With the spiralling cost of healthcare in the UAE putting pressure on an industry in flux, could a switch to a fresh medical philosophy give the emirates’ healthcare landscape the evolutionary momentum
According to a trio of healthcare professionals who meet to discuss the issue during a roundtable meeting at Gulf Business’ head office in Dubai Media City, a new approach could help redefine what healthcare means in the country, and produce better outcomes for patients, providers, practitioners and insurers.
With medical inflation rising to a reported 25 per cent on the back of factors such as an ageing population, the prevalence of lifestyle related diseases, and a culture of over-prescription and over-diagnosis, companies are able to afford fewer benefits for their employees, while studies show patients have started to view the healthcare industry as a business. And it is a move to evidence-based medicine that could provide the change the UAE needs, argues the panel.
“Everybody is involved in this,” says Neil Buckley, CEO of Kings College Hospital London in the UAE. “The patient, the corporate, the insurance company – all of us together to look at a different way of delivering healthcare that is evidence-based and optimises your spend.
“It’s incumbent on all of us to make sure we’re not wasting money in certain areas, and making sure we’re focusing that resource elsewhere.”
The view is backed up by Stephen MacLaren, regional head of distribution, human capital and benefits at Al Futtaim Willis Insurance, who adds: “We have to move to the evidence-based approach, where the doctors are trained to do what’s before them and make sure they are doing what’s right, rather than thinking ‘well, the insurance company will pay for it’.”
But what exactly is evidence-based medicine? The third member of the panel, Dr Mansoor Anwar Habib – family medicine and occupational health consultant, and corporate wellness and happiness director at du – explains.
“Evidence-based medicine is the use of a multitude of research that has been populated to try to treat or diagnose or to manage a certain specific case,” he says.
“If I am a patient and I need to know what the management plan is, you look at a group of strong studies that has been backed up by research that has no biases, for example there is no drug company that is sponsoring a certain study, or there is no conflict of interest. When you get that group of research that tells you that this management plan is the most suitable one, then that will allow us to give the plan of management based on sound evidence rather than just our own experience, which is shown not to be the best when it comes to getting the outcome of the results.”
After joining du in 2009, Dr Mansoor established two in-house staff clinics and a wellness department in a bid to provide treatment for day-to-day occupational health complaints, management of chronic diseases and implementation of prevention strategies. He also launched a programme that set wellness KPIs for du executives.
And it is his personal journey that bears witness to the potential in evidence-based medicine.
“I am a practical example. Why would a company in the telecom industry like du need a physician in-house? Why do they need a doctor? They have medical insurance, they are covered, so what is the need?
“Here is where our leadership comes in. They saw it coming back in 2010. It had a bit of costing initially, but their vision was how can we leverage on this clinic to be able to look at what is coming in the future.
“This clinic will not bring down the medical insurance premium because it doesn’t operate 24/7; we don’t have a group of physicians that can look after all the staff – staff will still go any hospital they are following up at. The presence of the clinic is just an added value, from the perspective of managing cases. But our role was not just to manage cases, it was to create a platform of prevention under the wellness umbrella.”
It is here that the panel highlights another element of change that could lead to positive results for patients: family medicine practitioners.
Based on the principle of providing continuing and comprehensive care, family medicine gives patients a familiar first point of contact in the shape of a physician that they can be in contact with on a regular basis, for all health related complaints or concerns. Currently in many parts of the Gulf, patients must seek out experts for their specific ailments, which often involves a lot of research, trial and error, and cost.
“You need to see the family medicine consultant as the conductor of the medical orchestra,” explains Buckley.
“The culture here in the UAE is very much that you go to see your cardiologist, you go to see your gastroenterologist, or whoever it may be. What this means is that you have to find maybe five doctors that you trust and you know and you have faith in.
“If you have a family medicine consultant, that person can be your trusted healthcare champion. They can send you to the right doctors – they know better than anybody who the trustworthy ones are.
When that specialist gives an opinion or advice on the path of care, you can go back to your family medicine consultant and discuss what’s best for you. These people will know you for a long period of time, they’ll know your family history, and be in a very good position to direct you in a much more refined way.”
And according to Dr Mansoor, businesses have a key role to play in establishing this new model.
“If you don’t have a champion from the healthcare industry anchored in your organisation, it would be very difficult to sustain it. Why am I concentrating on the organisation? As a society, every one of us works somewhere … Once you have these hubs within different organisations, you can cover the population,” he says.
And while there were some concerns when he launched the practice within du, he reveals that it didn’t take long for opinions to turn.
“We started embracing wellness in a positive and fun way, attracting people to participate in fun races, marathons, weight loss challenges. In the beginning it was difficult – people were very sceptical. ‘Why do we need to have that?’ ‘Is the doctor going to find out that I’m unfit, so they’re not going to renew my visa?’ Let’s be realistic, these are people’s concerns.
“Then they realised we are there because we care for them. If you’re coming from a long-term disease, we’re going to rehabilitate you – we can change your working hours, we’re going to look after you. That allowed more retention and allowed more people to have a positive relationship with the clinic.
“The prevention tool that we used, we went an extra mile – we linked a percentage of the performance of our executives to cholesterol, sugar, weight parameters, and we decided we are going to have these targets on yearly basis and we’re going to follow up on them. Hence, it became a strategy, part of the DNA of the organisation. And guess what – four years down the line we were able to absorb the medical inflation, and now our premium and claim-loss ratio will hardly cross 90 per cent.”
It is this economic part of the equation that MacLaren elaborates on.
“That’s where it’s got to be,” he says. “It’s down to making sure that’s the best use of the healthcare spend. There’s so much misuse by going straight to the consultants.
“And I think [it’s] the carrot-stick mentality that we have to move into to an extent, or we will continue to slash benefits. I think du is the model of what we need to do more of – most CFOs are looking at what’s the return on investment, so we’re moving from the mercenary to the missionary approach – the mercenary being ‘who cares’ and just looking after themselves, to the missionary sharing of ideas.”
For family practitioners and evidence-based medicine to really work in the UAE, however, there are broader responsibilities that the panel identified.
First, that of the patient, who must feel empowered to ask questions and take a more active role in their own wellness.
“As a patient it’s incumbent on us to ask questions of our doctors,” says Buckley.
“Why am I having this medication? Why am I having this blood test? What decisions are you going to make based on that test? So it’s incumbent on patients to have that level of understanding and that empowerment, and to be responsible for our own health, our diet and our exercise. We as patients need to take it on board and be responsible for our own health.”
“We encourage our patients to ask,” adds Dr Mansoor.
“Whenever they come asking for a referral to a specialist in another field outside the clinic, we make sure to tell them ‘ask these questions – these are your rights’, and to tell us whether the experience was negative – we will make sure not to refer anyone else back to that facility.”
On the part of the provider, a willingness to create a family and evidence-based environment is key, including enhanced training efforts for medical staff.
Buckley says: “It takes quite a specific training to work with patients as an equal partner, and provide that education to patients that allows them to control their healthcare. It’s a very different mind-set.
“So it’s [about] employing doctors with that training, having a culture within your hospital or organisation where that is promoted.
“Huge steps are being made. Just last week I was at Mohammed bin Rashid University, at the facility there. It’s an amazing facility that has just taken its second cohort of medical students. The facilities are here, the infrastructure is being built up … and we’re working with that to increase the level of medical education here in the UAE.”
On the insurance side of things, MacLaren suggests that the marketplace needs to make some important changes.
“There are a lot of insurance companies and there needs to be some consolidation probably,” he says.
“Everybody’s fighting for a bit of pie that’s not enough, and that’s where consolidation is required – certainly from a broker’s point of view and an insurer’s point of view.
“When you’re looking at most mature markets you’ve got fewer insurers who are well established that can come out with innovative tools. Clients stay with those insurers for a longer journey, so we’ve got to get corporates to stick with insurers past [the current culture of a] one-year scenario. Moving it from a one-year contract to a three-year model so that insurers will actually start to invest the money that’s required.”
A final aspect the panel highlights is the role of the government, which they agree is moving in the right direction.
“There are various bodies involved,” says Buckley. “There’s the Ministry of Health, Dubai Health Authority, Health Authority Abu Dhabi, all the providers, lots of insurance companies, plus the corporates. So there are a lot of players that are required to move in the same direction.
“And there’s a lot more direction coming from the government now – lots of initiatives coming from the Prime Minister’s Office to see how we can coordinate; looking at what the goals are, what should the details be, and so on. Central coordination is improving.”
In closing, the trio emphasise the importance of such manoeuvres, and the positivity they have seen in moving to a new paradigm for healthcare.
“The resources are here, so it’s really just a fine-tuning of where people’s focus is,” says Buckley.
“Rather than focus on sickness we need to focus on wellness. It’s a change of emphasis for providers, patients and everybody else. And the novel way that du is doing this, that’s a way that corporates can mimic and show these benefits.”
“We have to remember as well that it’s still a young country,” adds MacLaren. “It’s evolving, it’s vibrant, and it very much is up to nationals, government, and everybody else to get things right. Because if we don’t then we’ve got a spiralling inflation of anywhere between 10 and 20 per cent. We need to get that under control, which I believe is possible.”
Dr Mansoor concludes: “The secret word is leadership. To make that change and hit the targets, it always has to come from the top. And I believe we now have a golden opportunity.
“Creativity has no limit when it comes to wellness … whether it’s from the government or from the private sector – the providers, the brokers and the corporates. It’s teamwork. We need to be sustainable, and sustainable, and sustainable. That’s the key. We can’t stop.”