International Finance
Healthcare Magazine November- December 2019 Issue

Saudi Arabia: Private providers should fill 21st century healthcare gaps

KPMG’ s head of health for the Saudi Levant cluster says that the rising female workforce will boost Saudisation in healthcare

The transformation of Saudi Arabia’s healthcare sector is a core agenda of the Kingdom’s ambitious Vision 2030 strategy. The Kingdom faces a number of healthcare challenges, including a rapidly ageing population, increasing incidences of chronic diseases such as diabetes and obesity, and staffing challenges with an over reliance on expatriate manpower for critical healthcare functions.

The Kingdom’s National Transformation Plan envisages a larger share for the private sector in the healthcare spending and the nationwide deployment of digital healthcare technologies. The Saudi Arabian ministry of health targets at least 70 percent of the local population having unified electronic healthcare records (EHR) by 2020. Equally important is the reform of the primary healthcare system focusing on improved integration with the national healthcare system while ensuring continuity in services offered.

Among the strategic initiatives mentioned by the NTP are increase in training, both nationally and internationally, improvements in infrastructure, facilities management, and safety standards; identifying additional sources of revenue, as well as investing in improving the skills of healthcare providers. The Ministry of Health in Saudi Arabia is also interested in increasing public private partnerships through the privatisation of at least one of the medical cities and the localisation of the pharmaceutical industry.

Foreign investors interested in investing in healthcare in Saudi Arabia might find opportunities in setting up additional private medical facilities, healthcare education, deployment of digital healthcare technologies or healthtech, and local manufacture of pharmaceuticals. In an exclusive interview with International Finance, Emmeline Roodenburg, Head of Healthcare for KPMG in the Saudi Levant Cluster talks about the readiness of the Saudi healthcare system for digital technology deployment and the challenges facing Saudi healthcare.

In an earlier role, Emmeline Roodenburg was one of the lead directors in a $100 million KPMG engagement to transform New York state’s healthcare system in the US. Her areas of expertise include international health systems with a focus on care system redesign, including value-based payment systems, provider transformation, life sciences and change management.

International Finance: What are the current barriers to IoT healthcare implementation in Saudi Arabia and how can they be overcome?

Emmeline Roodenburg Technical, administrative, and legal barriers exist. Technical barriers are the full implementation of health information systems that are automated and interoperable at national level, between emerging clusters and providers (and patients!) within the clusters. Central coordination is the key. Many countries in the world would like to press the ‘reset button’ when it comes to IoT healthcare implementation.

Saudi Arabia actually gets the opportunity to be the architect of a well-functioning system and should (will) grab that chance with both hands. The administrative challenges, that are inevitable in any IoT implementation, should be tackled through cultural training and development of healthcare staff to adopt and promote the use of IoT, especially with regards to patient care. Legal barriers, as anywhere else in the world, need clear policies on data sharing, privacy and recovery, and backup plans on information systems and the robustness of those systems.

With the increasing adoption of technology-driven healthcare in Saudi Arabia, how will healthcare organisations assuage consumers concerns on issues such as data safety?

As said earlier, clear policies on how data is shared with transparency of guidelines and a national stance on these is important. However, we need to be cautious about overregulation. The downside is that development of algorithms, which lead to smarter, targeted personalised care, can be slowed down if data protection is getting the overhand.

How do patient management systems in Saudi Arabia compare with the developed world?

Saudi Arabia is rapidly catching up with executing patient management systems, however, the implementation of full electronic health records that are used for patient care are still not in place, especially, where it matters the most such as in primary and community care. This includes proper coded records that allow for population health management to be implemented and financial mechanisms aligned with quality metrics.

Saudi Arabia has seen a change in pattern of prevalent diseases from communicable diseases to chronic diseases. How can the healthcare system in Saudi Arabia meet the increasing demand for chronic disease treatment?

Saudi Arabia is moving to population health management systems that will be essential to managing chronic diseases. As data begins to be gathered robustly on prevalence of diseases and segmentation of patients becomes possible, the Kingdom can proactively target patients. Using technology to drive these interventions, such as digital behavioural management programmes supplemented with offline care management systems, will achieve better outcomes and better patient satisfaction.

Crucially, and I understand this will take time, but specifically on prevention and treatment of non-communicable diseases, I am a strong believer in alternative payment systems that reward providers for their added value, the patient outcomes. Finally, consumers or patients can be incentivised to take their health more into their own hands.

How important is Public Healthcare Centre reforms to the improvement of healthcare outcomes in Saudi Arabia?

Extremely important as the areas of reform are geared towards a shift to population health management, involving patients in their care and shifting care to the most appropriate settings.

Are the healthcare information systems in Saudi Arabia mature enough for the implementation of the latest healthcare technologies? If not, how can the gap be closed?

They are not currently. The trick is not to go for the simplest systems that are just good enough, but to go for the best new-generation systems that are fully interoperable – not just from the system point of view – but also from the patient perspective in how consumers of healthcare expect to interact with their health systems through their mobile phones and wearables and apps. Systems need the backbone and infrastructure to be robustly developed so that machine learning, remote diagnostics, and treatments can be superimposed.

What are the challenges to the deployment of healthtech systems in Saudi Arabian hospitals and how can these challenges be overcome?

There are many, but one of the biggest challenges remains the cultural shift that busy healthcare workers will have to make to get systems integrated in their daily way of working. The best systems fail when healthcare staff is not engaged in the implementation. A definite digital dip occurs when new systems are implemented and it is essential to stay close to the difficulties front line staff face and help iron those out as quickly as possible.

Has the Saudi Telemedicine Network brought any discernible improvements to healthcare outcomes in Saudi Arabia?

We know that systems that have a good data and telecom coverage generally achieve better universal health coverage. This is the same for Saudi Arabia.

What challenges do an increasing population and ageing bring to the Saudi healthcare system? What investments are needed to meet these challenges?

An ageing population brings the challenge of increasing comorbid conditions and frailty that need a different healthcare response for the 21st century. The cost of care goes up, so keeping care in the right setting which is in the community, and wrapping interventions that allow for keeping independence at home with supportive structures like multidisciplinary teams that are geared and trained to support people at home will be needed, supported through technology. In addition to improved home and community care, investment is needed in long-term care, specifically nursing homes.

What does the private healthcare sector need to do to meet the government’s target of raising the private healthcare’s share of healthcare expenditure to 35 percent from 25 percent?

The shift in shares is a combination from a shift from public to private, but also private providers simply offering access to care and services that didn’t exist before. The biggest contribution that the private healthcare sector can make to fill the gaps in care that are going to be required in 21st century care such as investment in remote and point of care diagnostics and monitoring, offering different models of care like home multidisciplinary teams, technology-enabled care coordination of chronic comorbid conditions, investment in artificial intelligence and personalised medicine, digital pathology and at the high-end training and development of professionals, to be able to use robotic interventions and new treatment techniques. The government, in return, is going to have (to continue to) fulfil its part to help create the right environment and payment mechanisms to allow this to happen, in collaboration through public private partnerships.

How can the government increase the rate of Saudisation in the healthcare sector?

The biggest challenge that modern day medicine faces today is going to be the skills gap and the healthcare workforce shortages. Even after optimisation of the current facilities, the gaps are dazzling. A skills transfer is going to be needed quickly as other countries rapidly industrialise and keep their workforce at home. The beauty of Saudi Arabia is that the female workforce participation is growing rapidly. I am not saying it will be easy, but it brings great opportunity for Saudisation in the healthcare sector.

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