GCC nationals can expect to enjoy much longer lives than their forebears, thanks to investments made in Gulf healthcare since the first oil boom in the 1970s. Average life expectancy across the region has increased to
75 years from 60 in the late 1970s. Over the same period, infant mortality has dropped from an average of 70 deaths for every 1,000 births to nine for every 1,000, which puts the GGC’s six states among the 30 nations with the lowest infant mortality indicators.

But GCC nationals are likely to suffer from more health complications in future. In little more than a generation, urbanisation and rising personal wealth have prompted local populations to reject active outdoor lifestyles and adopt Western ways of living, characterised by a fondness for processed foods and an aversion to exercise. This has triggered an explosion of chronic diseases previously uncommon to the region, such as diabetes, coronary problems and other obesity-related illnesses.

The UAE already has the second-highest prevalence of diabetes in the world, with about 20 per cent of the population diagnosed with the disease and another 18 per cent at high risk of developing it. Throughout the Gulf, diabetes rates are forecast to triple by 2030, from 1.5 million cases in 2000 to 4 million in 2030.

Changing demographic

A combination of low mortality and high fertility rates will change the demographic structure of the region over the next 20 years, as well as helping to fuel population growth. Currently, the average age in Gulf countries ranges from 23 to 31 years. At the current growth rate of
5 per cent a year, the GCC’s 35 million population will double over the next two decades.

These changes bring enormous long-term challenges for healthcare providers. Chronic diseases require long-term, costly, specialist treatment. An ageing population represents a significant drain on resources since four-fifths of a human’s healthcare needs typically occur after the age of retirement. When the Gulf’s young people reach retirement age in 30 years’ time, there is likely to be a sharp rise in healthcare demand from older people.

The high number of road traffic accidents in the region puts additional strain on healthcare systems. The GCC states are among the worst performers globally when it comes to road safety. In 2007, in the UAE, the number of road traffic deaths was 37.1 for every 100,000 people, compared with 5.4 in the UK and 13.9 in the US, with even more people injured in road accidents.

The GCC lacks the expertise and specialist hospitals required to deal with these health challenges. Governments spend millions of dollars each year sending patients overseas for treatment – for example, the UAE pays about $2bn each year for patients to receive treatment abroad. In 2007, Dubai sent 946 patients overseas for medical care at a total cost of AED178m ($48m). The majority were treated in Germany, the others in the UK, US and India. Most of the consultations sought were in the fields of oncology, paediatrics and orthopaedics. Kuwait, in its 2009 budget, allocated KD130m ($454m) to send patients overseas for treatment not available locally.

This strategy is unsustainable over the long term. The Gulf countries will need to develop the infrastructure to treat their own patients. With chronic non-communicable diseases becoming increasingly prevalent, demand for specialist healthcare is set to soar.

USconsultant McKinsey & Company forecasts healthcare demand will increase by 240 per cent over the next 20 years and the total cost of healthcare delivery in the Gulf will rise to nearly $60bn by 2025, from $12bn in 2007. Treatment for cardiovascular disease, in particular, will become an enormous cost burden, taking 24 per cent of total healthcare expenditure, compared with half that figure today.

Although investment in the healthcare sector has been rising steadily across the GCC, per capita spending is low compared with developed countries. In 2006, per capita spending on health in the US amounted to $6,719, and in the UK $2,815. In the same year, Oman spent just $526 per person. The figure in Saudi Arabia was $720, while the biggest spender regionally was the UAE, at $1,409 per person.

The availability of health professionals and hospital beds in the Gulf also compares unfavourably with developed countries. Bahrain and Qatar are the best performers in the region with 2.6 doctors, 6 nurses and more than 2.5 hospital beds for every 1,000 people. But in Europe levels are much higher, at 3.2 doctors, 7.2 nurses and 6.3 beds.

Standards of treatment in some hospitals are failing to match patients’ expectations as a result, with patients complaining of substandard service, equipment shortages and lengthening waiting times in state-funded hospitals. With faith in the health system so low, those who have the choice go abroad for treatment.

Aware of the enormity of the challenges ahead, governments in the Gulf are now -making investment in health a priority. In its 2009 budget, Oman has set aside OR168m ($436m) for new healthcare projects. Bahrain’s Health Ministry has been allocated BD17.2m ($45m) for expenditure on projects for both 2009 and 2010.

Saudi expansion

Given its large and rapidly expanding popu-lation of 22 million nationals, Saudi Arabia has the most aggressive healthcare investment plans in the region. In its 2009 budget, the kingdom allocated SR52.3bn ($14bn) for running its healthcare and social welfare services. This figure includes the construction of 86 hospitals with a combined total of 11,750 beds, but the budget represents an 18 per cent increase on the SR44.4bn allocated in 2008.

Saudi Arabia predicts demand for hospital beds in the kingdom will rise from 50,000 to 70,000 by 2016, driven by an ageing and increasingly wealthy population seeking more specialist healthcare treatment.

According to regional projects tracker MEED Projects, more than $10bn worth of healthcare-related construction projects are under way in the Gulf. Included in this figure is the $1.3bn Jaber al-Ahmed al-Sabah Hospital in Kuwait, the first to be built by Kuwait’s Health Ministry in 20 years. A further eight new facilities are planned for the country by 2016, at a total cost of $4.5bn.

Health authorities are not just building new hospitals, they are also investing in primary care clinics. These serve as a first point of call for non-urgent medical complaints, as well as providing much-needed screening and diagnostics for chronic diseases.

By detecting symptoms early, health providers hope to prevent the development of such diseases and ease some of the strain on the health system. Saudi Arabia is currently setting up 250 primary healthcare centres across the kingdom.

At the same time as investing in new facilities, the Gulf states are attempting to raise the quality of healthcare in existing hospitals. Some health authorities are choosing to outsource management, bringing in Western experts to improve operations. This is especially the case in Abu Dhabi, where the management of six public hospitals has been handed over to international operators.

Compulsory health insurance for expatriates is being introduced across the Gulf and the region’s governments are encouraging the private sector to invest in the health sector in a bid to offload some of the burden of healthcare provision. Government incentives such as interest-free loans and partnership schemes are being promoted to make the sector more appealing for potential investors, with the hope of improving the range of specialist treatments on offer. The initiatives are meeting with a positive response, especially in the UAE, where private capital is funding about two-thirds of the new hospital capacity under construction in Dubai.

But attempts to improve the quality of healthcare in the GCC could be undermined by a lack of skilled professionals. The region’s healthcare sector is heavily reliant on imported manpower – in 2007, 72 per cent of workers at Dubai’s Rashid Hospital were non-nationals.

In recent years, hospitals in the Gulf have struggled to recruit and retain staff amid strong global competition for talent. With so many healthcare projects under way, this competition can only intensify. Kuwait alone expects to require an additional 4,000 doctors and 10,000 nurses by 2016, if its nine hospital projects all go ahead.

Although all the Gulf states are trying to boost the number of locals employed in the health sector by opening new medical teaching facilities, interest among GCC nationals in pursuing a career in healthcare remains limited. Of the 17 students who graduated from Weill Cornell Medical College in May this year, for example, just two were Qatari despite the institution being in Qatar Education City.

The question of whether the clinical workload of new specialist hospitals will be sufficient to attract leading surgeons to the region and maintain their skill levels will remain unanswered until the major projects under construction are completed and operational.

Given the small populations of the Gulf countries, specialist hospitals will have to attract patients from overseas to ensure an adequate clinical workload to attract the best medical talent.

Since the region faces similar health challenges, there is a strong argument for the GCC states to collaborate on health reforms to avoid the duplication of specialist clinical care offerings, establishing regional referral centres where patients can be sent instead.

Some of the most modern, technologically advanced hospitals are under construction in the Gulf, but care needs to taken to ensure that the quality of health services provided matches the high standards of the facilities and equipment. Otherwise patients will continue to go overseas for treatment.