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David Hadley

UAE, DUBAI - Health & Education

Healthcare expenditure in the UAE is just 3.5% of GDP

CEO, Mediclinic Middle East

Bio

David Hadley is the CEO for Mediclinic Middle East, which is owned by Mediclinic International, one of the top 10 largest listed private hospital groups in the world. He holds an MBA and has worked for Mediclinic International since 1993, and has enjoyed many positions throughout the company.

"In Dubai we opened our comprehensive cancer center in September 2016."

How far along is the integration of Al Noor Group into Mediclinic’s structure?

Approximately 18 months ago we acquired the Al Noor group in Abu Dhabi, making us one of the largest healthcare providers across the UAE, with facilities in Abu Dhabi, Al Ain, the Western Region, and Dubai. We spent most of the year working on that integration. There were many challenges during that phase, and due to the sudden changes within the regulatory framework. In Dubai things are going well. The economy across the UAE is not growing as it used to during the boom years of 2011-2014. Living within the constraints of the new oil price is however becoming the norm, and all government entities and businesses are realigning their business practices accordingly, but despite this all we have confidence in the future of the UAE and are thus still growing. In Dubai we opened our comprehensive cancer center in September 2016 and it has been performing ahead of expectations since opening. We are currently building a comprehensive cancer center in The Mediclinic Airport Road Hospital in Abu Dhabi too, as part of the expansion project where we will add an additional 100 in-patient beds. We are also busy with upgrade projects across most of our existing hospitals and clinics, and have recently announced that we are building a new hospital in the Western Region. In the beginning of January this year we inaugurated the Mediclinic Al Jowhara hospital in Al Ain, and it is performing well. One of the largest greenfield facilities in Dubai is starting operations next year too; it is a 180+ bed hospital on the southern side of Dubai called the Mediclinic Parkview hospital. Finally, we completed the rebranding of all the newly-acquired Al Noor facilities to Mediclinic during the last year.

What are the differences between the regulatory framework in Abu Dhabi and Dubai?

The role of all the players in the healthcare system is very different between the Emirates. In Dubai, the regulator, on top of setting policy, also manages the government hospitals. They are not really growing these hospitals as they want the private sector to invest and take on this responsibility, so they support the private sector and competition through policy. The payer sector is also very competitive – when mandatory health insurance was introduced in Dubai, there were initially seven providers that could provide the basic package to the market, whereas in Abu Dhabi there is just the one provider. This means that this one provider comprises two-thirds of the market. The rest of the companies are fighting for that remaining one-third, so it is not as competitive as Dubai. In Abu Dhabi, the regulator also sets policy but it does not operate the public hospitals directly and thus onus is not left to the private sector to take on this responsibility.

What effect does medical tourism in the region have on your business?

How the statistics are garnered for medical tourism can be misleading, as an example, emergency room visits from a normal tourist could be considered as medical tourism, so statistics need to be read in context. There is a medical tourism visa now available for healthcare specifically, but those numbers are still growing. I do however see potential for growth in the medium to long term. It is important to understand that medical tourism occurs due to one of three reasons. Firstly, the person does not have access to such services in their home countries. Secondly, the quality of facilities in the source country is not as required. And thirdly people are looking for healthcare at a cheaper price. When it comes to price the UAE cannot compete with lower income countries such as India and Thailand. But we can compete on quality and this is the area we need to focus on.

In what areas do you see the most potential for growth?

Whilst the healthcare spend per capita is fairly high at USD2,200 per capita it must be remembered that the UAE is a High-Income country. The expenditure on healthcare in the UAE is actually still fairly low as a percentage of the GDP at around 3.5%. That will inevitably increase over time as quality improves and less people travel abroad for their healthcare needs. Whilst around 80% of our customers are expats and whilst less than 1% of the population are over the age of 65, there is an ever-ageing population and the burden of disease is increasing with increasing prevalence of diabetes, obesity, heart disease, and cancers. All of these factors will increase the cost of healthcare over time.

In what GCC countries do you see more potential for expansion?

We have expansion plans within the UAE, to other Emirates like Ras Al Khaimah, Fujairah, and Umm al-Quwain. We previously looked at Qatar but we anticipated that there was potential political uncertainty so did not invest. We have looked at other countries in the region such as Egypt and Saudi Arabia and there is certainly a lot of opportunity, but we are going to wait first to see how certain country specific macro factors develop.

What are the most important trends you see coming into healthcare?

The regulations will increase and I hope that there will be a larger focus on ethics and the subsequent cost of over utilization. Improved technology will also make a more significant impact on the services within healthcare. Artificial intelligence will be a large component of this technology and will support improved quality of care. The patient to doctor relationship will also change; we will have mobile health such as video and telephonic appointments plus wearables will become a more significant part a of healthcare monitoring.. It is important to note that these innovations whilst expensive will need to be adapted quickly. Healthcare is an exciting and an ever-changing environment and the UAE is at the forefront of these changes.

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