TBY talks to Thomas J. Murray, CEO of American Hospital Dubai, on the evolution of the private healthcare sector.
TBY How has the private healthcare sector in Dubai evolved?
THOMAS J. MURRAY Our institution has been around since the beginning of the development of large private sector companies. There were some small physician’s offices and clinics, but we were the first full-service, complete hospital with permanent staff. We started with outpatient services and performed a small amount of surgery. We then opened up our inpatient units and performed more surgery, and added more physicians to our staff. It evolved over time. It was not a get-rich-quick deal; it took a lot of vision and resources to get it up and running. Building a first-class hospital isn’t something that can be done fast—the tradition, staff, and the building processes are all very important.
What are the main defining characteristics of the local healthcare industry?
In the US, many of the hospitals are charities, either public or private, and as part of their missions they are non-profit organizations. At the end of the day, however, they need turnover to reinvest in people, buildings, or new technology. We see an awful lot of that in the US, but you don’t find that here in Dubai. There’s a government sector, and a private sector, and we don’t see any charitable-type institutions here. Health care and technology is expensive, and there are extensive operational costs associated with it, and somehow people need to be paid. There’s a balance that you have to have, but it’s a little different here in Dubai.
If you look at the national health insurance groups around the world, they are beginning to realize that they need mechanisms for accountability. People can’t come into a hospital and stay forever, using all the services. Abu Dhabi has been leading the way, with its accountability schemes. In Dubai as well, people are signing up for insurance, and the companies are asking more questions. They didn’t ask as many questions before. People have high expectations; in the past everything was done basically for free. There is a huge value in the services we provide, and more places with insurance are starting to institute copayment schemes. It’s a natural gatekeeper. If you have to pay for it, hopefully people will think before running to the doctor or emergency room for every little thing.
What are your current expansion plans?
We mainly want to finish the commissioning of our new building, which will involve relocating our intensive care unit (ICU) in the original building to the new facility here. We have 19 beds now, but we’ll move up to 25 beds in ICU. The original building needs refurbishment, although it’s only 16 years old. It’s not old, but it has been used constantly, and we need to renovate. We would like to move the patients into our new building, keep them here, and if we find that we still want to expand, we can renovate our old building to meet demand. Currently, we only operate here at our facility in Dubai, but in the future we would consider expansion outside of this area. We have been invited to many locations in this part of the world, not only in the UAE.
How is information management involving in this market?
We are being very careful to maintain a high standard of professional care and to continue managing information. The documentation of our product is our medical record, which contains all the patient information. We are spending a large amount of time and money on the computerization of these records. It’s necessary for patient care so we do not lose charts or x-rays, for example. If everything is digitized, we can transfer everything quickly or put it on a flash drive in seconds. One issue is the security of information. We have to be careful in terms of connectivity. Another issue is that the internet service is not reliable in every part of the country. We can send bills digitally to our insurance company, and we get paid online, too. The money moves appropriately and safely, and if we move to another part of Dubai or the UAE, we want to ensure that any of our physicians can review one of our patient’s medical record from any location in the region. This is extremely important for many reasons.
How much of a challenge is it to attract talented staff to the hospital?
We are seeing a significant number of physicians from Germany, the UK, and the US who want to work here. Many who visit are returning to this region of the world. The way we organize our hospital structure is exactly the same as it is done in the US. It was easy for me to be here as a CEO, because it is operated in a similar way, with only a few minor differences. The staff and patients are from many different countries, but they recognize the procedures here. Even some physicians from the US are choosing to move here in the midst of a confusing reimbursement program there. Other people just want a change. Although I’ve been in the business for many years, I wanted to do something different, and this hospital provides it to me. Many young nurses come here for a couple of years. Young people from the US come here and love it. German staff are especially eager to experience a different working atmosphere. I feel lucky to be in Dubai.
What sort of steps need to be taken to develop the local primary care market?
Primary care is extremely important, and everyone needs a primary care physician. From a health point of view, it’s better to see people on a routine basis and screen them, as opposed to just going to the doctor when you are sick. I applaud those who depend on primary physicians and focus their energy on the sector, calling upon specialists only at appropriate times. A lot of insurance companies have begun to demand that patients are referred from their primary care physician, and they can’t go straight to the specialist. Screening saves lives and money. If we have primary care physicians that have long-term relationships with their patients, we can take better care of them. There’s always a balance between quality and money. For example, looking purely at saving money, you could ban insulin. Frankly, you could just get rid of the diabetic population if you wanted to save money. If you accept the fact that you have to give people insulin, you must also accept the fact that there are other issues you will have to deal with concerning that patient, such as their eyes, exercise, kidney functions, feet, and diet. Diabetes is a gateway disease because it opens up all kinds of other diseases. If we permit insulin, we have to recognize that there are costs associated with that. Part of controlling costs is having a well-informed and motivated patient population.
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