Qatar has drawn up a National Health Strategy for 2011-16, which aims to create a world-class healthcare system. The plan is based around implementing 35 projects over the next five years at a cost of QR1.17bn ($322m). The projects range from improving training and boosting the importance of primary care, to introducing a health insurance system, as well as ensuring the whole system is integrated.

The private sector will [be key to] making these reforms … with policies implemented to lure firms into the market

The projects were identified as a priority following a six-month study that examined the status of the existing system, identified the changes required to reform the sector and established the actions required to achieve this. This study then formed the basis for the national strategy approved by the Supreme Council for Health (SCH) in December 2010 and launched by the emir’s wife, Sheikha Moza bint Nasser al-Missaed in April 2011.

At the time, the health minister and secretary-general of the SCH, Abdullah Khalid al-Qahtani, outlined the challenge: “We are striving to provide world-class health services that are patient-centred to ensure that the healthcare needs of the country’s diverse and rapidly growing population are met. Our integrated system of health is designed to meet the needs of existing and future generations, adding years of healthy life.”

Health system refocus

As in many Gulf states, modernisation of the health sector is a crucial requirement to meeting the health challenges of the future, which include rapidly increasing rates of cardiovascular diseases, diabetes and cancer.

The current system is curative, not preventative, meaning serious illnesses are often detected too late. People also head directly to hospitals for treatment no matter how mild or severe the issues are, meaning that in many cases the ailments are either not serious enough for hospital staff to treat, or too advanced to be effectively managed. Changing this is one of the most important parts of the five-year plan and nine of the 35 projects deal with promoting preventative treatment.

According to the SCH, making primary care the foundation of the future system is core to promoting preventative treatment. Local surgeries or primary health centres (PHCs) will be the first port of call for dealing with health issues.

Despite a trebling in Qatar’s population to 1.7 million today from 522,033 in 1997, the number of health centres has remained largely static, with the biggest medical provider Hamad Medical Corporation (HMC) having only 12. The ultimate goal, by 2016, is to ensure that 50 per cent of all patients requiring specialist treatment in hospital are seen following referral from PHCs, and that 40 per cent of patients requiring tertiary care (as a hospital in-patient) are referred in the same way.

To do this, the national health strategy contains a range of measures set to be implemented over the next five years including the establishment of a primary care forum, a clear definition of the scope of services for primary care, developing a capacity building strategy, launching pilot projects for primary care and expanding the current network of facilities. The SCH plans to invest QR50m in such measures up to 2016 with the cost of building new clinics yet to be estimated.

For this to work requires the health system to be fully integrated so referrals and information can be passed between health centres, hospitals and specialist units. Five of the 35 projects outlined in the strategy are related to improvements in this area, including raising quality standards, introducing an e-health system, setting up a healthcare data system and establishing disease management programmes.

According to the health strategy, the private sector will play a key part in making these reforms and policies will be implemented during the five-year period to encourage companies into the market. “The existing provisioning is supplied largely by one provider Hamad Medical Corporation. Healthy competition is likely to have a beneficial impact on the quality, choice, and efficiency of healthcare,” says the report.

Private-sector help

The non-profit HMC owns 80 per cent of all healthcare facilities in Qatar and is estimated to carry out 90 per cent of health-related services. It has been working closely with the SCH on the five-year plan with 12 of its most senior staff involved in various task forces.

It has already begun engaging the private sector to improve its operations. US-based Partners Healthcare International (PHI) was appointed to assist HMC in improving quality standards. It will work with HMC to develop a  programme to increase patient safety, reduce medical errors, improve efficiency. It is also advising HMC on decentralisation of decision-making, bringing responsibilities close to the point of delivery of clinical care.

At present, HMC has six major hospitals: Rumailah; Al-Amal; Hamad General; Al-Khor; Al-Wakra; and the Women’s General HospitalNew facilities are under construction. The most high-profile investment is Hamad Medical City, currently being fitted out under a QR1.9bn contract by South Korea’s Hyundai Engineering & Construction. Three hospitals will provide more than 500 new beds and there is also a rehabilitation hospital with 200 beds. Its network of PHCs also will be expanded

Further medical research investment

Beyond Hamad Medical City, Qatar Foundation has also invested $7.9bn in the new Sidra Medical and Research Centre, which will open in 2012 with 388 beds. The hospital meets many of the requirements of the five-year strategy, including a focus on training and research.

The facility will provide training for students from Weill Cornell Medical College in Qatar. Its research will also focus on preventative medicine, pregnancy and fertility, and the centre will contain laboratories and facilities to attract more scientists into the country.

In collaboration with organisations such as HMC and Qatar Foundation, the national health strategy also calls for an integrated ‘care pathway’ for key health areas, such as mental health, emergency care, diabetes, cancer, cardiovascular disease and women’s health.

HMC is currently investing in a five-year plan to improve the detection, prevention and treatment of cancer, the results of which will feed in to the national strategy.

Despite increased public investment, the private sector’s role is also set to expand. International and local insurers have been expecting Qatar to introduce health insurance and have been preparing for implementation for some time. As expected, the national health strategy confirms this approach and highlights Abu Dhabi in the UAE, which made the system compulsory for expatriates in January 2008, as an example of best practice.

As a short-term target, the strategy wants 50 per cent of the population to be covered by health insurance by 2016. Employers will be expected to contribute for their staff.

The SCH, however, is taking a cautious approach on the launch. It says several major issues have to be overcome before a new insurance system can be introduced.

First, it says the way patient information is recorded needs to be improved so individual patient billing can be introduced, with a small set of coding requirements before gradually transitioning to a fully fledged coding system.

It also calls for a pricing database, pre-authorisation methodology for coverage of clinical services and additional staff training on how to handle this information. At the same time, the SCH wants to introduce a regulatory system to support an insurance scheme.

By reforming its healthcare sector, Qatar hopes to stem the growth in healthcare tourism that has been a feature of the market for decades.

According to the SCH, Qatar spent about QR500m for sending patients abroad for treatment, enough for about 950 patients. The average cost per treatment is $165,000 and about 70 per cent of the costs are estimated to be related to flights and accommodation for patients and their families. This compares with 723 patients being treated abroad in 2007 and just 399 in 2004. These estimates do not include the spending in the private health sector.

Future network of health providers

Looking ahead, Qatar plans to establish a network of preferred providers for overseas care where necessary and negotiate volume contracts to control costs – something that has not happened to date. Despite the thoroughness of the strategy and the extensive measures now being implemented, achieving systemic change will not be easy.

Until now, investment has focused on new hospitals rather than the PHCs that form the core of future plans. Building a world-class primary care network is part of the plan, but, so far, this has not been evaluated, nor the cost estimated. Bringing in the private sector will aid Qatar in its modernisation plans, but policies and mechanisms for this are also yet to be revealed.

In short, much of the five-year plan involves more detailed planning to enable Qatar to lay the foundations for a healthy future.