A shot in the arm

The Sultanate of Oman faces several challenges in the healthcare sector despite commendable success on several fronts. The good news is that the private sector is trying to fill in the gap. An overview by Visvas Paul D Karra

Oman’s Ministry of Health recently declared that it is currently working on a number of significant healthcare projects at a total cost of more than RO73mn in an effort to develop the healthcare services for citizens in the Sultanate.

There are at least three major hospital projects currently underway – the RO50mn Psychiatric Hospital Project; a Heart Disease Centre and Magnetic Resonance Unit in Salalah, costing around RO18mn; and the third being the National Centre for Genetic Health, worth around RO5mn. The health ministry also said that in coordination with the private sector, it is working to establish a number of projects related to health quality, which amount to RO40mn.

The ministry is also carrying out a number of other projects related to health centres and other rehabilitation and expansion projects as part of its seventh Five-year plan at a total cost of more than RO60mn.

Growing demand

A report by Alpen Capital suggests that the overall GCC healthcare service market is valued at a little over RO7bn and is expected to grow to RO20-22bn by 2020 equivalent to a nine per cent CAGR over the next 10 years. This means that more healthcare services will be required on aggregate as well as per capita. This is not only due to a growing population but also because the Gulf baby boomers born during the region’s first oil price boom will enter the aged category.

The proverbial ‘an apple a day’ will no longer keep the doctor away as there are other factors also that drive the demand for healthcare services in the future. Communicable diseases such as malaria and tuberculosis have been substantially controlled through increased hygiene and higher availability of vaccines. However, while there is a decline in communicable diseases, a huge jump in lifestyle diseases such as cardiovascular ailments and diabetes related diseases has exposed the need to augment the supply of hospital beds for the growing demand for medical care.

According to WHO reports, the number of diabetic patients in the GCC is expected to increase 2.5 times the present number by 2030 with Kuwait and Oman leading the pack. Consumption of unbalanced diets and a more sedentary lifestyle, thanks to urbanisation and growing per capita income, are aggravating the prevalence of lifestyle diseases. One can safely add that coronary problems and obesity-related complications are also on the rise.

Private participation

Despite the active public-private partnerships in the healthcare of Oman, the industry is characterised by low private sector penetration. A majority of the private healthcare providers are polyclinics and there are only three private hospitals in Oman.

Murat Soner Kucukkaya, hospital administrator, Muscat Private Hospital (MPH) predicts that the private sector is going to be the leading health services provider. His firm belief is based upon increased public expenditure, combined with deliverable high quality private health services.

As hospitals like MPH continue to invest in modern technology and cutting edge medical equipment to complement their already established healthcare services, an ever increasing number of patients trust and recommend the treatment received at private hospitals. Kucukkaya, who came to MPH from Acibadem Healthcare System, Istanbul, Turkey, previously held positions as hospital director.

Kucukkaya states that MPH, is a 72-bed general medical hospital, established in 2000, and the first private facility in Oman providing cardiac surgery services. Strategically located in Baushar, the hospital provides out-patient and in-patient facilities and has diagnostic and treatment capabilities with state-of-the-art acute-care facilities; CCU, fully-equipped ER, Paediatrics, Obstetrics and Gynaecology, MRI, and a 64-slice CT delivering cardiac angiography, colonoscopy, lung and neurological imaging.

“Government hospitals historically have been associated with anecdotal accounts regarding long waiting lists. The public are no longer ready to wait in long queues when fast, affordable, dynamic healthcare is available at the point of entry to the hospital, and patients are looking in our direction and identify with our vision,” Kucukkaya observes.
He further feels that if one had to look at this scenario from a wider angle, then there is a lot of scope for greater public-private participation. Governmental policy decision to include private hospitals in the country into the list of referral hospitals, which presently is limited to big government hospitals in the capital area of Muscat, will facilitate greater public choice and autonomy.

Investments in infrastructure

Almost 75 per cent of the total healthcare expenditure is being incurred by the State but the private sector lags behind in establishing hospital infrastructure. But, as the economies of the region grew on the back of high oil prices and multi-billion dollar investments go into various other sectors like real estate, manufacturing etc, expatriate labour was added to the local populace. Consequently, the market for healthcare services increased which in turn brought out the necessity for more hospital beds.

Al Raffah Hospital was established by Dr Moopen’s (DM) Group in Muscat around two years ago. The DM Group has recently rebranded its healthcare vertical as ‘Aster’ to integrate the current brands of hospitals, polyclinics, pharmacies and diagnostic centres at 95 locations under one name. Aster interfaces with existing and new customers through Aster Hospital, Aster Medical Centre, Aster Pharmacy and Aster Diagnostic Centre.

According to Seeniya Biju, senior manager, Al Raffah Hospital, DM Healthcare is the first private sector organisation to be recognised by government organisations, all major companies, corporate and embassies in the country. In order to cater to the growing demand for medical care, Aster has major expansion plans in Oman, informs Biju, while also stating that the word Aster means flower in Greek. True to its meaning, Aster is flowering in Oman. After Al Raffah, Aster opened a super-speciality 50-bed hospital in Sohar, which was inaugurated by Dr Azad Moopen, the founder of DM Group.

Biju states that the Vision 2015 of the DM Group involves investments of $500mn all over the GCC region. Out of this, $27mn will be invested in Oman to build three hospitals, 15 medical centres and 15 pharmacies.

“The private hospitals and medical centres in Oman are in great demand because of the long waiting periods at the government hospitals in Oman. Otherwise, the public healthcare facilities are world class in the Sultanate. Another reason is that there is shortage of doctors and paramedical staff in the government medical centres,” explains Dr Sanjay Dalal, chief manager, activities and promotions of KIMS Oman Hospital (KOH) located in Darsait while talking about the recent growth of private health care facilities in the country.

KOH, which opened in June 2009, is a milestone in the private sector health care of Oman with its 50 beds and equipped with excellence in healthcare delivery. KOH is the protégé of Kerala Institute of Medical Sciences (KIMS), a prestigious 450-bed multi super-speciality tertiary referral hospital from Kerala, India. KIMS India is accredited by ACHSI (Australian Council on Healthcare Standards International) NABH, ISO for its Quality Healthcare Services. The KIMS Healthcare Group has medical centres in Saudi Arabia, Bahrain and Qatar.

International affiliations or accreditations lend credibility and respect, inspiring confidence among patients of all nationalities. MPH is managed by the UME Group – an international hospital management group with more than 28 years experience in the Middle East and the UK – and is leading the way by incorporating international accreditations in their current business objectives.

Infrastructure expansion has also been undertaken by polyclinics as well. In the past five years, Badr Al Samaa Polyclinic has opened branches outside Muscat in places like Barka, Nizwa, Sur, Sohar etc. Similarly, Dubai-based Welcare Hospital and India’s Apollo Hospital have also set up their affiliates in Muscat.

Quality of healthcare

Oman’s private hospitals are in the nascent stages of offering super speciality services, partly because of government regulations and partly because of the lack of demand caused by demographic reasons, which does not justify the investments.

Some of the inpatient and outpatient services provided by private hospitals include cardiology, orthopaedics, neurology, general medicine, woman’s health, urology, paediatrics, general surgery, dermatology, endocrinology, ENT, gastro-enterology ophthalmology, anaesthsiology, family medicine, plastic and cosmetic surgery and dentistry.

Apart from that, other hospital services also include 24 hrs emergency and trauma care, 24 hrs pharmacy, telemedicine, corporate services, ambulance services and clinical laboratories.

Government regulations do not permit all private hospitals to offer super-speciality surgery services like cardiac bypass and critical services; chronic and potentially life-threatening diseases like cancer for example. The exception is MPH which is Oman’s first private hospital to start a cardiac surgery programme for the correction of cardiac disorders.
This cuts both ways because while hospitals say they have less demand for such critical services, most affluent citizens and resident expatriates go abroad or to their home countries for specialised treatments citing inadequate facilities in Oman.

But some of the hospitals are apparently excelling in what they do. Biju of Al Raffah says they were able to successfully conduct a knee replacement surgery on a 73-year-old. Further, Al Raffah offers consultations only by prior appointment in order to differentiate itself from other polyclinics, says Biju but that does not mean they will reject any walk-in patient if the situation demands. Talking about the cost of treatment, Biju adds that expatriates and even Omani residents should fully utilise the services provided by the local hospitals instead of hopping on a plane and flying to some other country. If one takes into account the expenses incurred for air tickets and stay, the costs would amount to the same.

Insurance is the key

KOH is one of the best private hospital in the country with its own custom-built 50-bed hospital, claims Dalal when asked about the services provided and cost of treatment. “We have all the facilities that any hospital can boast of and people have now come to know about the excellent treatment that we give to our patients. We are doing all kinds of surgeries including neuro and laproscopy in three state-of-the-art operation theatres,” says Dalal.

“Many companies are now giving health insurance to their employees. Even then, most people are not confident about the medical services here. Recent reports have indicated 20,000 Omanis travel to Bangkok annually for treatment. Therefore the need of the hour is to strengthen your own hospital facilities to attract patients,” Dalal points out.

Differing from Biju, Dalal says the cost of treatment is going up mainly because the profile of players involved in medical care has changed drastically. Previously it was only the doctors who used to decide the type of treatment but now the main players are the insurance companies who are interfering with the workings of hospitals and doctors. It has reached such a sad state that a doctor has to take pre-approval for all kinds of facilities to be provided to patients, right from admitting a patient, the type of treatment and even the kinds of medicines. How can doctors work under such circumstances? Therefore, the cost of treatment has gone up, says Dalal, mincing no words.

The most hurting factor is that while the West is trying to reform healthcare and insurance systems, we are trying to get into that same situation which they are trying to avoid, Dalal adds. Hopefully, this scenario would change soon.
 

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