The document discusses public-private partnerships (PPPs) in healthcare in the UAE. It outlines several issues facing public hospitals globally and in the UAE, including rising costs and demand outpacing budgets. It then presents various models for PPPs, such as private management of public hospitals or provision of specialized clinical services. Case studies from Saudi Arabia and India show successes with the PPP approach in controlling costs and improving services while maintaining regulatory oversight.

1. Public Private Partnering Taking UAE Healthcare ahead. Gururaj Rai & Dr.Kishan Pakkal Zulekha Healthcare Group Hospital Build Middle East ,Dubai Investment & Finance In Healthcare 3 rd June 2010

2. Objectives 1) Definition of the terms 2) Global issues in Public Hospitals 3) UAE healthcare Profile 4) Issues for patient migration from UAE, 5) Options for Private participation in Public Hospitals 6) Case study -Success stories of PPP model

3. Definition Public-private partnership in health services involves the government encouraging private sector to participate in the delivery of public services. This also leads to the situation where the government mobilizes private sector sources of funds to finance health care services.

4. UAE –a welfare state A model in which the state assumes primary responsibility for the welfare of its citizens. All Emirati citizens get free education ,health care, Housing benefits and subsidized utilities. Expatriates pay a subsidized fee in public hospitals.

5. Global issues in Public Hospitals A welfare state Round Up Healthcare - manpower and expertise – not easily available comes at a cost changing demographic and disease trends, Increasing cost of pharmaceuticals and technology Constraints on public Healthcare Budgets

6. Public hospitals are forced to cut costs while trying to ensure free / subsidized quality healthcare to all

7. Govt. Strategies to Combat the issue narrowing the basic package of services available to all citizens, linking hospital funding to outputs and efficiency, amalgamating hospitals into networks, Some governments have also turned to public-private partnerships to bring private sector efficiency

8. UAE – Healthcare Market Source: Medical Markets Fact book - 2009 20 4 Dubai Health Authority PHC Hospitals Regulators NA 35 Private Sector Field clinics 3 Army Directorate 40 12 HAAD - SEHA 88 22 Ministry of Health

9. Population -5.6million [2009 census]; · The number of beds per 1,000 people in UAE is 2, still below the international average of 3 · Private healthcare providers in UAE receives 70% of their income from insured patients. Rapid shift in Health insurance due to Legislation Source: WHO - Business Monitor International

10. 3 drivers that will dramatically increase health-care demand in the region: population growth, Increasing no. of aging population unique health-risk factor Source: Mckinsey survey report

11. Projected Burden of disease

12. UAE – 160% demand for Hosp beds by 2025

13. Overview Medical Tourism Market - Expense on Overseas Medical Treatment of UAE Nationals -2 billion USD every year Thailand recieves-90,000 Emirati pts every year, In 2007, Singapore Hospitals received 40 million USD on medical tourism from UAE alone Source: Arabian Business Regional Health Systems Observatory- EMRO

14. Why is UAE Losing Patients to Medical Tourism? perception towards The general quality of health services in UAE – 57 % of UAE Nationals seek medical treatment abroad.- 2009 survey by YouGov agency, Source: Arabian Business

15. Nationals have more trust in Western or S.Asian Healthcare. Heavy dependence on Govt. for Abroad treatment. Key Issues Source: Arabian Business/ Gulfnews

16. Challenges Retaining Quality Human Capital – Doctors, Nurses and Technicians. Healthcare Legislation Non Uniform investment in Healthcare

17. Case Study Over 60 % of people in the UAE are obese or overweight –Resulting in Heart/Diabetic, Renal issues Source : Abudabhi Congress

18. Source: Research Data – Zulekha Hospital Dialysis Services- Dubai & Sharjah * Pt Figures taken on Approximation 50 7 Private Sector 1200 16 Sheikh Khalifa Hospital, Ajman 1500 17 AL Qasssimi Hospital, Sharjah Approx pts*/PM Units Providers - Renal Dialysis- Shj & Ajman 150 20 Private Sector 2000 30 Dubai Hospital Approx pts*/PM Units Providers -Renal Dialysis- Dubai

19. Population that rely on Govt for Dialysis service is at large. Huge Expat waiting time in Govt Facility – High cost of Treatment in Pvt Sector Pvt Sector – Capacity Under utilised Pvt Sector –Facing problem of retaining Medical Professionals Dialysis Services- Case study

20. Embark Case load Sharing Subsidized treatment- at Pvt facilities Govt. to monitor Quality How Pvt Sector can help

21. Options for Private participation in Public Hospitals

22. Options for PPP Manages public hospital for public patients and contracts with private wing for sharing joint costs, staff, and equipment. Operates private wing (for private patients). May provide only accommodation services or clinical services as well. Co-location of private wing within or beside public hospital. Public Responsibility Pvt Responsibility Options

23. Options for PPP Provides all clinical services (and staff) and hospital management. Provides non clinical services (cleaning, catering, laundry, security, building maintenance) and employs staff for these services. non clinical support services Public Responsibility Pvt Responsibility Options

24. Options for PPP Manages hospital and provides clinical services. Provides clinical support services such as radiology and laboratory services. clinical support services Public Responsibility Pvt Responsibility Options

25. Options for PPP Public Responsibility Pvt Responsibility Options Manages hospital and provides most clinical services. Provides specialized clinical services (such as lithotripsy) or routine services. Outsourcing specialized clinical services

26. Options for PPP Public Responsibility Pvt Responsibility Options pays private operator for services provided, and monitors and regulates services and contract compliance. Manages public hospital under contract with government provides clinical and non clinical for services provided. Private management of public hospital

27. Source : WHO Franchising DBFO( design, Build, finance, operate) BOO (build, own, operate) BOOT (build, own, operate, transfer) BOLB (buy, own, lease back) Alzira model Models of PPP in Hospital

28. SEHA – PPP Model

29. Limitations of PPP Can lead to unethical means to maximize profit Retaining Human Capital Labour and Financial issues Compromise on Quality in the long run

30. Conclusion PPP can provide innovative ways to control costs and improve service, provided there is Implementation of sound regulatory arrangements Adherence to Commitment by both parties

31. Case studies Success Stories KSA India

32. Saudi Arabia

33. Saudi Arabia A new entity established, MOH hospitals assets to be transferred to this new organization Entity works on to prepare PPP Source: SAGIA & Booz Co.

34. Source – Booz & Co.

35. India

36. Sri Sathya Sai Medical Trust- Bangalore

37. 52.26 acres free land given by Govt. Waiver of taxes subsidies in utilities. Exemption of customs duties for imports of equipments High end technology deployment from Principal suppliers Model of Volunteering developed – Doctors,Public

38. Hospital offers totally free of charge service in 5 years golden years of service, over 6,000 cardiac operations, more than 5,500 neuro surgeries, Totally free treatment including medicines 3.5 lakh outpatient consultations Source: Radiosai

39. Thank You A panoramic view of SSSIHMS ,Bangalore