New cost controls to clean up 'wild west' UAE healthcare market

Ending financial incentives for doctors and encouraging natural births rather than C-sections are among the measures needed to control financial costs for the UAE healthcare industry, doctors have said.

Medics from King’s College London were speaking at the launch of the latest new clinic to open in Jumeirah, Dubai and said cost effective techniques would clean up healthcare’s ‘wild west’ market, helping to save hundreds of millions of dirhams in the process.

In a 2017 survey, KCH London found 20 per cent of 1,964 patients surveyed during independent research felt the UAE healthcare industry had become a business.

In the same research, 32 per cent felt their doctors over-prescribed medication.

KCH London said it is working with insurers and health authorities to help reduce spiralling costs of care, after those surveyed felt they were treated more like customers than patients.

Doctors at King’s College claim their health protocols on certain treatments could save the UAE economy Dh1 billion if they were implemented more widely.

“There are plenty of good doctors, but there is a lack of trust of doctors amongst patients,” said medical director Dr Stuart Fraser.

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“Trust is used a lot in healthcare advertising, but we want to be sure our patients are getting the right advice that will not make a profit for the clinic.”

As well as a more cost effective approach to diabetes, the hospital said more focus should be on natural births rather than C-sections

KCH London has an elective C-section rate of 17 per cent, compared to the current industry average of 25 per cent in the UAE.

Hospital analysts estimated annual national savings could be as much as Dh305 million by 2020, when 77,000 babies are expected to be born at current population growth rates, if other hospitals reduce their elective C-section rates to 18 per cent.

“In uncomplicated situations, a natural childbirth should always be preferred,” said Dr Fraser, a vascular surgeon.

“Not just because of the cost implications, but primarily the child comes out when it is ready through spontaneous delivery.

“We know there are higher complication rates in C-section babies.”

Further savings could be made by reducing unnecessary hospital admissions for minor ailments, such as cold and flu viruses.

“In my experience, standard treatment for upper respiratory tract infections can be done very differently here to make huge savings and reduce the need for medication,” he said.

“I have seen doctors here admit children to hospital for the same condition.

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“In some cases, after a clinical assessment is made – the patient will then collect a bag load of medication as that generates income for the provider.”

Unlike in some private sector hospitals, doctors at KCH London are paid a salary, so are not incentivised to push unnecessary tests or medication to help top up clinic profits.

A culture of over-prescribing by incentivised doctors and pharmacists has led medical inflation to spiral to 25 per cent, with insurers claiming that has pushed up the price of healthcare cover for some, reducing their coverage.

“This is part of what the healthcare market needs, as legislation cannot change the culture on its own as it is fairly widespread,” said Stephen Maclaren, an Al Futtaim Willis Insurance Broker, a specialist in medical insurance.

“If the insurance industry changes, so will all the healthcare providers.

“We’ve seen figures about what they propose to do, but it will be some time before that success if achieved.

“If we can get clients to understand the true cost of each incident of care – that will hopefully educate people to understand why the cost of health insurance is going up and the coverage is often reducing.”

KCH London plans to make key performance indicators publicly available so patients can see any success of failures, at each of its UAE clinics.

Publishing infection rates, patient mortality, 30-day mortality and readmission rates more widely, would help patients make a more informed choice over their healthcare and help improve standards, doctors have said.

KCH London’s CEO Neil Buckley, a former pharmacist, said patients would be offered evidence based healthcare, suited to their specific needs.

“Many drugs and procedures coming onto the market show a benefit, but are not suitable for everyone,” he said.

“We know the region is suffering from medical inflation, driven by an ageing population and lifestyle related diseases like diabetes.

“Offering care in an evidence based way gives payers value for money, so patients are no longer prescribed multiple drugs and may not be offered any drugs at all, if they are not required.

“Those savings can then be used elsewhere, such as for cancer drugs which can be very expensive.”