The entire Gulf region is witnessing an exponential population growth. Over 49% of the density, however, consists of expatriates from all over the world, engaged in trades engineering, and service industries. At the same time, longevity contributes to the growth of as people live longer develop many common chronic conditions encountered in more developed nations. These disease include, among others, cardiovascular diseases, diabetes, obesity and cancers in various forms. These developments have created the a perfect story to overwhelm GCC health delivery systems forcing the governments to take action to enhance local care sourcing. Government health schemes also desire to curtail expensive outbound medical tourism expenses paid for by the various Diwan funding programs.
Why change? Why Now?
In the past, Diwan programs paid for citizens of their country to ravel to the US, UK, Germany and a few Asian nations. They received an allowance to cover the cost of care as quoted by the provider plus up to 30 days’ per diem for accommodation for their companion travelers. If they required additional time at the destination due to medical necessity, their case was reviewed and extensions were granted accordingly. Some GCC states have spent billions in outbound medical travel without cont containment as they never attempted to negotiate steerage and volume discounts with the medical providers and health facilities or accommodation suppliers. I’ve listened to complaints by GCC health officials that they pay advance deposits and receive no return of unused funds, pay double, triple and quadruple rates compared to charges that local patients are billed – often without explanation, have difficulty in requesting and receiving medical records for local continuity of care, and they are tired of being “ripped off”.
Spending in medical care abroad by GCC citizens is reported to range between $7.2bn to 12bn. Unfortunately, there is no tracking mechanism to externally validate that number or what was counted as elements of the enumeration alleged and syndicated by the news media. Some reports allege that 80% of the spend is covered by government health schemes and Diwan programs. In my work as a consultant abroad, I learned that tiny Qatar (2.57m population; 2016) spent millions with average per case expenditures of around USD $260,000. These exchequers are unsustainable, no matter how much per capita wealth may be.
A 2014 study, published in 2015 involving 127 respondents evaluated the perceived quality of healthcare services. By investigating the factors affecting patient satisfaction in private and public hospitals in the UAE based on five service quality dimensions of the SERVQUAL namely; tangibles, reliability, responsiveness, assurance, and empathy researchers measured satisfaction using amodified SERVQUAL questionnaire. They determined the outcome was satisfactory, but I take issue with the small sample size. Nonetheless, it was a good start and should be repeated periodically.
Not all GCC residents want to travel abroad for healthcare
GCC residents are not as eager to leave home for care as the media might portray. Most Islamic patients choose to remain stay home if the services they need are adequate and close to home. Similar to Latin cultures, family life and social support by family is of great importance. It gives Islamic families a reason to live and work for, and provides immense pleasure and enhancement to their quality of life. It gives purpose to their lives. This is one of many social determinants of health that marketers and sellers of medical tourism hoping to attract GCC patients should consider when targeting medical tourism source markets and reading market size allegations that are published by conference organizers to substantiate the value of their events and explain their high sponsorship fees.
As GCC governments move to enhance their local care delivery systems, the outbound trend of seeking medical care abroad will decrease over time, rather than increase. It is already beginning to slow down. At the same time, these brand new, high-tech facilities are also being created with intentional excess capacity to accommodate medical tourism patients. this is the plan to boost economies with alternatives to oil and gas related exports.
Mandatory Health Insurance is now the law
The introduction of MHI (Mandatory Health Insurance) in several GCC states has been driving change by means of increasing a percentage of healthcare expenditure burden to the private sector. This change is driving rapid expansion of private hospitals and clinics and managed care contracts with private insurers who negotiate contractual discounts with physicians, dentists and healthcare facilities, pharmacies and allied health providers.
Evidence of change at the forefront
At last count, over 100 new healthcare projects were under construction in the region, several of which I am involved as a consultant, but under seal of confidentiality NDAs until the clients decide when to announce their intentions, strategies and plans. Therefore, I can only speak in generalities.
GCC inbound medical tourism outlets currently boast an unverified and poorly enumerated alleged visitor spend in excess of USD $106bn for medical treatment in 2010. They report receiving and unspecified number of travelers, allegedly from UK, France, Germany, USA, Iraq and Libya, that have sought care in Saudi Arabia. Without details to critically analyze the numbers, however, these numbers are meaningless and unable to be vetted for accuracy or market segmentation.
Strategic Implications going forward
Once GCC residents can begin to see change and trust domestic healthcare sources, the reliance on treatment abroad is bound to lose attractiveness.
Foreign physician and nursing talent will continue to be recruited for some years as GCC health facilities rush to staff new and expanded health facilities. Talent will come from both from Arabic-speaking countries and English-speaking countries alike. The time spent in the GCC will be split between consulting and treating patients and knowledge transfer to build local capacity of locally-trained, employed and independent practitioners. Some of the projects I’ve consulted on have consisted of operational guidance drawing on my experience as a hospital administrator, medical group practice administrator, surgical nurse, and accreditation preparation consultant. Other projects have drawn upon my past work experience in medical staff development, operations, and contracting between healthcare providers and private insurance plans. In fact, very few of the projects are actually ready to begin developing a medical tourism “product”. Their focus is centered on curtailing treatment abroad and serving their local citizens better.
Another strategic consideration is the recruitment of female physicians ready and willing to teach and transfer knowledge. Much of the women’s healthcare in the GCC has been in short supply because women must be treated by women and educating women in medicine has only recently gained traction but hits walls culturally. As a result, many women suffer health neglect, lack of preventive health and access to diagnostic testing such as mammograms and pap smears. These lapses in care give rise to late stage cancers and other chronic but preventable conditions. They are also responsible for a huge impediment to Middle Eastern societies and economies within the post-revolutionary paradigm. Extremist movements drive setbacks leading to reversals of progress and social isolation leading to deterioration in women’s health (due to limited medical access), as well as stunted educational, economic, and social advancements. Bringing in foreign female medical talent in both medicine and nursing can help to build fair, empowered civil societies if that’s what they want. The training of physicians is something that takes years to produce a licensed physician with residency and specialist fellowship. Often their careers are interrupted by pregnancy and raising children. Aspirational statements aside, one way to make change happen is to import the talent that is required to move forward and support change by any reasonable means necessary, including importing women physicians and nurses to fill gaps in locally sourced healthcare.
The contracts with foreign medical talent are for a finite period. Foreign physicians cost more to hire, accommodate, and support. Knowledge transfer is more important than seeing patients in clinic on a routine basis. This translates to a need for super specialists and surgeons with well-established, international professional brands, that local physicians hold in high-regard. New graduate physicians seeking a “job” at a foreign destination will probably not make the cut. The work is fast paced, demanding, and requires highly-developed interpersonal communication and teaching pedagogy skills in a multi-cultural, environment, not just a knowledge of medicine and surgery.
Once the locals come to know and trust the local healthcare delivery outlets, and are willing to provide testimonials, and at such time that the hospitals and practitioners are ready to improve marketing messages and product offers, only then will medical tourism begin to grow steadily and consistently. Simply having a target number without a strategy and tactics to execute makes GCC medical tourism outlets as a whole appear “noisy”, without success.
Multi-vector marketing strategies for medical tourism development
GCC medical tourism outlets must allow for steady-paced development, and then identify their ideal customers so that they can begin developing recognizable, branded products and packages that meet the needs and desires prospective visitors considering a pilgrimage to perform the hajj, when hajjis from all walks of life and every corner of the globe converge on Mecca, Saudia Arabia and nearby holy sites in KSA and consider efficiencies of travel.
One could reasonably expect that visitors will plan their pilgrimage during the 5-day event in August and extend their stay to remain for medical treatment in the region. But they won’t be planning their medical care during the 5-day period of the hajj. And given the extremes in temperatures, many health facilities will be overwhelmed by the usual casualties amplified by the surge in population over that period of time. The timing of the event is a challenge to medical tourism planners because the hajj takes place only once a year, in the 12th and final month of the Islamic lunar calendar. Therefore, because the Islamic lunar calendar is about 11 days shorter than the 365 days of the standard Gregorian calendar, the timing of the hajj moves backward each year. This is similar to the challenges that medical travelers to Japan face in securing accommodation during the cherry blossom time, or Chinese New Year celebrations throughout Asia.
Timing of campaigns to coincide with inbound medical tourism visitor must be carefully considered.
International Hospital Accreditation
Many of the existing and almost all of the new construction projects for hospitals, clinics and diagnostic centers in the GCC region are currently accredited by recognized, well-established international accrediting bodies. The ones under construction frequently include accreditation fast-track pathways so that they can plan their survey appointments within 6 months’ of commissioning. Those already accredited usually choose to renew.
As the International Society for Quality (ISQua) accredits more accreditors around the world, some hospitals and health facilities decide to continue accreditation but may not renew with the same accrediting body. Most all that are themselves accredited by ISQua, are essentially equal and strive to document quality, safety, and patient-centered orientation and operations. At the same time, a number of “newly-minted” accrediting bodies who are merely proprietary designations by private companies are finding it more difficult to get a foot in the door of these establishments because they represent a medallion or plaque on the wall that is largely unrecognized by the public and of little marketing or promotional value.
One suggestion I’ve offered repeatedly to my GCC clients is that it is time to develop a local accreditation scheme and have it accredited by ISQua. This strategy can lower costs of surveys while preserving core purpose of international accreditation.
Medical tourism local value chain development
The entire medical tourism local value chain of stakeholders and suppliers within the GCC must begin working to integrate recognized hotels that have been inspected for appropriateness on a case-by-case, procedure-by-procedure basis. One incorrect assumption I frequently encounter is that all “recognized” branded hospitals are appropriate for all purposes in medical tourism. This is not true. A second incorrect assumption is that branded and recognized hospitals are eager to fill “heads in beds” with guests recuperating from medical procedures. Many are not eager to have people walking with catheter drainage bags smelling of feces and urine in large numbers in their public areas. They are not eager to have a large number of wheelchair and walker-bound patients as long-term guests for weeks on end.
Travel agencies, tour operators, and medical travel facilitators must be trained properly to manage logistics and set expectations for their clients. Failure to do this will result in extensive brand damage to the fledgling clinics and other associated service providers and health facilities involved in medical tourism.
About the Author
In the GCC and throughout the MENA region, I have received solicitations and requests for my expression of interest to participate as a “named” consultant in poorly organized initiatives for medical tourism. They seek to add my name to the prospectus for private investors but when I read their executive summaries, it is easy to see that their plans will not produce revenues. Many attempt to copy paste what they can see from the surface of neighbor medical tourism competitors. They should stop and take a time out to dig deep before imitating the worst of performers flailing to remain alive in the sector, despite their media hyperbole and industry event presence. I’ve declined most all of these overtures because I will not associate myself or my brand with a project I know to be wrong from the outset. Let others keen to “make a quick buck” as they pass through the medical tourism industry have those gigs. Unfortunately, those consultants are often unrecognized in the industry and the investors weren’t born yesterday. They do verify the experience and track records of those so-called consultants. Many of them contact me through GLG and Third Bridge, and of course, many avoid their platform surcharges and come to me directly for vetting and Q&A.
I welcome the opportunity to present or consult to your strategic planning teams, economic development councils, healthcare standards councils and provide the benefit of my guidance as your trusted authority. Many times, however, my demanding schedule and client deliverable deadlines only leave time to participate via remote linkages and webinars.
For more information about medical tourism and health systems delivery enhancement in the GCC, Africa and Maghreb regions contact me via phone at +1 (800) 727.4160 or email me at your convenience.