The hard truth about healthcare in the Middle East and North Africa

Do you want to know the real truth about healthcare that no one dares to talk about?
The definition of insanity is doing the same thing over and over and expecting different results. This witticism that is attributed to Albert Einstein comes to mind when considering the problems facing healthcare in some parts of the MENA region.

“Every year, the insurance carriers meet with their enterprise clients to inform them that their premiums have to increase because the medical loss ratio is too high. Renewal will include higher premiums and/ or a reduction in benefits to the employees. This pattern is not sustainable,” says Raouf Khalil, Founder and CEO of Mobile Doctors 24-7 (MD-24-7). As of December of 2015, Goldman Sachs investment bank was standing by its prediction of $20 a barrel bottom1. According to Mr. Khalil, this new economic environment demands change to the cycle of wasted healthcare spending.

Insurance carriers are not only forced to increase premiums, but also take legal action against certain hospitals. According to a local publication, insurance firms in KSA are suing providers for ordering unnecessary, expensive laboratory tests and treatments for minor illnesses2. In some areas of the MENA region, insurance companies and their clients are facing massive inefficiencies. Last year, Haidar Al Yousuf, the Director of Health Funding at the Dubai Health Authority, revealed that $40 billion of many third-world countries’ spending on health, due to inefficiency, is not properly utilized: “A lot of doctors prescribe a lot of medication – they order a lot of tests, but there is no matching of what is actually needed by the patient and what is being done,”3 he said.

Increasing spending increases utilization

In certain sections of the Arab world, the trend is to increase spending as Al Masah Capital forecasts that the private-sector healthcare market will be worth $61bn in 20204. Raouf Khalil believes that spending more is not the solution: “Investment in healthcare is the current trend, but when you build more hospitals and clinics, it’s going to increase utilization. There are going to be less patients walking into each facility, which means that the administrators have to give patients the ‘full’ treatment.” Dr. Ziad Alobeidi, Mobile Doctors CMO and Co-founder, explains that providing incentives for overutilization creates an ethical dilemma for medical professionals: “The practice of medicine is a privilege which carries important responsibilities. All doctors swear by the Hippocratic Oath, which is a moral code of conduct for doctors that describes the basic ethics of medical practice: to help sick people and to avoid harm.” Dr. Alobeidi added that The National Institute for Health and Care Excellence (NICE) guidelines, prefaces its guidance to the effect that treatment and care should take into account patients’ individual needs and preferences. Patients should be provided with the best possible care.

The core problem with healthcare in third world countries is the total misalignment between patients, payers, and providers. Raouf Khalil, Founder and CEO of Mobile Doctors 24-7 (MD 24-7)

Ethics, economics, and public health

In the interview with CEO Report, Raouf Khalil explained the core problem is the total misalignment between patients, payers, and providers. Most doctors’ employment agreements with clinics and hospitals include fee for referral, which creates further incentive for overutilization. Patients usually receive what they can afford, not what they need: “Everybody suffers. The main stakeholders are the consumer and the payers, and ironically, these two want the same thing – they both want to avoid unnecessary spending: receiving MRI exams or prescribing antibiotics solely for profit. The healthcare providers are often the issue,” he said.

“At Mobile Doctors, we bring the trust back to the doctor-patient relationship by following current NICE international guidelines and adopting a patient-centered approach. Our doctors are not incentivized to overprescribe or over-investigate and will only tell patients the truth about what they need.”

Beyond ethics and economics, this is also a significant public health issue: according to a recent WHO report, antibiotics are losing their effectiveness due to unnecessary prescriptions. Evidence-based medicine is the only prescription Khalil insists that the solution to healthcare is not a healthcare solution but a change to consumer behavior by providing them what they want – 24/7 access to an integrated delivery system because this is the only way to ensure a proper balance between quality and cost. Dr. Alobeidi affirmed, “At Mobile Doctors, we bring the trust back to the doctor-patient relationship by following current NICE international guidelines and adopting a patient-centered approach. Our doctors are not incentivized to over-prescribe or over-investigate and will only tell patients the truth about what they need.” The statistics agree that the majority of routine doctor visits can be handled over the phone. Reports show that only 10% of 999 calls in the GCC are for true emergencies. In these instances, doctors can diagnose, prescribe treatment and even medication (when necessary) right over the phone or via video consultation without the need for an office visit. For Raouf Khalil, the situation is simple, “If you are a consumer (or their employer), do you want to go to a doctor who is receiving commission or a doctor who strictly practices evidence-based medicine? It is this dilemma that needs to be addressed in the future in order for healthcare to accommodate the big picture of the world economy.” It certainly does not require Einstein’s intellect to see that utilizing healthcare spending efficiently is the definition of sanity.

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