Healing the system
Are Middle East health systems prepared and ready to meet the challenge of
increasing health burden of non-communicable diseases in the future? Simon
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
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
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
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
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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of upload: 18th Oct 2011