural change is required to compliment any health system re-orientation. What are the options for making change?

Countries across the Middle East need to re-orientate their healthcare systems towards primary care. To achieve this, investment needs to be increased. At present, the Middle East spends an unsustainably low 0.5-4% of GDP on healthcare compared to 15% in the US. However, this money needs to be spent in the right way. Countries across the globe have been spending enormous sums of money, yet are now trying to salvage and transform large and expensive systems.

Investment needs to focus on creating the regulatory, legal, commercial and clinical frameworks to allow primary care focused healthcare systems to exist. Such a base would allow countries to roll out far-reaching and best practice health system strategies, attract international and/or private sector support with its ensuing expertise, efficiency and capacity, and improve and develop the current set of healthcare institutions.


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ate of upload: 18th Oct 2011


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