HW Editor Sarah Cartledge discovers why they are the future for Middle East healthcare.
The most well attended session of the festival, this lively discussion was chaired by Dr Niti Pall and focussed on the partnership between private and public in the development of healthcare across the Middle East. The particular accent on the utilisation of outcome-based payment models and the creation through those models of a nexus between provider, regulator and payor really caught the imagination of our large audience.
More than 1900 attendees tuned in to hear the views of our distinguished panel that comprised Dr Ibtesam Al Bastaki, Director of Investment and Private Partnership Dubai Health Authority, Dr Dirk Richter Senior Adviser to the Abu Dhabi Health Authority, Richard Cantlay, Global Health lead for Mott MacDonald, Simon Swift MD of Methods Analytics, Dr Stan Shepherd CEO of Instant Access Medical, Ben Furneaux Senior Director and Board Member Cigna, and Vincent Buscemi, Partner and Head of Independent Health and Social Care at Bevan Brittan.
Dr Ibtesam Al Bastaki began by saying that Public Private Partnerships (PPPs) were established in Dubai law in 2015 for better collaboration between the public and the private sector. She felt there has been more appetite for PPPs since the pandemic, not only in design and build but also in running services and distributing the risk between sectors more cost effectively. In her view, better processes ensure good focus on the patients by providing the best solution.
In both Abu Dhabi and Dubai, the challenge for regulators is to balance the cherry-picking approach so the non-profitable patients don’t only go to the public sector. But, as Dr Richter observed, the private partner needs to earn money and asked why it should be any different in healthcare, otherwise providers don’t deliver quality. There are big hospital groups in the region that are doing more complex procedures such as oncology, where before it was only simple out-patient cases, leading to more competition between public and private providers.
The changing face of healthcare
Richard Cantlay felt that healthcare is at a real juncture where the sector can think in a much wider context about PPP models, with more emphasis on preventative measures to address the healthcare burden at source to prevent increasing demand on healthcare systems. “I’m a strong believer that the public sector always needs to be the owners of the strategy – after all they are responsible for delivering health services and outcomes to their populations,” he said.
Simon Swift agreed there is potential to significantly broaden the PPP concept to think about it from a population wellness point of view. He felt it would bring a true partnership between governments, patients, providers and insurers across the primary, secondary and tertiary space. This alliance would enable them to think about the different motives of each part of that system and knit them together to provide improved health outcomes that are better for people, cheaper for governments and insurers, and reduce the burden on providers as everybody would be compensated and focused on wellness rather than delivering sickness services. “A PPP model with a value-based lens on it is a really exciting way to do this, but I’ve not seen that broad piece of thinking put into place yet,” he said.
The importance of data for outcome-based approaches
There are very few countries that have a healthcare system that is exclusively public or private; it’s usually a mix of both. The citizen is neither public nor private and lives in both worlds, so their data needs to include both. For Stan Shepherd, the data needs to be portable and the citizen needs to be the primary data owner who takes this data between public and private. “It’s about moving the centre of gravity,” he said. “It’s not about patients seeing doctors’ data, but doctors seeing patients’ data. The whole PPP envelope needs to encompass that.”
The US was cited as an example of how data has been collected successfully, while Dr Ibtesam explained the plans in Dubai to link patient data between the private and the public sector. There was consensus among the panel that there is a role for government, payers, providers, pharma and the client to create a balance that includes transparency. This is particularly important for the payer who needs to have sufficient visibility of the data to be assured the outcomes they are expecting are delivered.
Equally, governance around data was highlighted. In Simon Swift’s opinion, outcome-based approaches fail on lack of trust, but data transparency can deliver that trust and thus the outcomes.
Delivering innovation at speed
The next part of the discussion focused on innovation with the recognition that it comes from citizens themselves. So how do governments include citizens in PPP strategy and design in healthcare?
Stan Shepherd felt that we need finer granulation of the data than hitherto. “In healthcare we find the things that are easiest to measure and then we give them greater significance than they deserve,” he said. “Full function recovery should be measured by the patient, as value for the patient is different and we need to capture that data at a personal level.”
The Australia example was cited where the entire population data has been brought together in a single source and is being used for many projects. It was agreed that such data use can help governments understand problems at a macro level so they can design services, while individuals can understand how their behaviours can contribute to their own health as well as that of their family and country health. “Making it as visible as possible is crucial,” said Simon Swift.
From a lawyer’s perspective, Vincent Buscemi felt the data was vital in any model, particularly value-based remuneration where payers are asking providers to take on more risk and deliver better service with fewer resources. He also highlighted the importance of the business relationships between the two parties and observed that providers may take the risk but may not necessarily share the rewards.
Creating and regulating the future
Ben Furneaux emphasised that at Cigna they are focused on innovation for global markets as this will drive better outcomes. Certainly, innovation is key in the UAE where both Abu Dhabi and Dubai have innovation hubs that work closely with regulators to enable regulation in new areas. This regulation of the future is vital to move healthcare forward in today’s world without the traditional delays that have always characterised it to date.
“In Abu Dhabi we enable regulation and learn as an entity to regulate the future even though it’s unknown, and the best way is to work with innovators,” said Dr Richter. He went on to cite the example of the pandemic when Abu Dhabi worked with start-ups to help with solutions to COVID-19 and enabled them to modify their business models to fit with regulation.
Dr Ibtesam agreed, citing the work of the innovation hub and future accelerator in Dubai. “Depending on the size of the concept it can go into our facilities, but if not we can link them with a more mature concept,” she said. “Our work with the regulators depends on the company and what will add value to the market.”
Thus the future of healthcare in the UAE is dynamic and evolving. Public Private Partnerships have been around for a long time, but it’s clear PPPs could be better and more commonly used in the delivery of healthcare by bringing together the regulator, the private sector, the provider and the insurer.
If healthcare design can also be integrated with urban planning along with wellness and lifestyle concepts, there can be greater emphasis on prevention rather than treatment or cure. Currently the models still focus on the traditional methods, but PPPs offer the chance of a greater vision and collaboration between all parties at every stage of healthcare projects to deliver better outcomes for patients.