© Huron Consulting Services LLC. All rights reserved. The Globalization of Healthcare Leveraging...

© Huron Consulting Services LLC. All rights reserved.

The Globalization of HealthcareLeveraging the National Healthcare Workforce

Kuwait Medica Conference and Exhibition 2011April 12, 2011

Robert K. Crone, MD


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• GCC’s population is expected to double in 20 years to 80 million.

• The population is aging and acquiring chronic medical conditions,

• Governments are becoming more reluctant to fund medical travel

• Governments are encouraging the development of the private sector in healthcare.

• Consumers are becoming more discerning about quality

• Healthcare insurance coverage is being mandated in all GCC countries.

> USD $10 Billion investment in healthcare infrastructure projects underway in the GCC today*

Drive for Improved Quality of Care in the Region

*Source: Huron experience and interviews; MEED publication 2009; Grant Thornton publication, August 2008

Healthcare Overview


Trends in the Gulf StatesAdvanced, patient-centered healthcare facilities

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•Rapidly changing demographics & burden of disease

Intensive Care Medicine

Cancer Care


Healthcare Spend by Region 2010:- No place to go but up!

4Economist Intelligence Unit 2010

% of GDP


Shift from Public to Market Model of Payment

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•Government moving from provider of care to regulator of care and social safety net

oPrivate sector developmentoMandatory insurance for all employees

•Requiring hospitals to develop:oAbility to negotiate contracts with 3rd party payersoAbility to track costs, bill and collect from patients and payersoAbility to track and report outcomesoNeed for sophisticated data systems


Implications for Hospital Operations

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• Cost Reduction and Utilization Management: Efficient hospital operations will become increasingly important

o Revenue cycleo Supply chaino Pharmaceuticalso Clinical practice modelo HR functions

• Business Model Shifts: Anticipate the shift from a public to a market model

• Changing Role of IT and the Value of Data: Invest in data systems

• Consumerism and the Patient Experience: Will become increasingly important for patient-centered, cost-effective, high quality

• Physician Integration and Clinical Process Improvement: Invest in, and assure the quality of your professional health care workforce


Who is going to Staff these New Hospitals?

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The Lights are on, but Nobody’s Home !

•70 - 80% of physicians, and 90% of nurses in the GCC are expatriates.

•Fewer than 5% of Arab students pursue studies in science.

•Kuwait projects a need for an additional 4,000 physicians and 10,000 nurses by 2016.

•Saudi Arabia plans to import 5,000 expatriate physicians


Two Sources of Healthcare Professionals

• Educate and Train your own

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Challenges: Need to build the Educational Infrastructure Each Physician requires a 10+ Year Process


Two Sources of Healthcare Professionals

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Recruit migrating previously trained professionals

Challenges•Quality Assurance: Are they who they say they are?•Divergent Patterns of Practice•Knowledge of local culture•Public confidence


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Middle EastTotal 19,500 medical school students in the Middle East

~4,500 students graduate annually in Middle Eastern countries 2X students per capita vs North America (.12/1000 vs .06/1000)

Saudi Arabia 3,200 annual grads25 schools Oman

230 annual grads2 schools

Bahrain200 annual grads2 schools

Lebanon420 annual grads7 schools

Kuwait90 annual grads1 school

Qatar50 annual grads1 school

UAE320 annual grads4 schools

Medical Education in the Middle East

Medical Schools

Source: WHO – 2006; IMED


Rapid Expansion of the Healthcare Workforce- Implications for the Ministry of Health & Hospitals

• Recruitment

• Primary source verification of credentials

• Licensing

• Credentialing

• Maintenance of licensure and certification

• Continuous professional development

• Workforce oversight

• Outcomes and critical incident reporting

• Malpractice and professional disciplinary action

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In an immature regulatory environment, quality assurance of the workforce falls to the hospital.


How Do you Assure the Quality of your Medical Graduates & Imported Physicians?

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Setting & Maintaining International Standards

• Global standards at all levels of the educational continuum that facilitate local, regional and international migration for trainees & practitioners o Entrance to medical school (MCAT)o Medical school accreditation at a global standard (WFME, ? LCME)o Global standards for assessment of medical students (NBME)o Graduate medical education accreditation (ACGME)o Medical specialty certification (Royal Colleges, ABMS)

MOCo International portability of medical licensure

MOL13


Leveraging Your Existing Healthcare Workforce

• Invest in health professionals’ education, including Post Graduate Training

• Institutionalize continuous professional developmento Enforce rigorous standards for migrating physicianso Introduce maintenance of certification and licensure

• Encourage the development of medical care teamso Recruit/train/retain a strong nurses allied healthcare professional workforceo Expand the role of nurses, pharmacists, therapists, managerso Simulation training in teamso Embracing the ACGME core competencies

• Develop and implement clinical practice guidelines

• Focus not just on treatment, but on public health and disease prevention

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Embrace the ACGME Core Competencies

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CPD Medical Simulation

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Communication Skills

Team-Based Training

Technical Skills

Physical Diagnosis


Adopt Clinical Practice Guidelines

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• Diabetes care

• Hypertension

• Heart failure

• Otitis media


Develop and Support Team-Based Primary Care

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Public Health and Disease Prevention

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• Genetic testing

• Newborn metabolic disease screening

• Comprehensive immunizations

• Hypertension screening

• Diabetes screening

• Cancer screening

• Mental health screening

• Public health education


Focus on Care Outside the Hospital

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HOME TELEHEALTH REDUCES HEALTHCARE COSTSHelen C. Noel, Ph.D., A.N.P., Donna C. Vogel, M.S.N., C.C.M., Joseph J. Erdos, M.D., Ph.D., David Cornwall, R.N., M.B.A., and Forrest Levin, M.S.

TELEMEDICINE JOURNAL AND e-HEALTHVolume 10, Number 2, 2004

© Mary Ann Liebert, Inc.


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Thank You

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