The healthcare scene in the Middle East is rapidly changing, with new technologies and growing populations driving the industry—worth over $3.5 trillion worldwide—and patients increasingly aware of their medical needs. Developments in Lebanon, Saudi Arabia and the United Arab Emirates accurately reflect these trends; although each country has incorporated different healthcare approaches into its overall strategy, there is a common denominator among the three approaches. Today, more than ever before, quality standards are demanded by the sector itself, and the patients it treats.
The global healthcare landscape shifted dramatically in the late ’90s and the early millennium, as regulating standards for the sector grew increasingly mainstream. Many countries began implementing accreditation programs to improve the safety and quality of healthcare services, which providers were obliged to adopt to stay competitive. “These quality standards are usually developed by a panel of experts in the field and used by accrediting organizations,” explains Khalil Rizk, accreditation administrator and risk manager at Beirut’s AUB Medical Center.
Outside accreditation
Non-governmental agencies survey and assess providers by these standards before accrediting them, and generally review each facility every few years to ensure continued compliance. Accreditation involves both self-assessment and external peer review, while focusing on organizational performance. The process is designed to improve healthcare systems and procedures, thereby improving patient outcomes, but it also serves as a way to help patients identify facilities they can trust. Today, there are numerous national and international accreditation agencies.
At the very beginning of the standards “revolution” in the 1990s, the focus was primarily on structural elements of healthcare, later expanding to include procedures and outcomes. Today, however, most standards programs emphasize patient care issues and quality of service, which have been positively affected by the introduction of performance reviews. “The trend is on assessing actual performance, rather than capacity to perform,” explains Dia Hassan, Dean of Academic Affairs, Health Management in Dubai Healthcare City. “Assessment is geared towards organizational efforts in managing patient care as well as supporting process improvements, which result in better patient outcomes,”
Standards exist for virtually every area of the healthcare sector, ranging from guidelines for hospital operation to surgery practices and ambulatory care. According to Rizk, standards can be grouped into two categories: organizational standards, and those specific to patient care.
In general, hospitals in the Middle East apply international standards, such as those set by the Joint Commission International and the International Organization for Standardization, though the standards applied in the latter case, ISO 9000:2000, are from a broader quality standards framework not specific to healthcare organizations. Some countries, such as Saudi Arabia and Egypt, have opted to develop their own national standards. In Lebanon, the health ministry has also produced local standards, but some private hospitals—such as the AUBMC—are in the process of seeking JCI accreditation.
In the Saudi sector, the Ministry of Health (MOH) oversees the quality of all healthcare services. The MOH has strict standards for licensing healthcare facilities and providers, which were enacted partly in response to public demand. “Prompted by emerging complaints against the healthcare delivery system, the Makkah Region Quality Program was initiated in 2001 and the Makkah Region Quality Program (MRQP) was officially established in January 2003,” says Ghada al-Barakti al-Sharif, a strategic affairs consultant to the UAE Ministry of Health and director general of Healthcare Focus, a consulting firm located in Saudi Arabia. This initiative had a positive impact on services provided by participating institutions. Other hospitals are also seeking international accreditation.
The adoption of quality standards has directly affected the sector’s strategies and outlook, with healthcare providers seeing firsthand the value of quality management systems, and their impact on patient care, safety—and satisfaction. Healthcare institutions no longer skimp on resources to increase their profit margins, as accreditation and a reputation for quality have proven far more effective than any conventional marketing tool.
“The emergence of insurance and third-party payments made this approach even more profitable,” notes al-Barakti. “Insurance companies are now demanding streamlined processes, based on service intensity and severity of illness indicators. Any organization that does not meet quality standards will risk having many of its claims return unpaid. Another important factor is that third party payers (e.g. ARAMCO) reward providers who can show proof of quality systems implementation with higher per-capita premiums.” Insurance systems generally require close monitoring of the quality of care delivered. Insurances plans and rapid changes in technology result in the rise of healthcare costs, underscoring the importance of healthcare systems becoming more proactive.
Another key change spurring the healthcare quality movement is that end recipients have become increasingly well-informed about their options and what service to expect. Unsatisfied healthcare consumers are more vocal today than ever before, and many are now taking advantage of their legal systems to demand compensation when service is unsatisfactory. “Quality systems can reduce costs in the long term, by reducing the margin of error and improving performance,” emphasizes Rizk.
Standardization of health care boosts region
Major research supports the correlation between a rise in quality and the application of quality standards in healthcare organizations. One survey, conducted by Hassan, echoes the findings of the bulk of studies. “I led a longitudinal quantitative research over a period of three years, to measure performance of a UAE hospital, before and after the application of international quality standards (JCI),” explains Hassan. “Four stakeholders’ assessments—patients and their families, accreditation bodies, government authorities, and employees—were taken into account. The results showed a significant improvement of 51% in the overall organizational performance, 18 months after the implementation of the Joint Commission International standards. Performance improvement was demonstrated in all stakeholders’ assessments, ranging from 15%, as perceived by patients and families, to 177% as perceived by government authorities.”
However, it is not just local patients who are drawn in by better quality healthcare. With international travel now possible on a budget and medical histories transferable at the click of a button, patients are increasingly looking beyond national borders for their healthcare needs. The Dubai Healthcare City—no stranger to the global “health tourism” trend—is seeking to attract internationally-renowned clinics and staff to bolster its profile as a destination. According to Hassan, “Health tourism is expected to significantly contribute to the economy of Dubai in the near future.”
Health tourism is on the rise in other Arab countries as well. In Lebanon, the sector is dominated by “tourists” seeking cosmetic procedures, while according to al-Barakti, Saudi tertiary care centers in particular attract patients from across the GCC. These tertiary healthcare facilities accommodate patient referrals through governmental agencies in other Arab states as well as the Far East and Africa. “The healthcare industry has not yet focused on the ‘healthcare tourism’ concept as such,” observes al-Barakti. However, that doesn’t mean the sector isn’t poised for substantial growth. “By stressing commitment to quality and patient safety, this will eventually lead to a greater demand for Saudi healthcare services. It might also pave the way for special initiatives and legislation promoting health tourism, such as visa procedure facilitation.”
Ultimately, the standardization of healthcare services looks like a win-win situation for the region: greater profit margins for hospitals, better treatment for patients, and a growing reputation for countries like the UAE, Saudi Arabia, and Lebanon as centers of healthcare excellence
