Christina Sochacki, Senior Counsel, Head of Healthcare & Life Sciences, KSA at Al Tamimi, looks at key changes in UAE and KSA
According to the World Health Organisation, primary healthcare is a core basis of a successful healthcare system. The intention in the UAE and Saudi Arabia is that primary healthcare facilities will be able to better guide the care of patients, while reducing the burden on specialist and emergency medical services, arguably reducing the costs of the healthcare industry on the economy
Across the region, healthcare systems are faced with a rising demand on services, due to a rapidly expanding population caused by natural growth and a positive net migration. One of the challenges of the current model of care is the lack of sufficient prevention programmes integrated into care plans and patients’ direct access to services and specialty care, leading to an increase in the inappropriate use and over-supply of services. At present, patients opt to approach specialists directly as the first point of care for general medicine needs and, in some cases, approaching more than one facility and specialist (‘doctor shopping’), placing an unnecessary burden and expense on the healthcare system.
Set out below, policy changes in Abu Dhabi in the UAE that were aimed at driving primary care in the Emirate are as follows:
1. Abu Dhabi
With effect from 1 January 2018, the Department of Health – Abu Dhabi (‘DOH’) stopped issuing licences for general clinics, with limited exceptions. All licensed general clinics had until 20 December 2018 to change their facility type to meet the requirements of a primary healthcare centre, or another type of specialist healthcare facility.
This change put into full effect the DOH Standard for Primary Health Care in the Emirate of Abu Dhabi (‘Standard’), which is applicable to all healthcare providers, both public and private, wishing to provide primary healthcare in the Emirate of Abu Dhabi. The Standard, which was issued in August 2016 and updated in September 2022, defines the requirements for ‘Primary Healthcare Services’ in the Emirate of Abu Dhabi, aims to improve patient access to quality and safe primary healthcare services, and sets the minimum requirements and specifications that healthcare providers are required to comply with in providing healthcare in a primary care setting. These changes reflect the authority’s initiative to create a more patient-centric care model, ensure continuity of care, and reduce fragmentation in the healthcare system.
Excluding certain exceptions (clinics located in construction sites, hotels, schools, sports and social clubs, and companies), DOH no longer issues new licences for ‘general’ healthcare clinics in Abu Dhabi. Moreover, all licensed specialised clinics and medical centres wishing to practise family medicine must meet the Standard and submit a ‘change in type’ application in order to change the healthcare facility type to a ‘Primary Health Care Centre’. Likewise, hospitals in Abu Dhabi wishing to provide primary healthcare services must request to include such services under their clinical support services list approved by the DOH.
Clinics that provide only general healthcare from general practitioners will have to employ a specialist or consultant to lead the care. Such supervising physician must be a consultant or specialist in family medicine, internal medicine or paediatrics, depending on the local population demographics served and in accordance with DOH health professional licensing requirements. It is expected that primary healthcare facilities will provide advanced levels of treatment led by a specialist or consultant, guiding the patients towards receiving the best care.
The DOH has determined that primary healthcare services in Abu Dhabi comprise a range of services provided in support of preventive, curative, and palliative healthcare. Services that must be provided in a primary care setting include:
• family medicine, including planned and unplanned primary care services
• chronic disease management
• healthcare screening and prevention services
• vaccinations and immunisations
• non-communicable diseases management
• communicable diseases management
• unplanned and urgent primary care services, including, initial management, stabilisation and transfer of any presenting emergencies to an emergency department, as appropriate
• a pharmacy on site (this is discretionary if one already exists within 10 minute walk of the facility)
• access to basic on-site diagnostic services
There is also a list of additional services that may be provided, if required by the local population.
DOH’s ultimate aim is to have a licensed family medicine care provider within each precinct in Abu Dhabi. As a result, the DOH anticipates that there will be improved patient access to quality and safe primary healthcare services.
2. KSA
In 2016, Saudi Arabia announced Vision 2030, an ambition plan for reform across the Kingdom and seeks to create a more diverse and sustainable economy. The Vision 2030 strategic objectives include a number that are dedicated to healthcare, including targeting the privatisation of 290 hospitals and 2,300 primary health centres by 2030. Through the various Vision 2030 programmes, the Kingdom seeks to introduce new strategies to fulfil public health needs through insurance-based financing and increasing private sector participation.
Included in the goals of the health sector reform is: improving integration and continuity in service provision by developing the primary care, reforming and restructuring of primary health care, and updating and expanding primary care across Saudi Arabia.
We can expect to see a number of licensing, regulation, and reimbursement changes.
Splitting regulator and operator of governmental facilities
1. Dubai
On 12 July 2021, Law No. 13 of 2021 establishing the Dubai Academic Health Corporation (‘DAHC Establishing Law’) and Law No. 14 of 2021 amending some clauses of Law No. 6 of 2018 pertaining to the Dubai Health Authority (‘DHA Amendment’) was issued in Dubai. The goal of these two pieces of legislation was to shift the operation of DHA governmental facilities to the Dubai Academic Health Corporation (‘DAHC’), strengthen Dubai’s leadership in medical education and scientific research through the DAHC, and position the Dubai Healthcare Authority (“DHA”) as the unified regulator for the emirate of Dubai, including its free zones.
The DAHC will not take over the functions of the DHA; the two entities retain separate authorities. It is intended that the DAHC will operate and manage public sector services, with the DHA retaining its existing regulatory functions. In accordance with the DHA Amendment, the DHA will coordinate with the DAHC when preparing and supervising the implementation of strategies necessary for improving healthcare services in line with the Strategic Plan of the Emirate. The DHA will also coordinate with the DAHC when preparing a database for the health sector, healthcare services, and patients, as well as updating and developing the same on a regular basis.
a. DHCC
Under the DHA Amendment, the regulatory purview of the Dubai Healthcare City (“DHCC”) towards healthcare facilities and professionals registered in the DHCC was transferred to the DHA, as of 24 October 2021. The DHA now replaces the DHCC Authority as regards health regulation responsibilities and competencies including, but not limited to, licensing of healthcare professionals and healthcare facilities in the DHCC, supervising and inspecting healthcare professionals and facilities in the DHCC, and managing patient complaints in relation to DHCC healthcare professionals and facilities.
The transfer of the public health system including all assets to the DAHC was completed by 31 December 2022. The DAHC took control of the public health budget from the Department of Finance of Dubai on 1 January 2023.
b. DAHC
The DAHC Establishing Law recognises the DAHC as an academic health system, with financial and administrative independency. The DAHC seeks to strengthen Dubai as a global leader in medical education, research, and scientific innovation as part of the broader strategy to strengthen the knowledge economy in Dubai. Furthermore, the DAHC seeks to enhance the capabilities of Dubai’s healthcare sector to prevent and treat diseases and epidemics. The new corporation also aims to develop educational and professional programmes for healthcare personnel and promote strategic public-private sector partnerships to meet its objectives. The DAHC will also strive to attract strategic investments in life sciences and promote research and innovation in health and biomedical sciences.
The DAHC is tasked with managing and operating the following healthcare facilities:
• all DHA hospitals, primary healthcare centres, specialised care centres, medical fitness centres, and public health and occupational health centres
• the Mohammed Bin Rashid University of Medicine and Health Sciences
• Dubai Dental Hospital
• Al Jalila Foundation
• Al Jalila Children’s Specialty Hospital
• any other entities mandated to be part of the DAHC as per the legislation issued by the Ruler of Dubai.
(‘DAHC Entities’)
2. Abu Dhabi
Abu Dhabi’s government-owned ADQ is tasked with responsibility for centralising and consolidating the public health system of the Emirate of Abu Dhabi. It has consolidated several companies within one of its subsidiaries, Pure Health, creating the largest healthcare provider in the UAE.
The Abu Dhabi Health Services Company (SEHA) and The National Health Insurance Company PJSC (Daman) will merge into Pure Health as part of the restructuring. Other healthcare groups were also acquired in parallel to further strengthen the range of activities of the provider platform. These included, Tamouh Healthcare, Yas Clinic Group, and Abu Dhabi Stem Cell Centre, which further diversified the portfolio of hospital management, laboratory services, medical supplies and healthcare informatics.
3. KSA
In the summer of 2022, a new Cabinet Resolution was issued, establishing the Health Holding Company (“HHC”). It is a significant legal step in formally implementing the transformation plan for the Kingdom’s healthcare system.
The plan is for the Ministry of Health’s (“MOH”) current role, as regulator and provider of public healthcare services, to be bifurcated. Under the plan, the MOH will become the regulator and supervisor of public and private health institutions. All public health services will be transferred to the HHC, in due course. Public health services will be provided by HHC through its subsidiaries (or other legal bodies to be determined), including the Health Clusters (see below for further details), who are tasked with providing integrated healthcare services to beneficiaries in all regions of the Kingdom in accordance with the Kingdom’s “modern healthcare model”, which will be defined and requirements set by the MOH.
In due course, it is planned that all staff who are currently involved in providing healthcare services, at all levels, under the MOH will be transferred to the HHC, or to the company’s subsidiaries (such as the Health Clusters that are being formed).
a. Health Clusters
It is expected that, the HHC will establish health clusters in the form of independent companies to provide public healthcare services. As part of Vision 2030 and the Healthcare Transformation Strategy, all existing MOH/HHC providers will be migrated into Healthcare Clusters, which will amount to approximately 20-30 geographically defined, vertically integrated, “Accountable Care Organisations”, serving around 1-2m people each. These clusters will be established as “corporatised” public bodies, with substantial and defined decision rights. This strategy was drawn widely from the NHS experience in corporatising public healthcare providers. Healthcare Clusters have already begun issuing tenders and contracts for private companies to provide consulting services to assist the formation, management, and operation of these clusters and their facilities.
The goals of decentralisation and clustering public health service delivery is to increase competition, transparency, and efficiency as Health Clusters compete with each other as well as the private sector for clients and health care professionals.
Under these new models of care, it is anticipated that privatisation initiatives will be accelerated as the clusters will be encouraged to transfer the ownership, management and operations of their facilities to private companies, in due course.
b. National Health Insurance Center
The Resolution also established the National Health Insurance Center (“NHIC”), which will purchase health services provided by the HHC or its subsidiaries. The NHIC is expected to submit for approval the comprehensive health insurance vision for Saudi citizens in due course. Essentially, we can expect to see a form of universal health coverage emerge in the Kingdom.
The budgetary allocations for the MoH for the provision of healthcare services are expected to be transferred to the NHIC, in accordance with the plan, phases and mechanisms decided by the supervisory committee for the privatisation of the health sector. The NHIC will purchase health services provided by the HHC or its subsidiaries. The beneficiaries of the NHIC insurance include Saudis working in the public and private sectors, their family members as well as children of a Saudi mother from a non-Saudi husband residing in the Kingdom or non-Saudi wife married to a Saudi, and a non-Saudi married to a Saudi woman residing in the Kingdom, in the event their healthcare is not covered by a cooperative health insurance policy (being the private health insurance). The beneficiaries of NHIC healthcare service also include non-Saudi workers in government sectors, if they are not covered by special healthcare systems, programmes or services.