Report: Dubai Clinical Services Capacity Plan 2015- … Dubai Clinical Services Capacity Plan 2015-...

Report: Dubai Clinical Services Capacity Plan 2015- 2025

CORPORATE EXCELLENCE DEPARTMENT 27/11/2014

Dubai Clinical Services Capacity Plan 2025/ Version 2

CORPORATE EXCELLENCE DEPARTMENT

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ACKNOWLEDGEMENT The Dubai Clinical Services Capacity Plan (DCSCP) is a periodic study, conducted for the first time in

2012-2013, to understand the current healthcare sector, the demand, supply of services and existing

gaps. The study was administered across government and private sectors in Dubai. The collected data

was validated and analyzed to develop a comprehensive report that is an integral tool in planning for the

Dubai healthcare sector until 2025

The DCSCP was developed by the Policy and Strategy Department (currently Corporate Excellence

Department), Dubai Health Authority (DHA) but executed collaboratively by DHA and TAHPI, an

experienced health planning firm. This report is based on a robust and detailed survey of the current

facilities as well as a systematic analysis of the future demand.

The DCSCP and its results have been tested with stakeholder consultations and collaboration.

Schedules and details of meetings and consultations conducted throughout the course of the project are

described in the Appendices.

Sincere gratitude and appreciation goes to the public and private facilities and other stakeholders for

their cooperation in providing information to the surveyors, filling out the survey forms and actively

participating and providing feedback during the consultation workshops and the initial presentation of the

results.

The authors of this report recommend its adoption as a fundamental basis for health sector strategy and

its implementation. It is also recommended that this document be regarded as live, subject to updates

every three years in order to align with prevailing conditions, changes to the healthcare industry,

technology and Government policy including the implementation of Mandatory Health Insurance.



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READING THIS REPORT This is the Final Report emerging from the work done as part of the DCSCP by the former Policy &

Strategy Department, Dubai Health Authority, and Government of Dubai in 2012 - 2013.

The objectives of this report include:

Highlighting the current supply of health services in Dubai

Presenting the projected demand of health services over the next period, from 2014 to 2025,

Broadly identifying the areas that require more detailed studies and planning to close gaps in

infrastructure and healthcare workforce

The report has been structured into 7 main chapters within which relevant sections have been

developed:

Chapter One – Introduction

This chapter describes the rationale and the framework for conducting the DCSCP, the main objectives

and the benefits that can be realized. It also highlights the critical success factors that have been vital to

the successful completion of the study

Chapter Two – Background & Context

This chapter includes a description of the current Dubai environment and geography, including its health

care sector, population and health status. The implications of introducing Mandatory Health Insurance

(MHI) are described and it further highlights the general assumptions and areas out of scope for the

DCSCP Study

Chapter Three – Approach & Methodology

The chapter describes the methodology used to conduct the supply and demand assessment, as well as

give an understanding of the areas focused on to identify gaps for development. The chapter further

defines key terminology used in the report and describes in detail the status quo and MHI scenarios

used to project demand



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Chapter Four – Findings & Analysis

This chapter contains the descriptions and implications of the survey results. This has been structured

into two main areas: health infrastructure, including major medical equipment, and health manpower to

allow for a clearer understanding of the current supply. The demand projections have been shown to the

period of 2025 for the same areas

Chapter Five – Gap Analysis

The chapter describes the priorities that will need development within infrastructure and manpower to

accommodate Dubai’s health requirements to year 2025 as per the two scenarios, status quo and MHI

Chapter Six - Sensitivity Analysis

This chapter shows the change in demand for health services that can occur with a change in the

assumptions, to understand the variance in demand in the case of unexpected change in the healthcare

sector and Dubai’s socio-economic status

Chapter Seven - Conclusions & Recommendations

This chapter summarizes the results and implications on future developments in infrastructure and

manpower for the Dubai health sector. It further outlines the recommended actions to be undertaken to

meet projected demands in an efficient and effective manner



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CONTENTS

ACKNOWLEDGEMENT .................................................................................................................. 1

READING THIS REPORT ................................................................................................................ 2

1 INTRODUCTION .................................................................................................................. 5

2 BACKGROUND & CONTEXT ............................................................................................. 8

3 APPROACH & METHODOLOGY ..................................................................................... 13

4 FINDINGS & ANALYSIS ................................................................................................... 27

5 GAP ANALYSIS ................................................................................................................ 64

6 SENSITIVITY ANALYSIS .................................................................................................. 81

7 CONCLUSIONS & RECOMMENDATIONS ...................................................................... 85


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The Dubai Clinical Services Capacity Plan brings together the collaborative efforts of the Dubai Health Authority to create a detailed and practical planning resource that will support the development of the Dubai health sector with efficiency and effectiveness, while providing comprehensive and quality services to the community

1 INTRODUCTION

1.1 Imperative

The planning study has been designed, conducted and used to achieve specific strategic objectives

and initiatives as outlined by the Dubai Health Sector Strategy:

− Develop a comprehensive Dubai Clinical Services Capacity Plan that includes detailed, evidence-

based projections of supply and demand for medical and allied health services in the Emirate of

Dubai until 2025

− Define, on the basis of the Dubai Clinical Services Capacity Plan, relevant volume-quality

thresholds for particular services and specialties and integrate these with regulatory oversight and

health planning processes

− Improve the spatial distribution of primary healthcare facilities by identifying geographic gaps and

facilitating the development of primary healthcare services in convenient, accessible locations by

both public and private sectors

− Facilitate private investment in primary healthcare services by publishing information on

geographic service gaps in Dubai, especially in newly-developed residential areas


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1.2 DCSCP Framework

The DCSCP framework is inclusive in identifying the current healthcare environment (supply),

projecting the need for services (demand) and using the data and information to develop practical

plans for the future as depicted in figure 1 below.

1.3 Objectives

The objectives of the Dubai Clinical Services Capacity Plan are to:

− Assess the current supply of clinical service capacity

− Assess the clinical service capacity approved for development

− Project the demand for clinical service capacity through 2025 taking account of the Dubai’s

resident population and visitors using health service in Dubai from other United Arab Emirates and

from abroad (i.e. medical tourists)

− Develop scenarios to assess the impact of the introduction of MHI on demand for health service

capacity

− Assess the gap in the supply of clinical service capacity for each scenario

− Identify the priorities and strategies from 2015to 2025 for the development of clinical services

− Produce an investment guide for clinical service capacity development

Figure 1: DCSCP Framework

SUPPLY Identify existing health services in Dubai, including facilities that belong to MOH, DHA, DHCC and private sector (response rate 77%)

DEMAND Project the demand

of health services over the next period

on two scenarios: Status Quo & MHI

PLAN Develop efficient planning

mechanisms to close the gaps in infrastructure and

health workforce


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1.4 Critical Success Factors & Key Benefits

In responding to these objectives the following critical success factors have been considered to ensure

that the associated key benefits are achieved (see figure 2):

• Investment opportunities – direction for

public and private investment in primary,

secondary, tertiary healthcare services to

fill gaps

• Resource alignment - proper utilization of

current beds & developing low cost

programs versus establishing new

hospitals

• Economic solutions – allows practical

forecasting and planning for more

efficient spending by health care

providers

• Regulatory impact – Health Regulation

entities in Dubai will have clear guidance

in licensing of health professionals and

health facilities according to actual needs

• Medical & Health Education impact

Medical and Health education institutes

will have clear guidance in education

priorities and capacity needed over the

years

• Stakeholder cooperation -

involvement of key stakeholders

across government and private

entities is essential to develop a

practical and relevant plan

• Data collection – accuracy and

availability of data is important in

forming basic assumptions and

developing scenarios

• Planning module – timely

responses and concentrated effort

to develop and refine the planning

module so it reflects the Dubai

environment

• Reports & Updates - the study is

updated periodically to reflect on

the current environment

CRITICAL SUCCESS FACTORS CRITICAL SUCCESS FACTORS

KEY BENEFITS

Figure 2: Factors & Benefits


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2 BACKGROUND & CONTEXT

2.1 Dubai’s Healthcare Sector

The Dubai healthcare sector is inclusive of government and private entities (see figure 3) that are

aligned to the overall healthcare strategy and strive to provide quality services that are accessible and

affordable for the Dubai community.

Dubai has a highly evolved health services, including a sophisticated physical infrastructure of well-

equipped hospitals, specialized clinics and primary care centers. In the year 2011, the baseline year

for the study in hand, there was 23 private, 2 MOH and 4 DHA hospitals in Dubai with a capacity of

3,740 beds, over 5,000 doctors in most specialties, and 1,075 public and private outpatient clinics.

Dubai’s health services are internationally recognized and are of a high standard, comparable to other

high income countries. Hospitals and clinics, which boast modern facilities, are strategically located to

ensure accessibility. Dubai continues to provide new clinical technologies and innovative clinical

services to meet the growing demands of residents and visitors. Dubai has a combination of public and

private outpatient clinics distributed around the city that cater to the specific medical needs of both the

Emirati and the expatriate residents. The 23 private hospitals range from small specialty short stay

centers to larger comprehensive facilities. They provide care to paying patients with accommodation

that ranges from basic to luxurious.

Figure 3: Health Sector Framework


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Implication of Health Insurance Law of Dubai

The Government of Dubai issued the Health Insurance Law 11 of 2013. The Health Insurance Law is

being implemented by DHA in three phases for Dubai Nationals and Residents; and the plan is to have

the universal coverage by mid-2016. The mandatory coverage provides an essential benefit package

for residents, and emergency care for visitors. Insurance coverage can be purchased from the private

insurers so long as it fulfills the mandated basic requirements. Dubai Government will provide

coverage for the Nationals. The Law mandates employers to provide coverage to employees, while

employees sponsoring their families or additional persons have to provide coverage to any person

they sponsor if not provided by their employer.

The new health insurance law determine the level of services mandated, the rights and responsibilities

of the various stakeholders in the new model, the information requirements, consumer protection

clauses, and the regulations and regulatory functions related to health insurance.

The Status Qu Scenario (SQ) indicates the demand for healthcare in the absence of the mandatory

health insurance (MHI), and it uses the data prior to the Law. At the time of this study, we could not

identify a study that measured the effect of introducing a mandatory health insurance on the utilization

of services, except for Abu Dhabi Emirate. The data from Abu Dhabi shows the utilization pattern

before and after the introduction of mandatory health insurance. Our team used this data as a

benchmark for general and specialized healthcare services. Therefore, we included the Status Qu

Scenario in this study to help policymakers in other jurisdictions – to plan the needed adjustments as a

result of introducing mandatory health insurance in their countries. in Dubai, the SQ scenario should

only be used for comparison, while the MHI scenario data is the one to be used for planning purposes.

2.2 Dubai’s Population Profile

Mid 2013 Dubai population is estimated at 2,158,740; with 88% expatriates and 12% UAE Nationals

(based on Dubai Statistics Center population projections). The official scenario, as per The Executive

Council (TEC) projects a 5.3% increase in population until 2015 and a 7.4% increase, between 2015

to 2020. The 7.4% increase has been assumed to continue until 2025. The structure of the Dubai

population is predominantly males in the young, working age groups.


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2.3 Dubai’s Geography

Dubai is one of the seven Emirates that constitutes the United Arab Emirates, it is located at Latitude:

25°15′07″ N and Longitude: 55°16′48″ E. It occupies an area of 4,114 Km square with a population

density of 463 persons per square kilometer. Dubai is divided into nine geographic sectors in regards

to the distribution of health services (Figure 4). Each sector has a specific mix of genders and

nationalities. Baseline data for each sector was provided by Dubai Statistics Center (DSC), DSC

Bulletins, 2004 and 2009). Nationality profiles for the sectors reveal that most sectors contain an

average 13% of UAE Nationals, except for sectors 5 and 6 which show a larger number of expatriates.

2.4 Dubai’s Health Status

The life expectancy for the total population in Dubai is 75.6 years, with a breakdown of 74.3 years for

males and 77.3 years for females (Source: Dubai Annual Health Statistical Report, 2013)

The main causes of death have been identified as cardiac diseases, cancer, respiratory diseases,

trauma and other injuries (Figure 5). Cardiovascular diseases account for 30% of deaths across the

population

Figure 4: Dubai Land Sectors

Source: Dubai Municipality

5

9

5

6

5

3

5

1

5

8

5

7

5

4

5

2

5


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The main causes of death among children under 5 (Figure 6) has been identified as Prematurity & low

birth weight, at 23%, followed by Causes originated in the neonatal period (18%) then Birth asphyxia &

respiratory failure of the newborn (16%).

The major reasons for hospital admissions in 2013 includes Pregnancies and Childbirth with any

diseases and complications associated with those events, then hematological diseases and injury &

poisoning (Figure 7)

2%

19%

30% 24%

6%

7%

12%

Figure 5: Causes of Death Registerd in Dubai 2013

SEPTICAEMIA

NEOPLASMIS

CIRCULATORY SYSTEM

OTHERS

INJURIES

PERINATAL PERIOD

RESPIRATORY SYSTEM

8% 1%

23%

1% 18% 5%

12%

16%

16%

Figure 6: Causes of Under-Five Deaths in Dubai 2013

Diseases of the Circulatory System

Pneumonia

Prematurity & low birth weight

Injuries (Post-neonatal)

Other Causes originating inperinatal periodNeonatal./post infections

Congenital anomalies

Birth asphyxia & respiratory failureof the newborn

Source: Dubai Annual Health Statistical Report, 2013, DHA



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.


Figure 7: Major Causes for Hospital Admission by Nationality in Dubai 2013


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3 APPROACH & METHODOLOGY

3.1 General Terms & Assumptions

The general terms and assumptions used in developing DCSCP are described below:

− Demand Planning Study: a study of a population’s requirements for health services based on

application of reference rates, trends and projections

− Supply Planning Study: a study of the health services supplied to a population in order to meet

its healthcare needs. It examines types, ranges and volumes of services as measured by activity

(admissions, outpatient occasions) and capacity (e.g. bed days) for a specific geographic area and

population

− Gap Analysis: the difference between demand and supply across two scenarios from 2011 until

2025

− Base Year(s), Planning Horizon and Intervals: the beginning year or year of a planning study.

The base year for the capacity plan is 2011. A planning horizon is the end or target time point of a

planning study. The planning horizon for the capacity plan is 2025. Intervals are standardized time

periods between the base and horizon years. The capacity plan intervals are 2015 and 2020

− Study Population: the population for which a health service is to be assessed and planned. The

supply and demand for healthcare of the study population is examined in detail and demand

projections developed for a specified period to determine gaps in supply and develop strategies for

the development and enhancement of health sector

− Study Population Catchment: the study population is further defined by geographic and

population characteristics. It is broken down into three catchments:

A Dubai catchment, where the majority of a population resides within close proximity to a

health facility. The primary catchment of DCSCP is the Emirate of Dubai segmented into its 9

sectors

Other UAE catchment is a population in surrounding distant localities where referrals may be

expected to flow into primary catchment areas. It is composed of the following emirates:

Abu Dhabi

Sharjah

Ajman

Umm Al-Quwain


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Ras Al-Khaimah

Fujairah

A regional/international catchment is defined as populations in surrounding states or

countries where referrals may be expected to flow into primary catchment areas. These

referral flows are usually due to specialized or lower cost services being available in the Dubai

catchment comparatively

− Western Asia: according to the World Health Organization, the UAE is situated in the Western

Asia Region. The region is composed of the following countries: Bahrain, Cyprus, Iraq, Jordan,

Kuwait, Lebanon, Occupied Palestinian Territory, Oman, Qatar, Saudi Arabia, Syrian Arab

Republic, Turkey, United Arab Emirates, and Yemen. (WHO, 2008)

− Reference Population: this is the population of a state, country or a group of countries that

represents the demand for health services. Three countries have been identified and used for

reference population demand projections, based on the following criteria:

Very good health status as measured by low mortality and disability

High socioeconomic status

Comprehensive and contemporary health service provision for all types of care

Optimal use of health care resources as measured by adequate supply of hospital beds

and health workforce

Affordable and broadly accessible healthcare within its catchments

Standard coding and classification of health statistics that can be compared against

supply statistics in the study population

Readily available and comprehensive health service statistics for a sufficient time period

to enable reliable trend estimates

The reference population countries include, Australia and United States of America for inpatient

services; and the United Kingdom, Australia and the United States of America for ambulatory and

outpatient services. Other countries such as Singapore and Hong Kong were considered but the lack

of public access to their longitudinal healthcare statistics made it a challenge to do the detailed

profiling of their services necessary to calculate appropriate and comparable per capita rates and

trends


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3.2 Out of Scope

The scope of DCSCP did not include:

− Full range of Allied Health or management and clinical support services such as pharmacies,

ambulance services and school health clinics

− The survey did not include the detail information on expenditure and revenue of healthcare

facilities

− The survey collected data on the capacity of health manpower with prime focus on physicians,

nurses and dentists, but the detailed information in regards to qualification/certification and years

of experience for the medical personnel was not in the scope of the study

− The key planned units (KPU) demand projections do not include estimates for diagnostic

technologies such as X-ray machines and pathology instruments

− The quality audit of the healthcare facilities was not in the scope of the study

3.3 Limitations

The limitations to the study include:

− Population projections are based on an exponential growth rates regardless of age, gender and

nationality composition

− Sector population projections for age, gender and nationality distributions are based on one year’s

estimates

− Supply is based on a period estimate of one year

− Clinical specialties used for hospital supply beds in the gap analysis were taken from the Dubai

Annual Health Statistical Report 2011 hospital bed profiles grouped by ICD-10 codes. These

codes were grouped into specialties and the ungrouped cases were distributed to specialties using

demand profiles on a proportional prorate basis


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3.4 Approach

A structured and systematic approach has been taken to conduct DCSCP across Dubai health sector.

This includes the key steps that are shown in figure 8 below:

3.4.1 Demand Assessment – Dubai Clinical Service Catchment Projections

Population projections

For the purpose of the current DCSCP demand assessment, population projections were calculated by

age and gender, until 2025. Dubai’s total population projected for the three scenarios is presented in

the figure 9 below. The three population scenarios differ in their growth rates, from 3% yearly growth in

the low scenario to 5.3% in the medium scenario to 7.4% yearly growth in the high scenario. The

medium scenario is used as the official projection for capacity planning. As figure 9 shows, national

and non-national proportions remain constant in all scenarios across all years

Figure 8: Step by step approach to the DCSCP

2015 2020 2025

0

1

2

3

4

5

Population (millions)

Low Medium High

Non-

National

Figure 9: Projected Growth per Scenario of National and Non-National Populations in Dubai, 2011 to 2025.


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1,000 500 0 500

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Population (000)

Age

Low Variant Medium Variant High Variant

Males Females

The three different growth rates maintain the population structure of Dubai, with working age males the

most frequent group in the population, as seen in figure 10:

− Dubai’s population is estimated to be 3mn, 4.9mn, 5.6mn for the low, medium and high scenarios

respectively in 2025

− Under the three scenarios the population 0 to 14 years will constitute 9% among non-nationals

and 35% among nationals.

− Under the three scenarios the elderly population 60 and above will constitute 1% among non-

nationals and 5% among nationals.

Dubai’s population is projected to remain a predominantly young male society with high proportions of

the population in the high fertility age groups as summarized in table 1 below

Age group

% of Nationals in age group % of Non-Nationals in age group

0-14 35% 9%

15-59 61% 90%

60+ 5% 1%

Total 100% 100%

Figure10: the comparison of the three projection scenarios in

2025.

Table 1. Age Distribution Summary of Nationals and Non-Nationals in 2025

Source: DSC Population Bulletin 2011, p. 2.


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800 600 400 200 0 200

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Population (thousands)

Age

Nationals Non-Nationals

400 200 0 200

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Population (thousands)

Age

Nationals Non-Nationals

Population Projections for the Medium Scenario by Gender & Nationality

The medium scenario population projection series shown in the figure 11 assumes a 5.3% per annum

growth to 2015, 7.4% per annum up to 2020 and then remains constant. The growth rate is

consistently applied across all age and gender groups.

The age, gender and nationality distribution of Dubai’s population is expected to remain constant

across the planning period. Growth will be consistent with the global rates for the mid scenario

projections series

The following figures (12 and 13) contrast Dubai’s 2011 and 2025 population distribution estimates. Of

significance is the projected growth in the working aged population, particularly males. There is also

projected continuing growth in 0-14 children age groups for both males and females

1,000 750 500 250 0 250

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Population (000)

Age

Males Females

Figure 12: Population Pyramid of Dubai's Population in 2011. Figure 13: Population Pyramid of Dubai's Projected Population in 2025.


Figure 11: Medium Scenario Population Projections by Age and Gender, 2011 and 2025.



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Reference Population

Three high income countries have been used to calculate reference population demand projections.

These include Australia (Australian Institute of Health and Welfare (AIHW), 2011-2013) and United

States of America (Agency for Healthcare Research and Quality, 1998-2010) for inpatient services and

the United Kingdom (Health and Social Care Information Centre, 2004-2011), Australia and the United

States of America (Centers for Disease Control and Prevention, 2008-2010) for outpatient services.

Reference files with a 12 year time series, 1998-2009, have been used to project age and gender

specific episode, presentation and stay period rates

*Note: Data from USA was used only to supplement other reference sources because the country

does not strictly meet the reference population selection criteria. Other countries such as Singapore

and Hong Kong were considered, but the lack of public access to their longitudinal healthcare statistics

made it unfeasible to generate the detailed profiling of their services necessary to calculate

appropriate and comparable per capita rates and trends.

Adjustments have been made to the reference population per capita rates to align them with the

Western Asia Region using Burden of Disease (BOD) rates from the World Health Organization

(WHO, 2009; WHO 2008). BOD is measured in disability-adjusted life years (DALY) which “combines

years of life lost due to premature mortality and years of life lost due to time lived in states of less than

full health” (WHO, 2008). DALY rates are reported for a selection of diagnostic classes that are

grouped into International Classification of Disease chapters. These chapters align to the Major

Diagnostic Categories of DRGs.

Ratios are calculated by dividing the Western Asia BOD rates by the BOD rates of high income

countries for age, gender and diagnostic groups. They have been adjusted using a square root

trimming technique to reduce the effect of DALY classes with highly scenario ratios. The ratios are

then applied to the reference population rates to redistribute the DRG per capita rates and align them

with Western Asia adjusted BOD DALY rate distributions

Case mix based regression projections to 2025 are estimated for the populations of each study

catchment by applying the BOD adjusted age and gender specific rates of the reference data sets to

the study population projections for each catchment. A mid scenario population projection series for

each study catchment was combined and linked with the reference rates to calculate Infrastructure and

Manpower capacity projections


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Reference rates are derived from representative countries for ten years, grouped by DRGs (or

equivalents), age and gender. The reference rates have been projected using a mixture of regression

techniques for future time periods in five year intervals up to 2025. Regression equations for the

projections are selected using tests of goodness of fit.

The projected per capita reference rates are

multiplied by the equivalent age and gender group

population projections for a study population and

converted into Key Planning Units for the estimation

of capacity projections. The projections have been

grouped into the following clinical service capacity

categories, shown in table 2:

Service types have been further broken down into the following Clinical Service Specialties, shown in

table 3:

Allied Health Care Immunology & Infections

Primary Care & General Practice Interventional Cardiology

Breast Surgery Medical Oncology

Cardiology Neonates (Newborn Care)

Cardiothoracic Surgery Neurology

Chemotherapy Neurosurgery

Colorectal Surgery Obstetrics

Dentistry Ophthalmology

Dermatology Orthopedics

Diagnostic GI Endoscopy Pain Management

Drug & Alcohol Plastic Surgery

Endocrinology Psychiatry

Extensive Burns Renal Dialysis

ENT Respiratory Medicine

Gastroenterology Rheumatology

General Medicine Transplantation

General Surgery Ungrouped

Gynecology Upper GIT Surgery

Hematology Urology

Head & Neck Surgery Vascular Surgery

Acute Inpatient Care

Non-Acute Inpatient Care

Pediatric Care

Obstetric And Newborn Care

Ambulatory And Outpatient Care

Intensive Inpatient Care

Emergency Department Care

Operating Theaters And Procedural Care

Table 2: Clinical service capacity categories

Table 3: Clinical Service Specialties


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Manpower Categories

Separate projections were constructed for manpower using variance adjusted per capita rates for high

income countries converted to full time equivalents. The manpower categories defined are Dentistry,

Nursing, Medical, Allied Health and Management and Support. Table 4 shows medical categories

segregated into the following clinical specialties:

Primary Care & General Practice Orthopedic Surgery

Anesthesia & Intensive Care Medical Oncology

Psychiatry Intensive Care

Pediatrics and Child Health Nephrology

General Surgery Otolaryngology

Cardiology Endocrinology

Emergency Medicine Geriatric Medicine

Other Surgery Neurology

Gastroenterology and Herpetology Dermatology

Obstetrics and Gynecology Clinical Pathology

Radiology Plastic Surgery

Ophthalmology General Medicine

Key Planning Units (KPU)

Key Planning Units (KPU) have been defined for infrastructure and manpower capacity units. The

following two tables (5 & 6) describe the infrastructure KPUs used for the DCSCP.

KPU Setting Capacity Measure

Admitted Acute Overnight Beds

Admitted Non-Acute Beds

Same day Surgery Beds/Chairs

Same day Medicine Beds/Chairs

Renal Dialysis Chairs

Intensive Care Beds

Emergency Department Cubicles/Rooms

Operating Theaters Rooms

Outpatients Rooms

Table 4: Clinical Specialties for manpower categories

Table 5: Infrastructure KPUs


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All workforce categories are estimated by Full Time Equivalents (FTEs). An FTE is the number of

working hours that represents one full-time employee during a fixed time period. FTE simplifies work

measurement by converting work load hours into the number of people required to complete that work

KPU Setting Capacity Measure

Dentistry

Full Time Equivalent (FTE)

Nursing

Medical

Allied Health

Management and Support

Assumptions used for the Demand Assessment

− The reference population is representative of demand for clinical services in Dubai and its

surrounding catchments

− BOD adjustments accurately represent disease and clinical service demand patterns in Dubai and

its surrounding catchments

− The clinical practices and outcomes of the reference population illustrate utilization and clinical

distribution profiles that can be achieved in Dubai clinical services

− The services excluded from the scenario modeling will not be included under Mandatory Health

Insurance

− DRG based age and gender specific per capita rates are the best available method for projecting

future clinical service capacity demand

− Key Planning Unit measures are sufficient to define and measure clinical service capacity

Table 6: Manpower KPUs


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3.4.2 Supply Assessment – Survey of Existing Clinical Services

Supply is the total amount of a service that is available for use by a customer. Supply is defined in this

study as the clinical services reported by survey respondents as being available at their facility.

The survey was deployed to enable data collection via electronic and paper based forms. The purpose

of the survey was to collect clinical services infrastructure and manpower data

Six individually tailored survey forms were developed and deployed in the following clinical service

facilities:

− Hospitals

− Polyclinics

− Dental Clinics

− Specialty Clinics

− Primary Health Clinics

Specific questions varied according to the type of facility being surveyed, and included the following

categories:

− Name, address, lot number, contact details and establishment details

− Operating hours and appointment process

− Transport and car parking information

− Full time equivalent for major clinical manpower categories

− Inpatients, outpatients, including surgeries performed

− Nationality and residency of patients

− Clinical services including sub-specialties according to:

Personnel by key manpower categories (specialists and consultants)

Bed occupancy rate and average length of stay

Total admissions (inpatient) and outpatient visits

− Number of operating theater rooms

− Number of functional and non-functional beds

− Accident and Emergency resources

− Health Informatics

− International Classification of Diseases and Procedure coding used

− Major medical equipment


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Separate survey techniques were used for Hospitals and Outpatient Clinics that included a

combination of telephone interviews and facility visits. A team of eight surveyors were engaged in the

collection of data, 5 for telephone surveys and 3 for face to face hospital surveys

Hospital Surveys

Each hospital was visited by a surveyor who distributed the survey forms to a senior hospital executive

team. All contents of the survey form were explained and clarifications provided on request. A two

week period was allowed for hospitals to complete the survey forms and return them, electronically or

as a hard copy.

A more detailed, sub-module of the survey was conducted at Rashid hospital to identify the number of

chronic patients (patients who have stayed for longer than 30 days) occupying acute beds, to

categorize them by type of extended healthcare services needed (homecare services, long-term

healthcare facilities, sending expatriates home with supportive aids).

Outpatient Clinic Surveys

Outpatient clinic surveys were conducted by telephone interview at a scheduled time. A follow up

interview was scheduled if a respondent was not available or they required time to gather information.

Further follow up was under-taken after a detailed review of each survey to ensure data requests were

completed

Data Entry, Review and Analysis

Returned surveys were stored in a Health Facility Briefing System (HFBS) and were reviewed using an

automated survey tool. The returned forms were examined to identify inconsistencies and missing

data. The survey forms were checked to correct inconsistencies and/or collect missing data. This

procedure was repeated up to 5 times to increase response rates and accuracy of data. Detailed

elements in all surveys were examined to identify missing data and specific survey responses were

weighted by a facility specific correction factor to complete population estimates

In cases where data was not sufficiently reported in the surveys, DHA official statistics were used to

supplement estimates. Two areas of clinical supply were specifically supplemented and blended with

additional data:


25

− Overnight bed estimates for clinical specialties where hospital respondents did not differentiate

their beds by specialty

− Numbers of Physicians by specialties were reconciled with previously published information

Data were formatted into spreadsheet pivot tables for supply summations and capacity gap analysis

Planned Future Health Facilities

A sub-module survey of planned health facilities was also conducted. This information was gathered

from DHA’s Health Regulation Department, market intelligence and direct contact with prospective

providers

Assumptions Used for the Supply Assessment

− The response rate of the survey (77%) is sufficient to provide reliable supply estimates for non-

responding facilities, after adjustment

− Respondents uniformly and correctly understood the terminology and classifications used in the

survey forms. Effort was spent on clarifying the survey forms with all facilities

3.4.3 Gap Assessment – Dubai Clinical Service Catchment Assessment

Supply and planned capacity growth estimates were compared against two scenario’s demand

projections ( ref chapter 4) to quantify the gaps in supply. The assessment covered each service type

and manpower classification for Dubai’s clinical service catchment as distributed by sectors. A detailed

service specialty gap analysis was provided for clinical specialty beds and medical manpower


26

Assumptions used for Gap Assessment

− The following services were excluded from the demand profile of each scenario because they will

not be covered by MHI:

Abortions

Bone marrow and organ transplants

Sports related injuries

Long term mental health care

Alcohol and Drug abuse related conditions

Plastic Surgery for cosmetic purposes, (it is added to the gap assessment in the update

in hand, after the approval of Medical Tourism Strategy (MTS) which identified plastic

surgery as one of seven specialties to be promoted in phase one of the implementation

of MTS (2013-2020))

− It was assumed that Intensive Care KPU and the Dental and Oral Health services manpower

demand will not be significantly impacted by scenario differences. The SQ and MHI scenarios are,

therefore, equivalent for these indicators.

3.4 Review of Findings – Stakeholder consultations

Key stakeholders workshops were held periodically throughout the study with government and private

clinical services sectors. These consultations were carried out to confirm and validate findings, report

on study progress, results and agree on assumptions

3.5 Recommendations & Priority Setting

Priorities have been set as per the identified gaps in healthcare services for the period 2014 until 2025

based on the rating given below in figure 14:

High Priority with greater than a 10% deficit in total supply gap

Medium Priority with greater than or equal to a 3% deficit in total supply gap

Low Priority with less than a 3% deficit in total supply gap

A recommendation matrix was developed using a Priority, Recommendation and Action

Framework

Figure 14: Rating definition


27

4 FINDINGS & ANALYSIS

4.1 Demand

Two scenarios were developed to identify Dubai’s demand for clinical capacity until 2025: namely the

Status Quo (SQ) Scenario and the Mandatory Health Insurance (MHI) Scenario. As presented in this

chapter, these scenarios utilize the medium population growth as a population base for calculating the

demand till 2025. Both scenarios were adjusted for specific local conditions, including; Burden of

Disease, Doctor Availability, Geographic Location, Socio-economic Status, Life Expectancy and

Hospital Bed Supply as well as the trends in the service delivery models. The only period where the

high population scenario is used in this report is 2015-2020 to accommodate for Expo 2020 and the

first two phases of the Medical Tourism Strategy (the full DCSCP will be repeated before the year

2020 to accommodate for the third phase of the MTS.

4.1.1 Status Quo Scenario (SQ): The Status Quo scenario (assuming absent of mandatory health

insurance) assumes that the same proportion of nationals and non-nationals will access clinical

services, i.e. the healthcare utilization levels among the population will remain same in the future

period, as in 2011, but the population size will grow as per three defined growth rate scenarios.

4.1.2 Mandatory Health Insurance Scenario (MHI): The MHI assumes that the proportion of

nationals and non-nationals accessing healthcare in Dubai will increase leading to an increase in the

level of utilization of healthcare services.

4.1.3 Total Demand for KPUs by SQ and MHI Scenarios

Table 7 summarizes the demand projections for Status Quo and MHI demand scenarios. KPU

projections by these two demand scenarios contrast the differences in demand for Beds, Outpatient

Rooms and Operating Theaters, while ICU demand is assumed to be unchanged. Emergency

Department demand is projected to be lower under MHI compared to the SQ as more patients use

outpatient centers for treatment as needed.


28

Total KPU demand is projected to increase from 5,450 in 2011 to 11,997 in 2025 under the SQ and

from 6,926 to 15,394 under the MHI. Overall the difference between the two demand scenarios for

total KPU ranges from 27% in 2011 to 34% in 2025. More hospital beds are projected under the MHI

scenario

Table 8 below shows demand for each scenario by sectors

− Projected demand is greatest in sectors 1, 3 and 5, which are projected to account for 75% of

demand in 2025

− Within sectors, projected demand is consistently greatest for Acute Beds, followed by Outpatient

Rooms

− Total KPU demand is projected to increase by 220% under both scenarios from 2011 to 2025

− Almost 20% of Dubai’s total projected 2025 SQ demand is in Sector 3 for Total Beds (Acute, Non-

Acute and ICU)

− Projected demand in sectors 7, 8 and 9 is 3% of total Dubai demand in 2025

KPU Type Status Quo Demand MHI Demand

2011 2025 2011 2025

Sector 1

Acute Beds 505 1,063 779 1,630

Non Acute Beds 17 43 27 66

Emergency Department

Cubicles 53 137 53 130

Intensive Care Beds 45 93 45 93

Operating Theaters 21 40 28 53

Outpatient Rooms 464 954 475 1,019

Total 1,107 2,329 1,407 2,990

Key Planning Indicator

SQ Demand MHI Demand

2011 2015 2020 2025 2011 2015 2020 2025

Total Beds 2,573 3,233 4,835 5,693 3,966 4,972 6,698 8,728

ICU Beds 224 278 371 477 224 278 371 477

Emergency Department Cubicles

262 346 546 704 262 314 477 669

Operating Theaters 103 126 193 206 136 166 255 272

Total Outpatient Rooms

2,288 2,580 3,548 4,417 2,338 2,704 3,704 5,248

Total KPUs 5,450 6,563 9,493 11,997 6,926 8,434 11,505 15,394

Table 7: KPU Demand Projections by Scenario, 2011 – 2025.

Table 8: Projected Key Planning Unit Demand by Scenario and Sector, 2011 & 2025 (cont.)

Note: Total Beds include both acute and non-acute beds


29

KPU Type Status Quo Demand MHI Demand

2011 2025 2011 2025

Sector 2

Acute Beds 521 585 804 897



Cubicles 55 75 55 72



Outpatient Rooms 480 525 491 561

Total 1,143 1,283 1,453 1,646

Sector 3

Acute Beds 975 2,025 1,502 3,104



Cubicles 103 261 103 248



Outpatient Rooms 898 1,824 918 1,949

Total 2,138 4,448 2,717 5,709

Sector 4

Acute Beds 31 140 48 215



Cubicles 3 18 3 17




Total 70 311 88 398

Sector 5

Acute Beds 320 1,028 493 1,577



Cubicles 34 132 34 125




Total 698 2,247 888 2,885

Sector 6

Acute Beds 94 454 145 696



Cubicles 10 58 10 55




Total 206 991 262 1,273

Table 8: Projected Key Planning Unit Demand by Scenario and Sector, 2011 & 2025 (cont.)


30

Sectors 7, 8 and 9

Acute Beds 40 175 62 268



Cubicles 4 23 4 21




Total 88 384 112 492

Total Dubai

Acute Beds 2,487 5,469 3,833 8,385



Cubicles 262 704 262 669



Outpatient Rooms 2,288 4,912 2,338 5,248

Grand Total 5,450 11,992 6,926 15,394


31

Figures 15 & 16 show the Hospital KPU clinical services capacity projections by consolidated service

types and specialties for both scenarios.

Under the SQ scenario

Emergency Departments are projected to increase to be the highest KPU volume followed by

Neonatology, Psychiatry, Obstetrics & Gynecology, Orthopedics and Trauma. Gastroenterology and

Gastrointestinal Surgery are projected as the most significant high volume specialties. The following

specialties projected to have the highest growth rates between 2011 and 2025

− Psychiatry

− Emergency Department

− Intensive Care

− Immunology and Infections

− Cardiology including Interventions

− Neonatology

0 100 200 300 400 500 600 700 800

Psychiatry

Obstetrics & Gynecology

Orthopedics & Trauma

Gastroenterology & Gastrointestinal Surgery


Neonatology (including NICU)

Pediatrics

Intensive Care

General Surgery

Rehabilitation/Long Term Care

Renal Dialysis

Cardiology including Interventions

Endocrine, Renal and Urological

Immunology & Infections

Neurosciences

Respiratory Medicine

Oncology & Hematology

General Medicine & Ungrouped

Plastic, Skin & Breast

Ear, Nose, Throat & Eyes

Cardiothoracic & Vascular

2025 2020 2015 2011

Figure 15: SQ Hospital KPU Demand Projections by Consolidated Service Types and Specialties


32

Under the MHI scenario

Psychiatry, Obstetrics & Gynecology, Orthopedics and Trauma and Gastroenterology, Gastrointestinal

Surgery and Emergency Departments are projected as the most significant high volume specialties

The following specialties projected to have the highest growth rates between 2011 and 2025

− Psychiatry

− Immunology and Infections

− Renal Dialysis

− Emergency Departments

− Cardiology including Interventions

− Neonatology

− Ear, Nose, Throat and Eyes

− Rehabilitation and Long Term Care

0 200 400 600 800 1,000 1,200

Psychiatry




ED cubicles

Neonatology (including NICU)

Pediatrics

Intensive Care

General Surgery


Renal Dialysis

Cardiology including Interventions

Endocrine, Renal and Urological


Neurosciences



General Medicine & Ungrouped




2025 2020 2015 2011

Figure 16: MHI Hospital KPU Demand Projections by Consolidated Service Types and Specialties


33

4.1.4 Manpower Capacity Demand Results by SQ and MHI

Manpower demand is projected to grow for all key categories, with Dentist demand not expected to be

affected by MHI. Nurses and Management and Support Staff for both scenarios will be higher in

demand by 2025 as shown in table 9

− Demand for Medical Manpower is projected to almost double under both scenarios with an

increase of 7.4% under MHI compared to SQ

− Demand for Nurses and Allied Health is projected to increase significantly in both scenarios. Both

categories are projected to increase by 16% under MHI compared to SQ

Key

Planning

Indicator

Scenario 1 - SQ Demand Scenario 2 - MHI Demand

2011 2015 2020 2025 2011 2015 2020 2025

Medical 4,102 6,035 12,906 14,668 5,860 8,231 13,881 15,740

Nurses 10,966 13,322 19,066 21,852 11,124 15,055 21,289 25,428

Dentists 920 1,293 1,713 2,351 920 1,293 1,713 2,351

Allied Health Practitioners

4,719 6,353 9,215 13,047 4,787 7,179 10,285 15,182

Management & Support Personnel

4,388 6,589 10,235 20,767 4,451 7,445 11,424 24,165

Total FTE 25,095 33,592 53,135 72,685 27,142 39,203 58,592 82,866

Assessment of Clinical Manpower, as percentage of the population, shows that demand is projected to

increase from 1.3% to 1.6% under SQ and from 1.4% to 1.8% under MHI. The difference between the

two scenarios ranges from 8% in 2011 to 14% in 2025.

Table 9: FTE Demand Projections by Scenario, 2011 – 2025.


34

The following two figures (17 & 18) show the projected changes in demand for Medical Manpower

Specialties through 2025. Except for specific FTE volumes, the following findings apply to both

scenarios

− Primary Care & General Practice is projected as the specialty with the highest demand across the

planning period composing 53% of projected Medical Manpower capacity

− Anesthesia, Psychiatry, Obstetrics and Gynecology, Pediatrics & Child Health, General Surgery

and Cardiology are the highest volume Medical specialties

− The following specialties are projected to have the strongest growth from 2011 to 2025:

Plastic Surgery (mainly due to the implementation of the Medical Tourism Strategy)

General Surgery

Cardiology

Otolaryngology

Medical Oncology

0 2,000 4,000 6,000 8,000 10,000

Primary Care & General…

0 100 200 300 400 500 600 700 800 900 1,000

Anesthesia

Psychiatry

Obstetrics and Gynecology

Pediatrics and Child Health

General Surgery

Cardiology

Emergency Medicine

Radiology

Other Surgery

Ophthalmology

Orthopedic Surgery

General Medicine

Gastroenterology and Hepatology

Otolaryngology

Intensive Care

Endocrinology

Nephrology

Dermatology

Plastic Surgery

Medical Oncology

Clinical Pathology

Geriatric medicine

Neurology

Radiation oncology

2025 2020 2015 2011

Figure 17: SQ Medical Manpower FTE Demand Projections by Clinical Specialty, 2011 – 2025.


35

0 2,000 4,000 6,000 8,000 10,000

Primary Care & General…

0 200 400 600 800 1,000 1,200

Anesthesia

Psychiatry


Pediatrics and Child Health

General Surgery

Cardiology

Emergency Medicine

Radiology

Other Surgery

Ophthalmology

Orthopedic Surgery

General Medicine

Gastroenterology and…

Otolaryngology

Intensive Care

Endocrinology

Nephrology

Dermatology

Plastic Surgery

Medical Oncology

Clinical Pathology

Geriatric medicine

Neurology

Radiation oncology

2025 2020 2015 2011

Figure 18: MHI Medical Manpower FTE Demand Projections by Clinical Specialty, 2011 – 2025.


36

4.2 Supply

Overall 1,102 facilities were surveyed providing a weighted (by volume of inpatients and outpatients)

response rate of 77%. The surveys took place late 2012, therefore the baseline of the study is 2011

data. All hospitals were fully covered (100%) and the lowest response rate was found among General

Clinics with 60% response rate (table 10). Listed clinics which were not covered included those still

being built, recently closed or did not have accessible contact information

The survey results presented in this section are described in sufficient detail so that they can be

compared against the demand analysis presented in the next section of the report

The narrative of this section is provided to highlight capacity distribution and utilization of services by

KPUs and population sectors. These observations have been used to supplement the capacity gap

analysis and the formation of priorities and recommendations.

Facility Type Surveys

Distributed Surveys Returned

Response Rate

Hospitals 27 27 100%

Polyclinics 379 283 75%

Specialty Clinics 144 97 67%

Dental Clinics 141 106 75%

General (Primary)

Clinics 411 247 60%

Total 1102 760 77%*

Table 10: Distribution of surveys and response rates by facility type

Note: *Weighted by volume of inpatients and outpatients


37

The number of facilities in each of Dubai’s sectors is summarized in table 11 below:

Clinical Service Type

Facility Classifica

tion

Sector Total

1 2 3 4 5 6 7 8 9

Dental Clinics

MOH 1 1

Private 47 15 73 2

2

1

140

Total 47 15 74 2 0 2 0 1 0 141

Hospitals

DHA 1 2 1

4

MOH 1

1 2

Private 4 4 11

2 21

Total 6 4 14 0 2 0 0 1 0 27

Polyclinics Private 75 59 212 5 14 14 0 0 0 379

Primary Health (General) Clinics

DHA 4 4 3 2 1 14

MOH 2 4 2 1 9

Private 64 101 170 8 24 19

2

388

Total 70 109 175 10 24 21 0 2 0 411

Specialist Clinics

DHA 1

6 7

Private 29 14 91 1

2 137

Total 30 14 97 1 0 2

0 0 144

Grand Total 228 201 572 18 40 39 0 4 0 1,102

Table 11: Distribution of facilities surveyed

Note: The Private includes Dubai Healthcare City (DHA) data throughout the study


38

4.2.1 Residency of Patients

All clinical services were surveyed for nationality and status of admissions for the year of 2011. Of the

1102 services surveyed, 649 responded to this section of the survey (59%). Figure 19 below shows

that General Clinics reported the highest proportion of services provided to Non-Emiratis, while

Hospitals, Specialist Clinics, Dental clinics and Polyclinics reported the highest proportion of services

provided to Emiratis.

4.2.2 Hospital Infrastructure

The Dubai Annual Health Statistical Report 2011 supplemented survey results. Average length of stay

was calculated using the number of inpatients and functional beds and the bed occupancy rate.

Summary results and selected bed rates are presented in tables (12 & 13).

The following observations are made from the results, and are presented in the tables below:

− The majority of hospital beds are concentrated in the highly populated and central city sectors of 1

and 3. Hospitals are spread out in smaller volumes to the sectors of 2, 5, and 8

− 50% of beds are reported in Sector 3. 36% of beds are reported in Sector 1, 11% reported in

Sector 2, 3% are reported across Sectors 5 and 8

− DHA’s Dubai Hospital is the largest hospital by reported bed number, while DHA’s Latifa Hospital

and the private American Hospital reporting greater numbers of encounters than Dubai Hospital

0% 20% 40% 60% 80%

Dental Clinic

GeneralClinic

Hospital

Polyclinic

SpecialistClinic

Emirati from Dubai Emirati from Other Emirate

Non-Emirati, Non-Resident Non-Emirati Resident

Figure 19: Proportion of Nationality Status Group per Clinical Service Facility Type. n=649.


39

− Six private hospitals reported over 100 functional beds

− Private hospitals reported an average of 68 beds per hospital. Government hospitals reported an

average of 305 functional beds per hospital

− Occupancy rates at private hospitals vary considerably from 15% to 90%

− The reported occupancy rates at Government hospitals were all above 70%, with Dubai Hospital

reporting the highest rate of 76%

− Average length of stay (ALOS) varies considerably amongst private hospital from one to 17.2 days

with 19% of hospitals reporting ALOS of greater than three days

− Government hospitals reported ALOS of 2.8 days to 7.8 days, with three reporting ALOS of over

three days

− All private hospitals reported Emergency Rooms with numbers ranging from 6 or less rooms in 7

hospitals to 10 or more rooms in 7 other hospitals

− All hospitals with the exception of Al Amal, which is a psychiatric hospital, reported Operating

Theaters (OT). The Dubai, Rashid and Saudi German hospitals reported 9 or more OT rooms


40

Hospital

Cla

ssif

icati

on

En

co

un

ters

Ad

jus

ted

Fu

nc

tio

na

l

Bed

s

No

n-

Fu

nc

tio

na

l

Bed

s

ICU

be

ds

Em

erg

en

cy

Ro

om

s

Op

era

tin

g

Th

eate

r

Ro

om

s

Avera

ge

L

en

gth

of

Sta

y (

da

ys)

Avera

ge

Bed

Occu

pa

ncy

Rate

(%

)

Sector 1

Al Baraha MOH 7,151 154 28 11 9 4 4.0 51

Belhoul Specialty

Private

4,849 93 3 23 4 3.3 50*

Canadian Specialist

4,148 142 64 12 10 5 1.8 15

Dubai DHA 24,494 731 77 59 12 10 4.2 76

Gulf Specialty

Private

129 5 1 4 1 2.4 17*

New Medical Center

1,108 10 1 8 2 1.1 34*

Total 41,879 1,135 169 87 66 26

Sector 2

Al Garhoud

Private

1,508 42 6 4 3 2 20

N.M.C. Specialty

5,928 107 24 7 5 1.9 40*

Welcare 12,091 125 26 10 4 3.4 90*

Zulekha 10,769 81 13 1 4 2.2 85

Total 30,296 355 0 69 22 16 2.6 67.4

Sector 3

Al Amal MOH 23,636 80 n/a n/a

The City

Private

14,248 227 42 16 6 3.4 60*

Al Rafa 2,543 14 2 2 1.6 80*

American 37,780 172 15 5 0.8 50*

Belhoul European

2,077 10 1 2 1.5 86*

Dubai London Specialty

470 7 3 2 n/a n/a

Emirates 2,983 21 4 1 38*

International Modern

5,779 65 9 14 5 2.9 70

Iranian 11,170 127 16 18 6 2.6 62

Latifa DHA 24,769 300 66 14 6 2.8 70*

Medcare Private

9,103 58 13 3 2 90*

Neuro Spinal 611 37 8 5 3 17.2 78

Rashid DHA 15,524 468 72 48 9 7.8 71

Saudi German

Private 1,654 89 230 4 14 10 n/a n/a

Total 152,347 1,675 230 246 134 63 4.3 67.7

Sector 5

Cedars - Jebel Ali International Private

1,109 12 2 6 2 1.4 36*

Lifeline 1,529 30 20 4 3 2 n/a n/a

Total 2,638 42 20 6 9 4 1.4 36

Sector 8

Hatta DHA n/a 47 45 6 10 4 n/a 3

Grand Total 227,160 3,254 464 414 241 113 3.9 64.3

Table 12: Hospitals and Key Indicators by Sector and Classification for 2011.

Source: Dubai Annual Health Statistical Report 2011a: pp. 96, 142-143 Note: Adjusted Functional Beds’ are a blend of surveyed functional beds and specialty beds and they include Dialysis

Units

Note: Adjusted Functional Beds’ are a blend of surveyed functional beds and specialty beds and they include Dialysis Units

Note: Adjusted Functional Beds’ are a blend of surveyed functional beds and specialty beds and they include Dialysis Units


41

Hospital Classification

Rate per 100 Functional Beds

ICU Emergency

Rooms Operating Theaters

Sector 1

Al Baraha MOH 7.4 3.4 2.0

Belhoul Specialty

Private

3.2 24.7 4.3

Canadian Specialist

8.5 7.0 3.5

Dubai DHA 8.1 1.6 1.4

Gulf Specialty

Private

20.0 80.0 20.0

New Medical Center

10.0 80.0 20.0

Total 7.5 5.3 2.1

Sector 2

Al Garhod

Private

14.3 9.5 7.1

N.M.C. Specialty 22.4 6.5 4.7

Welcare 20.8 8.0 3.2

Zulekha 16.0 1.2 4.9

Total 19.4 6.2 4.5

Sector 3

Al Amal MOH 0.0 0.0 0.0

The City

Private

18.5 7.0 2.6

Al Rafa 0.0 14.3 14.3

American 8.7 0.0 2.9

Belhoul European

10.0 0.0 20.0


0.0 42.9 28.6

Table 13: KPU Rates per 100 Functional Beds


42

Hospital Classification

Rate per 100 Functional Beds

ICU Emergency

Rooms Operating Theaters

Sector 3

Emirates

Private

0.0 0.0 19.0


13.8 21.5 7.7

Iranian 12.6 14.2 4.7

Latifa DHA 22.0 4.7 2.0

Medcare

Private

22.4 0.0 5.2

Neuro Spinal 21.6 13.5 8.1

Rashid DHA 15.4 10.3 1.9

Saudi German Private 4.5 15.7 11.2

Total 14.7 8.0 3.8

Sector 5

Cedars - Jebel Ali International

Private

16.7 50.0 16.7

Lifeline 13.3 10.0 6.7

Total 14.3 21.4 9.5

Sector 8

Hatta DHA 12.8 21.3 8.5

Grand Total 12.6 7.2 3.4

Table 13: KPU Rates per 100 Functional Beds (cont.)


43

The 27 hospitals in Dubai provide a range of specialty clinical services which are listed in table 14,

with the number of hospitals which reported activity in the service. Almost all hospitals reported a

range of clinical specialties in Anesthesia and Intensive Care services, while six hospitals provide

Oncology specialties

Clinical Service Number of Hospitals (Total Hospitals = 27)

Anesthesia & Intensive Care 26

Laboratory Services 26

Clinical Imaging Services 25

Other Surgical Services 25

Other Medical Services 24

Physical Medicine & Rehabilitation Services 23

Obstetrics & Gynecology Services 22

Pediatric Services 22

Cardiac Services 21

Orthopedic Services 21

ENT Services 20

Dental Services 19

Urological Services 19

Ophthalmology Services 18

Neuroscience Services 15

Psychiatry/ Psychology Services 13

Oncology Services 6

The summary of ICU beds reported in the survey is provided in table 15 with a breakdown of specialty

ICU beds by sector and hospital classification. The survey findings indicate:

− The 13 hospitals in Sector 3 reported 58% of Dubai’s ICU beds. 23% of ICU beds are reported in

Sector 1, 16% are reported in Sector 2, and Sectors 5 and 8 both report 3% of Dubai’s ICU beds.

− Private and DHA hospitals each reported 48% of total ICU beds and MOH hospitals report the

remaining 4% of ICU beds in Dubai

Table 14: Number of Hospitals Offering Specific Clinical Services.

Note: ‘Number of Hospitals’ is the number of hospitals reporting that service out of the total 27 hospitals

surveyed


44

− All pediatric ICU beds are reported by private hospitals in Sector 2

− 51% of ICU beds are classified as Adult ICU, 38% are Neonatal ICU beds, 5% are Coronary Care

Units, 4% are Cardiac Surgery Units and 2% are Pediatric ICU beds. With the exception of

Coronary Care beds this distribution is unexceptional. It may be the case that some hospitals did

not define Coronary Care beds as ICU leading to a lower proportion

.

ICU Service

Classification

Sector Total

1 2 3 4 5 6 7 8 9

Adult ICU

DHA 18 n/a 64 6 88

MOH 5 n/a

5

Private 16 26 63 6

111

Total 39 26 127 0 6 0 0 6 0 204

Pediatric ICU

DHA n/a n/a 0

MOH n/a 0

Private 10

10

Total 0 10 0 0 0 0 0 0 0 10

Neonatal ICU

DHA 32 n/a 48

80

MOH 12 n/a

12

Private 31 45

76

Total 44 31 93 0 0 0 0 0 0 168

Cardiac Surgery ICU

DHA 9 n/a 6 15

MOH n/a 0

Private 2

2

Total 9 2 6 0 0 0 0 0 0 17

Coronary Care Unit

DHA n/a n/a 20 20

MOH 6 n/a 6

Private 1

1

Total 7 0 20 0 0 0 0 0 0 27

Grand Total 99 69 246 0 6 0 0 6 0 426

Table 15: Intensive Care Unit Beds per Sector

Note: Sectors 4, 6, 7 & 9 do not have hospitals, and therefore ICU infrastructure is not reported for these sectors.


45

Table 16 shows the Accident, Trauma and Emergency rooms reported in the survey:

− In Sector 3, 60% of the total Emergency KPUs account for 55% of all emergency visits

− All Emergency KPUs are reported as predominately located in Sector 3, and the two hospitals in

Sector 5 have one examination cubicle and one minor OT room between them

Sector

Total 1 2 3 4 5 6 7 8 9

Total Emergency Visits

154,405 95,104 244,835 0 40,415 0 0 6,921 0 541,680

Total Dubai Emergency visits = 2,708 per 10,000 population

Emergency Department KPUs:

Emergency cubicles

49 17 79 1 7 153

Minor operating theater

3 2 10 1 1 17

Resuscitation rooms

5 2 13 3 1 24

Emergency Rooms

7 1 32 4 1 45

Total Rooms 64 22 134 0 9 0 0 10 0 239

.

Further observations from the survey on Emergency Department (ED) are as follows:

− Hospitals in Sector 1 have the highest emergency visit rate per capita for 64 total ED KPUs

− Sector 3 reported the highest concentration of all ED room types (56%), with 2,624 emergency

visits per 10,000 sector population. Sector 1 reported 27% of all ED room types, while 17% of ED

services are located throughout sectors 2, 5 and 8

Table 16: Accident, Emergency and Trauma Visits and Rooms by Sector.

Note 1: Sectors 4, 6, 7 & 9 do not have hospitals, and therefore Accident, Emergency and Trauma activity is not reported for these sectors


46

4.2.3 Hospital Medical Equipment Infrastructure

The results for medical equipment are shown in table 17

Hospital

Cla

ssif

icati

on

Bo

ne

Den

sit

om

ete

r

Cath

ete

r L

ab

CT

Scan

ne

r

Dia

lysis

Un

it

Gam

ma K

nif

e/

Dete

cto

r

Gam

ma C

am

era

Lit

ho

trip

sy

Lo

w S

pe

ed

Han

d

pie

ce

Ma

mm

og

rap

hy

U

nit

/

Ma

mm

og

ram

MR

I

Ult

raso

un

d

Ma

ch

ine

X R

ay U

nit

Sector 1

Al Baraha MOH 1 1 1 1 1 7 4

Belhoul Specialty

Private

1 1 1 4 1 4 1 1 4 2

Canadian Specialist

2 1 1 6 1 11 2 1 10 5

Dubai DHA 1 1 1 61 1 3 1 1 1 30 4

Gulf Specialty

Private

1 1

New Medical Center

1 2 2

Total 5 3 4 71 1 3 3 16 6 5 53 18

Sector 2

Al Garhoud

Private

1 1 1 1 6 2

N.M.C. Specialty

1 1 1 3 1 6 1 1 8 1

Welcare 1 1 1 1 1 20 4

Zulekha 1 1 1 4 1 1 1 12 3

Total 2 3 4 8 0 0 3 6 4 4 46 10

Sector 3

Al Amal MOH

The City

Private

1 1 1 9 1 1 1 1 16 8

Al Rafa 3 1

American Hospital

1 1 2 7 1 1 1 1 9 6

Belhoul European

1 1 1 1

Table 17: Medical Equipment at Hospitals by Sector.


47

Hospital

Cla

ssif

icati

on

Bo

ne

Den

sit

om

ete

r

Cath

ete

r L

ab

CT

Scan

ne

r

Dia

lysis

Un

it

Gam

ma K

nif

e/

Dete

cto

r

Gam

ma C

am

era

Lit

ho

trip

sy

Lo

w S

pe

ed

Han

d

pie

ce

Ma

mm

og

rap

hy

Un

it/

Ma

mm

og

ram

MR

I

Ult

raso

un

d

Ma

ch

ine

X R

ay U

nit

Sector 3 (cont.)


Private

Emirates 1 1 7 1


1 1 1 1 4 2

Iranian 1 1 1 1 1 1 1 8 2

Latifa DHA 4 21 5

Medcare

Private

1 1 2 1 12 1 1 9 2

Neuro Spinal

1 1 1 1 1

Rashid DHA 2 2 1 1 6 7

Saudi German

Private 1 1 1 4 1 1 2 1 1 7 3

Total 5 8 10 23 0 3 6 18 9 9 92 39

Sector 5

Cedars - Jebel Ali International

Private

1 1 1 5

Lifeline 1 1 1 1 1

Total 0 0 2 0 0 0 1 0 2 0 2 6

Sector 8

Hatta DHA 1 3 2

Grand Total 12 14 21 102 1 6 13 40 21 18 196 75

Table 17: Medical Equipment at Hospitals by Sector (cont.)


48

The survey indicated (figure 20) that ultrasound machines are the most prevalent equipment type in

hospitals, followed by dialysis units and X-Ray units.

− 47% of ultrasound machines are in Sector 3 and 33% of ultrasound machines are in Government

hospitals

− 70% percent of dialysis units are located in Sector 1

The equipment summary is limited to what was surveyed, which is the most important and common

equipment, and does not capture all types of equipment

0 50 100 150 200 250

Ultrasound Machine

Dialysis Unit

X Ray Unit

Low Speed Handpiece

Mammography Unit/ Mammogram

CT Scanner

MRI

Lithotripsy

Bone Densitometer

Catheter Lab

Gamma Camera

Gamma Knife/Detector

Number of equipment

Figure 20: Total Medical Equipment Supply in Dubai, 2011.


49

4.2.4 Hospital Manpower

The survey identified manpower categories working across Dubai’s hospitals. Table 18 presents

medical and non-medical manpower from the survey, and FTE ratios. In summary:

− 52% of Medical FTEs are reported in Sector 3. 28% are in Sector 1, 14% in Sector 2 and 6% are

throughout sectors 5 (2.5%) and 8 (3.5%)

− Hospitals reported an average of 393 Total FTEs per hospital. 7 hospitals reported an above

average number of FTEs of which four were Government hospitals

− The survey reports an average of 227 Nurses per hospital, with three hospitals reporting less than

50 Nurses, and 8 reporting at over 200 Nurses

− 49% of Allied Health manpower is in private hospitals. 7% is in MOH hospitals and 44% in DHA

hospitals

− Physician to Functional Bed ratios ranged from 0.3 to 5.3. Nurse to Functional Bed ratios were

higher, given the larger number of Nurse FTEs in Dubai. Ratios ranged from 0.9 to 7.5

− Overall, Dubai’s Physician to Nurse Ratio is 0.45 compared to United States (0.23), United

Kingdom (0.28) and Australia (0.3).


50

.

Hospital

Cla

ss

ific

ati

on

Me

dic

al

Nu

rse

s

All

ied

He

alt

h

To

tal

FT

Es

Ad

jus

ted

Fu

nc

tio

na

l

Be

ds

No

n-

fun

cti

on

al

be

ds

Ph

ys

icia

ns

:

Fu

nc

tio

na

l

Be

ds

Nu

rse

s:

Fu

nc

tio

na

l

Be

ds

Ph

ys

icia

ns

:

Nu

rse

s

Sector 1

Al Baraha MOH 97 216 98 411 154 28 0.8 1.0 0.8

Belhoul

Specialty Private

60 200 13 273 93 0.6 2.2 0.3

Canadian

Specialist 88 184 51 323 142 64 0.6 1.3 0.5

Dubai DHA 455 1,018 321 1,794 731 77 0.6 1.4 0.4

Gulf Specialty

Private

3 11 3 17 5 0.6 2.2 0.3

New Medical

Center 53 75 19 147 10 5.3 7.5 0.7

Total 756 1,704 505 2,965 1,135 169 0.7 1.4 0.5

Sector 2

Al Garhoud

Private

67 88 28 183 42 1.6 2.1 0.8

N.M.C.

Specialty 119 262 74 455 107 1.1 2.4 0.5

Welcare 98 219 14 331 125 0.8 1.8 0.4

Zulekha 109 189 15 313 81 1.3 2.3 0.6

Total 393 758 131 1,282 355 0 1.1 2.1 0.5

Table 18: Hospital Manpower for all Key Categories by Sector

Note: Physicians comprise GP’s Registrars, Interns/Residents, Consultants and Specialists.


51

Hospital

Cla

ss

ific

ati

on

Me

dic

al

Nu

rse

s

All

ied

He

alt

h

To

tal

FT

Es

Ad

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ted

Fu

nc

tio

na

l

Be

ds

No

n-

fun

cti

on

al

be

ds

Ph

ys

icia

ns

:

Fu

nc

tio

na

l

Be

ds

Nu

rse

s:

Fu

nc

tio

na

l

Be

ds

Ph

ys

icia

ns

:

Nu

rse

s

Sector 3

Al Amal MOH 26 74 6 106 80 0.3 0.9 0.4

The City

Private

80 287 90 457 227 0.4 1.3 0.3

Al Rafa 27 46 13 86 14 1.9 3.3 0.6

American 124 268 252 644 172 0.7 1.6 0.5

Belhoul

European 27 51 13 91 10 2.7 5.1 0.5

Dubai London

Specialty 17 19 36 7 2.4 2.7 0.9

Emirates 48 83 46 176 21 2.3 4.0 0.6

International

Modern 60 93 27 180 65 0.9 1.4 0.6

Iranian 148 168 58 374 127 1.2 1.3 0.9

Latifa DHA 220 622 275 1,117 300 0.7 2.1 0.4

Medcare Private

69 185 51 305 58 1.2 3.2 0.4

Neuro Spinal 16 87 22 125 37 0.4 2.4 0.2

Rashid DHA 471 1,300 131 1,902 468 1.0 2.8 0.4

Saudi German Private 91 121 27 239 89 230 1.0 1.4 0.8

Total 1,424 3,404 1,011 5,838 1,675 230 0.9 2.0 0.4

Sector 5

Cedars - Jebel

Ali

International Private 23 55 23 101 12 1.9 4.6 0.4

Lifeline 47 86 27 160 30 20 1.6 2.9 0.5

Total 70 141 50 261 42 20 1.7 3.4 0.5

Sector 8

Hatta DHA 99 130 37 266 47 45 2.1 2.8 0.8

Grand Total 2,742 6,137 1,734 10,612 3,254 464 0.8 1.8 0.5

Table 18: Hospital Manpower for all Key Categories by Sector (cont.)

Note: Physicians comprise GP’s Registrars, Interns/Residents, Consultants and Specialists.


52

4.2.5 Hospitals and “Clinics” Outpatient Clinical Services Infrastructure

An outpatient room is defined as a room used to provide clinical care to a patient. Outpatient rooms

include consultation rooms, treatment rooms, and minor procedure rooms. The formula for room

estimates reported is the same formula defined under assumptions in the demand results section of

this report. Outpatient survey results and room estimates are reported in table 19.

− The majority of outpatient visits are reported in sectors 1, 2 and 3

− Over 90% of Outpatient visits for all facilities are in Sectors 1, 2 and 3

− Primary Health Clinics are estimated to have the highest proportion of outpatient rooms in sectors

1, 2, 4 and 6

− Dental Clinics are consistently estimated to have the fewest Outpatient Rooms across all sectors

− Outpatient visits for Laboratory Services and Clinical Imaging Services at hospitals were not

included in the tables

The distribution of outpatient clinic visits by sectors is presented graphically in figure 21 and detailed in

table 19

0 1 2 3 4 5 6

1

2

3

4

5

6

8

Outpatient clinic visits (millions)

Sector

Dental Clinics Hospitals Polyclinics Primary Health Clinics Specialist Clinics

Figure 21: Sector Breakdown of Outpatient Activity by Facility Type in Dubai in 2011.


53

.

Facility Type Clinic Visits in 2011 % Sector Activity Estimated number of rooms

Sector 1

Dental Clinics 45,567 2.6 10

Hospitals 647,003 36.2 141

Polyclinics 302,984 17.0 66

Primary Health Clinics 700,095 39.2 152

Specialist Clinics 91,213 5.1 20

Total 1,786,862 100.0 389

Sector 2


Hospitals 609,309 26.5 133

Polyclinics 712,513 30.9 155


Specialist Clinics 59,343 2.6 13

Total 2,303,490 100.0 501

Sector 3


Hospitals 1,516,507 27.5 330

Polyclinics 1,209,572 21.9 263

Primary Health Clinics 1,365,518 24.7 297

Specialist Clinics 1,281,607 23.2 279

Total 5,524,139 100.0 1202

Sector 4




Specialist Clinics 0 0.0 0

Total 250,477 100.0 55

Table 19: Outpatient Consultations at All Facilities with Estimated Number of Rooms


54

Facility Type Clinic Visits in 2011 % Sector Activity Estimated number of rooms

Sector 5

Hospitals 199,749 45.8 43



Total 435,839 100.0 95

Sector 6




Specialist Clinics 0 0.0 0

Total 234,135 100.0 51

Sector 8

Dental Clinics 160 0.2 0

Hospitals 65,967 99.8 14

Primary Health Clinics 0 0.0 0

Total 66,127 100.0 14

All Sectors


Hospitals 3,038,535 28.7 661

Polyclinics 2,518,553 23.8 548

Primary Health Clinics

3,343,362 31.5 728

Specialist Clinics 1,432,164 13.5 312

Grand Total 10,601,069 100 2,307

Table 19: Outpatient Consultations at All Facilities with Estimated Number of Rooms (cont.)


55

4.2.6 Dental & Polyclinics Outpatient Clinical Services Infrastructure

141 Dental Clinics and 379 Polyclinics were surveyed for number of clinical services and specialties. In

total, the survey included 7 services for Dental Clinics and 24 services for Polyclinics. Table 20 shows

the number of clinics, services and the number of facilities which reported the service. Polyclinic

services consist of the following specialties:

Service Number of Clinics

(Total=379) Patient Visits Visits per Doctor


99 288,064 807

General Medicine 88 650,981 114

Dentistry 68 96,425 1083

Orthopedics 51 153,803 147

Dermatology 48 162,588 3318

Pediatrics 44 210,687 5267

ENT 43 170,229 695

Ophthalmology 39 100,965 2463

General Surgery 32 70,425 220

Cardiology 19 47,803 2173

Plastic Surgery 15 7,964 37

Psychiatry 15 25,617 1971

Homeopathy 9 13,680 1244

Endocrinology 8 25,060 2784

Neurology 8 6,793 970

Urology 7 5,644 806

Respiratory 5 10,891 1815

Table 20: Total Clinics, Visits and Doctors for Polyclinic Services Offered in Dubai in 2011


56


(Total=379) Patient Visits Visits per Doctor

Physiotherapy 4 20,672 6891

Psychology 3 773 258

Acupuncture 1 160 160

Aviation Medicine 1 227 227

Cardio surgery 1 7,829 3915

Cupping 1 6,667 3334

Naturopathy 1 1,600 1600

Total 2,085,547 255

Note 1: ‘Number of clinics’ is the number of clinics reporting that specialty and should not be summed across

specialties.

Note 2: Polyclinics did not consistently report services or subspecialties such as for Dentistry. The table is an

aggregate of related services as entered by respondents.

Note 3: ‘These are the number of encounters at clinics for the services offered. These are not FTEs due to the

differences in reporting among clinics

• Polyclinics most commonly reported Gynecology and Obstetrics, General Medicine and Dentistry, with these

top three services accounting for over 1 million visits

• Over 8,000 visits were reported for alternative and niche treatments, such as Cupping, Naturopathy and

Aviation Medicine

• A relatively high number of Polyclinics reported Plastic Surgery, accounting for 531 visits per clinic

• 15 Polyclinics reported Psychiatric services with over 1,700 visits per clinic

Table 20: Total Clinics, Visits and Doctors for Polyclinic Services Offered in Dubai in 2011 (cont.)


57

As shown in table 21, below:

− Orthodontics was the most widely offered service at Dental Clinics, followed by Oral and

Maxillofacial Surgery

− Endodontic treatments were more common than Oral and Maxillofacial surgeries yet were offered

at fewer clinics

− Pedodontics visits were at over 700 patient visits per clinic

− Esthetic Dentistry was the least reported service


(Total Clinics = 141) Patient Visits Specialized Dentists

Orthodontics 40 41,972 38

Oral & Maxillofacial

Surgery 20 8,761 21

Endodontic 17 11,591 15

Prosthodontics 16 5,485 17

Periodontics 15 7,359 13

Pedodontics 12 8,424 28

Asthetic Dentistry 8 4,355 8

Total 87,947 140

Table 21: Dental clinical services

Note: ‘Number of clinics’ is the number of clinics reporting that specialty and should not be summed across

specialties


58

4.2.7 Specialist and General (Primary Health) Outpatient Clinical Services

Infrastructure

Specialist and Primary Health outpatient clinics reported 16 broad clinical services each. The following

two tables (22 & 23) show the clinical service areas reported for these clinics with the number of

patient visits for each service and an average consultation per clinic. Other than Psychiatry and Blood

Transfusion/Storage services, the four Specialist Clinics offering Physiotherapy reported the greatest

number of consultations per clinic, while 14 Plastic Surgery Clinics reported just over 16,000

consultations between them. Dermatology reported the highest number of clinics (25)

.

Service Number of

Clinics (Total=144)

Total Consultations

Consultations per Clinic

Dermatology 25 119,445 4,799

Alternative Therapies 21 41,845 1,962

Plastic Surgery 14 16,348 1,150

Gynecology & Obstetrics 14 37,723 2,652

ENT 11 25,520 2,393

Psychiatry 9 1,134,512 127,633

Pediatrics 9 43,022 4,840

Orthopedics 7 14,916 2,098

Internal Medicine 7 11,415 1,605

General Surgery 5 9,867 1,850

Blood transfusion & storage 4 124,444 35,000

Physiotherapy 4 23,111 6,500

Ophthalmology 4 16,889 4,750

Hematology & Genetics 4 16,052 4,515

General Medicine 4 9,236 2,598

Cardiology 2 3,556 2,000

Total 1,647,901 11,444

Table 22: Consultations per Specialty at Specialist Clinics in Dubai in 2011


specialties


59

General Clinics reported consultation activity for a range of services. Table 23 below shows that

General Clinics most commonly reported Obstetrics and Gynecology, ENT and General Medicine. In

comparison, the relatively few clinics offering Pediatrics, Chiropractors, and Dentistry reported the

highest consultation per clinic, outside of General Medicine.


(Total General Clinics = 411)

Total Consultations Consultations per

Clinic

General Medicine 43 189,233 4,420

Gynecology & Obstetrics

34 34,492 1,007

ENT 34 13,751 402

Orthopedic 30 11,964 399

Ophthalmology 30 9,468 316

General Surgery 30 6,837 228

Dermatology 30 5,589 187

Psychiatry 28 9,331 335

Respiratory 28 6,424 231

Endocrinology 28 3,288 118

Cardiology 28 2,605 94

Oncology 21 41 2

Dentistry 9 11,065 1,292

Pediatrics 4 9,663 2,257

Chiropractor 2 3,853 1,800

Pathology 2 1,284 600

Total 318,889 776

.

4.2.8 Outpatient Clinic Manpower

The following table 24 shows Manpower reported by the Outpatient clinics. The survey results

show:

− Consistent with Infrastructure results, the majority of outpatient manpower is located in sectors

1, 2, and 3

− Clinic GP’s are mostly reported by private clinics

− There is inconsistent reporting of Interns and Residents in Polyclinics

Table 23: Consultations per Specialty at General Clinics in Dubai in 2011.


specialties


60

Facility Type

Manpower Category

Facility Class.

Sector Grnd.Total 1 2 3 4 5 6 8

Dental Clinic

Dental Consultant

Private

63 28 146 3

4 1 245

Dental Hygienist

12 8 19

1 40

Dental Intern/

Resident 7 1 29

37

Dental Nurse

74 13 196 4

5 1 294

Pharmacist

Dental Clinic Total 156 51 390 7

9 3 616

Polyclinic

GP

Private

145 138 303 9 29 16

640

Nurse 465 250 755 32 68 23

1,592

Assistant Nurse

111 107 311 25 42 23

619

Intern/ Resident

226 55 480

3 1

766

Pharmacist 25 37 42

8 7

119

Polyclinic Total 972 587 1,891 66 150 70

3,737

Primary Health Clinic

GP

DHA 10 2 25 8

45

MOH 15 12 5

5

37

Private 80 88 73 5 28 20

295

Family Physician

DHA 48 58 37 38

10

191

MOH 5 3 2

3

13

Private 13 17 23

5 3

62

Intern/ Resident

DHA 15 3

18

MOH 3 2 2

7

Nurse

DHA 90 90 97 58

20

354

MOH 23 15 17

7

62

Private 378 177 334 17 73 47

1,026

Assistant Nurse

DHA 30 30 33 15

3

111

MOH 7 7 7

5

25

Private 33 18 131 2 3 5

193

Dental Consultant

DHA 58 43 50 12

163

MOH 7 13 10

3

33

Private 35 12 13

2

62

Primary Health Clinic Total 850 590 859 155 110 133

2,697

Specialist Clinic

GP DHA 1

1

Private 9 1 12

22

Intern/ Resident

DHA 43

31

74

Private

7 21

28

Nurse DHA 22

77

99

Private 52 12 128

1

193

Assistant Nurse

DHA 39

30

68

Private 7 3 18

28

Consultant DHA 4

18

22

Private 6

16

22

Specialist DHA 3

27

30

Private 37 12 108

1

159

Pharmacist DHA

1

1

Specialist Clinic Total 224 36 487

3

750

Grand Total 2,202 1,264 3,627 228 260 215 3 7,800

Table 24: Clinic Manpower by Classification and Sector..


61

Table 25 below is the aggregate of the manpower categories reported at all clinics:

Manpower Category

Facility Class.

Sector Grand Total 1 2 3 4 5 6 8

GP

DHA 11 2 25 8 46

MOH 15 12 5 5 37

Private 234 227 388 14 57 36 957

Total 260 241 418 22 57 41 1040

Consultant

DHA 4 18 22

Private 6 16 22

Total 10 34 44

Specialist

DHA 3 27 30

MOH

Private 37 12 108 1 159

Total 40 12 135 1 189

Nurse

DHA 112 90 174 58 20 453

MOH 23 15 17 7 62

Private 895 439 1217 49 141 71 2,811

Total 1030 544 1408 107 141 98 3326

Assistant Nurse

DHA 69 30 63 15 3 179

MOH 7 7 7 5 25

Private 151 128 460 27 45 28 840

Total 227 165 530 42 45 36 1044

Family Physician

DHA 48 58 37 38 10 191

MOH 5 3 2 3 13

Private 13 17 23 5 3 62

Total 66 78 62 38 5 16 266

Dental Consultant

DHA 58 43 50 12 163

MOH 7 13 10 3 33

Private 98 40 159 3 6 1 307

Total 163 96 219 15 9 1 503

Dental Hygienist

Private 12 8 19

1 40

Total 12 8 19 1 40

Dental Nurse

Private 74 13 196 4

5 1 294

Total 74 13 196 4 5 1 294

Intern/ Resident

DHA 58 3 31 92

MOH 3 2 2 7

Private 226 62 501 3 1 794

Total 287 67 534 3 1 893

Dental Intern/ Resident

Private 7 1 29

37

Total 7 1 29 37

Pharmacist

DHA 1 1

Private 25 37 42 8 7 119

Total 25 37 43 8 7 120

Grand Total 2,202 1,264 3,627 228 260 215 3 7,800

Table 25: Total Clinic Manpower by Category, Classification and Sector.


62

4.2.9 Coding Systems Reported by Hospitals and Outpatient Clinics

Of the 27 hospitals surveyed, 20 reported using the DHA standards for ICD-10 clinical coding, with

Dubai London Specialty Hospital using ICD-9 and the other 6 hospitals did not respond. The outpatient

clinics use a variety of coding systems, with 145 of 216 respondents (67.1%) using ICD-10. Other

clinics use ICD-9 (27 clinics), SAM coding (3) and Current Procedural Terminology (22).

4.2.10 Future Supply of Planned Clinical Service infrastructure

The information in table 26 below is a list of planned clinical service infrastructure, completion dates

and bed estimates through to 2020.

Hospitals Beds Estimated

Completing. Dates

Location by Sector

1 Aster (DM Healthcare) Dubai (Mankhoul-Bur Dubai) 300 2014/15 3

2 Emirates Hospital Supplies Co. L.L.C (Al Qubeisi) 25 2013 3

3 Sulaiman Al-Habib Hospital 200 2014 3

4 Al Jord Orthopedic Speciality Hospital 53 Q4 2013 3

5 Minimal Invasive Surgery Hospital 50 2014 3

6 University Hospitals 400 Paused 3

7 Al Jalilah Children’s Hospital 200 2014 3

8 The City Hospital expansion (Oncology) 200 2014/15 1

9 Iranian Hospital – Expansion 220 2013/14 3

10 Lifeline- Um Hurrain Hospital 94 2014/15 5

11 Mohammad Bin Rashid (formerly Al Maktoum)

Accident & Emergency Hospital 300 2017 5

12 Prime Hospital 70 Q3 2013 2

13 The Saudi-German Hospitals Group -Tower 215 clinics, 6 medical centers, and an educational institution

2015 3

Table 26: Planned Future Supply of Clinical Services in Dubai to 2020.

Source: DHA Corporate Excellence Department, 2013.

Note: DHA has planned to establish 3 hospital,40 primary healthcare centers and 6 specialty centers by 2025

300 beds planned for Saudi German Hospital have now been commissioned and have been included in the survey


63

An additional 1,412 beds at 10 hospitals and 215 outpatient clinics are planned for development by

2015. 400 beds are expected in 2025 at University Hospital. 9 developments are planned in Sector 3,

2 in sector 5 and 1 in sectors 1 and 2 each.


64

5 Gap Analysis

5.1 Infrastructure Capacity Gap

The MHI scenario is compared with projected supply and the SQ scenario for all Service Type KPUs.

Future supply includes non-functional and planned Key Planning Units as reported in the Capacity

Survey Results

.

• Demand for ICU beds in 2011 were almost met

• The supply of ICU Beds is sufficient to 2020 as planned facilities are opened

• There is a 62% growth in supply of ICU Beds to 2025 if the planned Al Maktoum Hospital is operated on time

• The supply and demand for ICU Beds is in relative balance by 2020, with a 5% deficit projected. ICU Bed demand is not affected by the introduction of MHI

• Demand is projected to exceed supply by 35% in 2025

• In 2011 there was a moderate over supply of inpatient beds in Dubai

• Status Quo (SQ) – the demand on number of beds will increase by 26% in 2015, taking 2011 as a base year

• In 2020 we expect the demand to increase by 50% from 2015, not including any planned projects

• MHI – data shows that the demand for hospital beds will nearly double in 2015 when MHI is introduced into the sector, taking 2011 demand as a base year

• In 2020 we expect the increase to be 54% from 2015

Figure 22: MHI and SQ Demand Scenarios for Inpatient Beds in Dubai to 2025.

Figure 23: MHI and SQ Demand Scenarios for ICU Beds in Dubai to 2025.

0

100

200

300

400

500

600

2011 2015 2020 2025

Supply SQ MHI


65

.

• 2011 shows a slight over supply of OT rooms as compared to demand (SQ)

• The supply of Operating Theatre Rooms is projected to increase by 50 Rooms from 2011 to 2015 exceeding SQ demand

• The SQ demand for Operating Theatre Rooms is projected to grow 87% from 2011 to 2020. The MHI scenario exceeds supply by approximately 60 rooms in 2020.

• There are projected gaps of 6% in the SQ scenario 41% in the MHI scenario by 2025

• Demand is projected to grow at approximately 11 rooms per year under MHI from 2015 to 2025.

• In 2011 there was an undersupply of 36 emergency room cubicles as per the demand (SQ)

• Status Quo (SQ) – the demand on number of cubicles will increase by 32% in 2015, taking 2011 as a base year

• In 2020 we expect the demand to increase by 58% from 2015, provided planned hospitals/clinics are completed by 2015

• MHI – the demand will increase by 26% in 2015 when MHI is introduced into the sector, taking 2011 as a base year

• In 2020 we expect the demand to increase by 52% from 2015

Figure 24: MHI and SQ Demand Scenarios for Emergency Department Cubicles/Rooms in Dubai to 2025.

Figure 25: MHI and SQ Demand Scenarios for Operating Theater Rooms in Dubai to 2025

0

100

200

300

2011 2015 2020 2025

Supply SQ MHI


66

5.2 Manpower Capacity Gap

• In 2011 there was an oversupply of physicians as compared to demand (SQ) for services

• Status Quo (SQ) – the demand on number of physicians will increase by 47% in 2015, taking 2011 as a base year

• In 2020 we expect the demand to double from 2015, due mainly to pop growth, Expo 2020 and the Medical Tourism Strategy

• The current and planned projects will meet the demand for physicians till 2020 resources

• MHI – data shows that the demand will double in 2015 when MHI, taking 2011 as a base year

• In 2020 we expect the 8% additional increase from SQ scenario in same year

• There was a good balance between demand and supply in 2011

• Status Quo SQ – the demand on number of outpatient clinics will increase by 11% in 2015, taking 2011 as a base year

• In 2025 we expect the demand to increase by 24% from 2020

• The current and planned projects will be able to meet the demand only till 2020

• MHI – data shows that there is an increase of 21% in 2015 taking 2011 as a base year

• In 2025 we expect the increase to be 28% from 2020

Figure 26: MHI and SQ Demand Scenarios for Outpatient Rooms in Dubai to 2025.

Figure 27: MHI and SQ Demand Scenarios for Physician/Surgeon FTEs in Dubai to 2025.

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2011 2015 2020 2025

SUPPLY SQ MHI


67

• In 2011 the number of dentists were in over supply as per the demand for services

• Dentist demand is not expected to be influenced by the introduction of MHI

• The supply of Dentists is projected to exceed demand through to 2020

• The demand for Dentists is projected to increase by 156% to approximately 2,300 FTE staff from 2011 to 2025

• In 2011 supply of nurses was almost meeting demand (SQ)

• Status Quo (SQ) – demand for nurses will increase by 21% in 2015, taking 2011 as a base year

• In 2020 we expect the demand to increase by 43% from 2015.

• There will be shortage of nurses even after considering the planned projects

• MHI – data shows that the demand will increase by 37% in 2015 when MHI is introduced into the sector, taking 2011 as a base year

• In 2025 we expect the increase to be 69% from 2015 when MHI is fully applied in Dubai

Figure 28: MHI and SQ Demand Scenarios for Nurse FTEs in Dubai to 2025..

Figure 29: MHI and SQ Demand Scenarios for Dentist FTEs in Dubai to 2025.

0

10

20

2011 2015 2020 2025

SQ MHI


68

Note: The supply data was not available for Allied Health.

Note: The supply data was not available for Management and Support Personnel.

0

10

20

2011 2015 2020 2025

SQ MHI

• The SQ demand for Management and Support Personnel is projected to increase by 51% by 2015

• The MHI demand for Management and Support Personnel is projected to increase by over 1,000 personnel per year from 2015 to 2025

• The supply of Management and Support Personnel was not reported during the planning period

• A comparison between the gap in demand and supply of Allied Health cannot be made because not all categories of the Allied Health services were included in the capacity survey

• The demand for Allied Health is projected to increase strongly throughout the planning period in both SQ and MHI scenarios

• The projected SQ demand for Allied Health increases by 176% from 2011 to 2025

Figure 31: MHI and SQ Demand Scenarios for Management and Support Personnel in Dubai to 2025.

Figure 30: MHI and SQ Demand Scenarios for Allied Health FTEs in Dubai to 2025

0

10

20

30

2011 2015 2020 2025

Supply SQ MHI


69

5.3 Hospital beds in low to high cost facilities as per the MHI scenario

Figure 32 shows the baseline supply of beds across low to high cost hospitals compared to the

projected demand once MHI is fully implemented. With MHI there will be a substantial increase in

demand for hospital services particularly in low cost facilities as a larger number of non-national

workers will have access to medical treatment in Dubai

5.4 Long stay patients

In the course of the larger DCSCP study it was discovered that a significant number of chronic cases,

with a stay longer than one month, are currently being managed at Rashid Hospital. In May 2013,

additional information was gathered on the status of these patients leading to a separate in-depth

study to identify the various factors involved in maintaining chronic cases and to fully understand the

mechanisms by which cost-effective management options can be put in place. The following table (27)

shows the nationality distribution

− A total of 147 patients were identified, by the case management department at Rashid Hospital, as

chronic cases through the study

− Of these 70 (47.6%) were UAE nationals and 77 (52.4%) were non-nationals

− The mean age of these patients was found to be 55 years (range 2 to 108 years)

Figure 32: projected demand on Low to High cost hospitals with MHI


70

Nationality Number of Patients staying in the hospital for more than 1 month

UAE Nationals 70

Non-Nationals 77

Total 147

Table 28 below shows the reason for admission among UAE Nationals. It is important to indicate that a

significant proportion of these patients have other comorbidities** and are bedridden

Disease Female Male Total

Neurological disease-CVA, Parkinson, Senility, TIA, Epilepsy

13 23 36

CP, Mental Retardation 0 1 1

Brain Injury (Traumatic, Anoxic etc.)/Head Injury 1 4 5

Spinal Cord Injuries/dystrophy 0 1 1

Miscellaneous Surgically or conservatively treated patients in orthopaedic wards, internal medicine cases (heart and pulmonary diseases, diabetes, renal failures, etc.), malignancies, patients in surgical wards, patients with infections and others.

9 18 27

Total 23 47 70

− Among 70 UAE patients as indicated above 36 (51.4%) patients were diagnosed as having

neurological diseases (e.g. CVA, Parkinsonism, TIA, Epilepsy etc.)

− 27 (38.6% ) were treated for other surgical/medical conditions such as; heart and pulmonary

diseases, diabetes, renal failure etc.

− A small proportion of 7 (10%) patients were treated for spinal/brain injuries and cerebral palsy

Based on the above table discharge options for Nationals are shown in figure 33

− 7% (5 out of 70) patients were fit to go home with or without equipment

7%

59%

16%

18% Fit to go home with or without equipment

Require home care support-basic nursing care

Require outpatient/inpatient rehabilitationservices

Require moderate to intensive nursing care

Table 27: Nationality of patients

Table 28: UAE Nationals – reason for admission by disease group

Figure 33: Non - Nationals – discharge options


71

− 59% (41 out of 70) patients were medically cured and required primarily basic nursing care such

as tracheal suctioning, bedsore prevention which can be provided by a trained caregiver at home

or at residential accommodation “suitable for age”

− 16% (11 out of 70) needed outpatient/inpatient rehabilitation services which doesn’t require

admission in acute setting hospital

− 18% (13 out of 70) required moderate to intensive nursing care that necessitate staying in long

term healthcare facility

As show in table 29, Among 77 non-national patients, 28 (36.4%) patients were treated for

neurological diseases, 18 (23.4%) for Head Injury/Traumatic Brain Injury and 25 (32.5%) for other

surgical/medical conditions such as heart and pulmonary diseases, diabetes, renal failure etc.

Disease Female Male Total

Neurological diseases, CVA, Parkinson, Senility, TIA 12 16 28

CP, Mental Retardation 0 0 0

Brain Injury (Traumatic, Anoxic etc.), Head Injury 5 13 18

Spinal Cord Injuries/dystrophy 0 6 6

Miscellaneous Surgically or conservatively treated patients in orthopaedic wards, internal medicine cases (heart and pulmonary diseases, diabetes, renal failures, etc.), malignancies, patients in surgical wards, patients with infections and others.

3 22 25

Total 20 57 77

Based on the above table discharge options for non-nationals are shown in figure 34

− 23% (18 out of 77) patients were fit to go home with or without equipment

− 38% (29 out of 77) patients were medically cured and required primarily basic nursing care such

as tracheal suctioning, bedsore prevention which can be provided by a trained caregiver at home

or at residential accommodation “suitable for age”

23%

38%

18%

16%

5% Fit to go home with or without equipment

Require home care support-basic nursingcareRequire outpatient/inpatient rehabilitationservicesRequire moderate to intensive nursing care

Others

Table 29: Non - Nationals – reason for admission by disease group

Figure 34: Non - Nationals – discharge options


72

− 18% (14 out of 77) needed outpatient/inpatient rehabilitation services which doesn’t require

admission in acute setting hospital

− 16% (12 out of 77) required moderate to intensive nursing care that necessitate staying in long

term healthcare facility

− 5% (4 out of 77) needed to come from home for dressing or required quarantine


73

5.5 Sector Gaps

Table 30 below shows the projected KPU gaps for both demand scenarios. For simplicity, due to small

numbers in sectors 7, 8 and 9, these sectors are displayed together. Supply for Dubai has been

adjusted for survey response error

.

KPU type Supply

Non-functional

beds

Planned KPUs

Status Quo Gap Mandatory

Health Insurance Gap

2011 2011 2025 2011 2025 2011 2025

Sector 1

Acute Beds 1,185 141 270 +821 +533 +547 -34

Non Acute Beds

-17 -43 -27 -66


64

11 -73 11 -66

Intensive Care Beds

45

7 0 -41 0 -41

Operating Theaters

26

0 5 -14 -2 -27

Outpatient Rooms 396

13 -68 -545 -79 -610

Total 1,716 141 290 752 -183 450 -844

Sector 2

Acute Beds 355

-166 -230 -449 -542

Non Acute Beds

-18 -24 -28 -37


22

-33 -53 -33 -50

Intensive Care Beds

34

-11 -17 -11 -17

Operating Theaters

16

-6 -6 -12 -13


26 -5 -24 -16 -60

Total 902

26 -239 -354 -549 -719

Sector 3

Acute Beds 1,675 230 1848 +930 +1,728 +403 +649

Non Acute Beds

-34 -85 -53 -130


134

31 -127 31 -114

Intensive Care Beds

126

114 38 58 38 58

Operating Theaters

63

23 -13 10 -37

Outpatient Rooms 1,192

1345 +394 +937 +256 +588

Total 3,190 230 3,307 +1,382 +2,498 +685 +1014

Sector 4

Acute Beds

-31 -140 -48 -215

Table 30: KPU Gap Analysis in Dubai’s Sectors


74

KPU type Supply

Non-functional

beds

Planned KPUs



2011 2011 2025 2011 2025 2011 2025

Non Acute Beds

-1 -7 -2 -10


-3 -18 -3 -17

Intensive Care Beds

-3 -12 -3 -12

Operating Theaters

-1 -5 -2 -7

Outpatient Rooms 81

+51 -47 +30 -56

Total 81 0 0 12 -229 --28 -317

Sector 5

Acute Beds 42 20 394 -258 -572 -431 -1,121

Non Acute Beds

-10 -40 -16 -61


9

-25 -123 -25 -116

Intensive Care Beds

6

15 -23 -69 -23 -69

Operating Theaters

4

-9 -35 -14 -47


24 -191 -793 -198 -856

Total 162 20 433 -516 -1632 -707 -2,270

Sector 6

Acute Beds

-94 -454 -145 -696

Non Acute Beds

-3 -18 -5 -27


-10 -58 -10 -55

Intensive Care Beds

-8 -40 -8 -40

Operating Theaters

-4 -17 -5 -23

Outpatient Rooms 51

-35 -354 -37 -382

Total 51

-154 -941 -210 -1,223

Sectors 7, 8 and 9

Acute Beds 47 45

52 -83 30 -176

Non Acute Beds

-1 -7 -2 -11


10

6 -13 6 -11

Intensive Care Beds

6

2 -9 2 -9

Operating Theaters

4

2 -3 2 -5

Outpatient Rooms 10

4 -27 -143 -28 -154

Total 77 45 4 34 -258 10 -366

Total Dubai

Acute Beds 3,304 436 2,512 1,254 782 -93 -2,135

Non Acute Beds 0 0 0 -84 -224 -133 -342

Table 30: KPU Gap Analysis in Dubai’s Sectors (cont.)


75

KPU type Supply

Non-functional

beds

Planned KPUs



2011 2011 2025 2011 2025 2011 2025


239 0 0 -20 -447 -20 -412

Intensive Care Beds

217 0 136 -11* -188* -11* -188*

Operating Theaters

113 0 0 10 -93 -23 -159

Outpatient Rooms 2,306 0 1412 +19* -699* -358* -2,118*

Total 6,179 436 4,060 1,168 -869 -638 -5,354

Note: - In the above table negative numbers indicate a deficit/gap and positive number indicate surplus - * The total outpatient rooms’ and ICU beds’ gaps is not taking into account the surplus in some sectors,

especially in sector 5, as we need it to reflect the real gaps by sector

As seen in table 30, the majority of gaps are due to the population growth projected through to 2025.

The KPUs associated with each sector indicate where future hospital service demands will be required

as the population of Dubai grows.

− The largest total KPU gap is projected in sectors 5 and 6,

− All the KPU gaps are more significant under the MHI scenario, except for ED cubicles and ICU

beds

− Only Sector 3 is projected to be in overall KPU surplus by 2025

Table 30: KPU Gap Analysis in Dubai’s Sectors - Total for Dubai


76

5.6 Clinical Specialty Gaps

5.6.1 Hospital Infrastructure (Beds)

The following tables 31 and 32 show the projected gaps in supply for hospital infrastructure

consolidated by service types and clinical specialties for the SQ and MHI scenarios for 2015-2025.

Please note the gap analysis for projected demand against 2011 supply, planned and unallocated

beds have not been distributed to clinical specialties, because it is not known

SQ Scenario

In 2025 all specialties with the exception of Pediatrics, are projected to have gaps in supply. Pediatrics

is projected to have a slight surplus in supply. The top gaps in supply for this scenario are Emergency

Departments, Intensive Care, Rehabilitation/Long Term Care, Psychiatry, Neonatology and Obstetrics

and Gynecology

Specialty 2015 2020 2025

ED cubicles -120 -276 -447

Rehabilitation/Long Term Care -235 -321 -421

Intensive Care -61* -154* -260*

Psychiatry 52 -85 -244

Neonatology (including NICU) 84 -48 -207

Obstetrics & Gynecology 51 -63 -191

Orthopedics & Trauma 13 -65 -164

Gastroenterology & Gastrointestinal Surgery 19 -72 -160

Renal Dialysis -14 -60 -122

General Surgery -1 -54 -104

Cardiology including Interventions 7 -38 -92

Immunology & Infections 3 -33 -75

Oncology & Hematology -1 -29 -63

Plastic, Skin & Breast -5 -26 -51

Ear, Nose, Throat & Eyes -7 -27 -50

Endocrine, Renal and Urological 28 -5 -46

Cardiothoracic & Vascular 1 -17 -39

Neurosciences 19 -6 -34

General Medicine & Ungrouped 12 -7 -33

Respiratory Medicine 39 19 -11

Pediatrics 94 58 4

Non-Functional Beds 451 451 451

Planned Beds 1,712 2,712 2,712

Total 2,141 1,854 353

N.B: * Due to the importance of ICU beds and the uncertainty of including them in the planned projects, the above gaps were

identified without taking the planned projects into consideration

Table 31: Projected Gaps in the Supply of Consolidated Service Types and Specialties for SQ Scenario 2015-2025


77

MHI Scenario

In 2025, all specialties projected have gaps in supply. Most significantly Psychiatry, Obstetrics &

Gynecology, Orthopedics & Trauma, Gastroenterology & Gastrointestinal Surgery, Emergency

Departments, Intensive Care, Rehabilitation/Long Term Care, Renal Dialysis and General Surgery are

projected to experience significant gaps

.

Specialty 2015 2020 2025

Psychiatry -172 -409 -684

Obstetrics & Gynecology -201 -399 -619

Orthopedics & Trauma -184 -319 -490

Gastroenterology & Gastrointestinal Surgery -142 -298 -450

Emergency Departments -103 -251 -412

Rehabilitation/Long Term Care -235 -321 -421

Renal Dialysis -95 -174 -281

General Surgery -103 -195 -281

Intensive Care -61* -154* -260*

Cardiology including Interventions -72 -150 -244

Neonatology (including NICU) 84 -48 -207

Pediatrics -49 -111 -203

Immunology & Infections -57 -119 -191

Endocrine, Renal and Urological -49 -107 -177

Oncology & Hematology -58 -107 -166

Neurosciences -46 -90 -138

Plastic, Skin & Breast -49 -85 -128

Ear, Nose, Throat & Eyes -49 -83 -123

Respiratory Medicine -29 -62 -115

General Medicine & Ungrouped -35 -68 -113

Cardiothoracic & Vascular -39 -68 -107

Non-Functional Beds 451 451 451

Unallocated Planned Beds 1,712 2,712 2,712

Total 419 -455 -2,647

N.B: * Due to the importance of ICU beds and the uncertainty of including them in the planned projects, the above gaps were

identified without taking the planned projects into consideration

Table 32: Projected Gaps in the Supply of Consolidated Service Types and Specialties for MHI Scenario 2015-2025


78

5.6.2 Medical Manpower

The following table 33 shows projected Medical Specialty gaps for the MHI scenario. The Specialty

distribution of gaps is identical with SQ, except consistent with general findings of this scenario, the

FTE volumes are larger. Please note the significant projected shortfalls in supply for Primary &

General Practice, Anesthesia and Psychiatry

Clinical Service 2015 2020 2025

Primary Care & General Practice -2,861 -4,935 -6,633

Anesthesia -355 -598 -793


Pediatrics and Child Health 5 -144 -279

General Surgery 13 -135 -282

Cardiology -19 -129 -236

Emergency Medicine -70 -155 -221

Other Surgery -22 -112 -193

Gastroenterology and Hepatology -79 -135 -186

Obstetrics and Gynecology 153 -1 -114

Radiology -26 -101 -137

Ophthalmology -43 -100 -142

Orthopedic Surgery 42 -29 -92

Medical Oncology -39 -70 -99

Intensive Care 6 -37 -80

Nephrology -7 -40 -66

Otolaryngology 65 10 -47

Endocrinology 12 -24 -54

Geriatric Medicine -2 -32 -53

Neurology 14 -9 -30

Dermatology 34 6 -22

Clinical Pathology 90 60 45

Plastic Surgery 189 151* 118*

General Medicine 422 355 295

Total -2,888 -6,799 -10,005

Note: 1) The rehabilitation and long term care services require primarily physiotherapist, occupational therapist, hydro therapist ,podiatrist, speech therapist and social workers which are calculated as allied health workers and are not included in the above table. 2) As could be seen in the above figures, there is surplus of plastic surgeons as plastic surgeries are not covered by health insurance, however, the potential success of Dubai Medical Tourism Strategy will lead to balance between supply and demand on plastic surgeons by 2025

Table 33: MHI Medical FTE Gap Analysis with No Projected Growth in Supply Due to Planned Hospitals.


79

The following table 34 shows the projected gaps in supply for Medical Manpower clinical specialties for

the SQ scenario for 2015-2025. Primary Health Care and General Practice with an additional 6,064

FTEs projected as required by 2025. Other Specialties with projected significant growth by 2025 are:

− Anesthesia

− Psychiatry

− General Surgery

− Pediatrics and Child Health

− Cardiology

− Emergency Medicine

− Other Specialty Surgery

− Gastroenterology and Hepatology

− Ophthalmology

− Radiology


80

.

Clinical Service 2015 2020 2025

Primary Care & General Practice -2,549 -4,482 -6,064

Anesthesia -317 -543 -725


Pediatrics and Child Health 27 -112 -238

General Surgery 29 -109 -246

Cardiology -6 -108 -208

Emergency Medicine -57 -136 -198

Other Surgery -11 -95 -170

Gastroenterology and Hepatology -72 -124 -172

Obstetrics and Gynecology 179 35 -70

Radiology -10 -80 -114

Ophthalmology -31 -85 -124

Orthopedic Surgery 51 -15 -74

Medical Oncology -35 -64 -91

Intensive Care 12 -28 -68

Nephrology -2 -33 -57

Otolaryngology 72 20 -33

Endocrinology 17 -16 -44

Geriatric Medicine 2 -26 -45

Neurology 17 -4 -24

Dermatology 39 13 -13

Clinical Pathology 95 67 53

Plastic Surgery 189 151* 118*

General Medicine 431 369 313

Total -2,301 -5,946 -8,934

N.B: As could be seen in the above figures, there is surplus of plastic surgeons in Dubai, however, the potential success of Dubai Medical Tourism Strategy will lead to balance between supply and demand on plastic surgeons by 2025

Table 34: SQ Medical FTE Gap Analysis with No Projected Growth in Supply Due to Planned Hospitals


81

6 Sensitivity Analysis

6.1 Description of Sensitivity Analysis

A three phase approach was conducted to assess the sensitivity of the capacity planning findings:

− The crude per capita rates for Infrastructure and Manpower KPUs were estimated and contrasted

against other countries in the Western Asia region and the selected high income regions, the

Americas and Europe.

− A population based analysis is presented to assess the impact of different age distribution for

males on the potential demand for services

− A 70% occupancy rate is applied to the aggregate bed demand for both scenarios. The gaps in

supply at 70% occupancy and the 80% occupancy, used for the capacity planning, are contrasted

to illustrate the differences for these occupancy assumptions

6.1.1 Crude Rate and Scenario Analysis

The crude rates per 10,000 people for KPU and Key Staffing Measures are presented below and show

that Dubai has a lower rate of demand of Nurses and Hospital Beds and a relatively larger rate of

demand for Physicians compared to the three predominant reference countries (Australia, United

Kingdom and United States of America). The relatively low Nurse and Bed demand rates are

explained by the young age and predominately male status of Dubai’s projected population, which

means that there are fewer healthcare resources required for the elderly (people over the age of 65)

who are more prevalent in the reference countries.

The elderly are known to use healthcare resource 3.8 times more than people under 65 years of age

(USA National Institute of Health, 2013). They are also more likely to reside in supported

accommodation staffed by nurses in the reference countries. The higher rate of physicians is

explained by cultural preferences in Dubai for more care to be provided by physicians than in the

reference countries.


82

Table 35 below compare Dubai’s supply after adjustment for response rate error to demand rates for

KPUs and Human Resource categories.

KPUs and Human Resources

Categories

Supply per 10,000

Dubai Population

SQ Demand

per 10,000

Dubai

Population

MHI Demand

per 10,000

Dubai

Population

2011 2025 2011 2025 2011 2025

Total Beds 19 14 13 12 20 19

ICU Beds 1 0.8 1 1 1 1

ED Cubicles 1.1 0.8 1.3 1.5 1.3 1.5

OT Rooms 0.6 0.4 0.5 0.5 0.7 0.6

Total Outpatient Rooms 12 9 10 7 10 11

Physicians/Surgeons FTEs 30 23 27 32 29 34

Nurses FTEs 54 40 55 56 56 56

Dentist FTEs 5.7 4.3 4.6 5.1 4.6 5.1

Allied Health FTEs 12 9.0 34 61 35 61

.

Table 35: KPU per Capita Rates for the Supply and Scenario Demands in Dubai.

Source of supply data: Dubai Annual Health Statistical Report 2011, DHA.


83

6.1.2 Population Distribution Sensitivity

From 2000 to 2010, the population in Dubai increased by 121% compared to the global increase of

13%. Adjusting the population in Dubai is instrumental for determining per capita health needs. The

adjusted population ensures that the comparisons of per capita health measure with other countries

take account the unique composition of the populations in Dubai.

The World Bank population data from five regions (total of 106 countries) over a period of 30 years

(1981 to 2011) was used to predict the modeled male population for Dubai using regression models.

The regression models were then used to predict the adjusted population for each age group of males

in Dubai. Two sensitivity specifications were used in the regression models, and thus two outputs are

reported: the lower and higher estimates.

Once the predicted value of the total population is estimated, an adjustment factor (Ω) is then

computed. The adjustment factor for each country is the rate of the total modeled population to the

total actual population. The per capita healthcare indicators are adjusted by dividing the nominal

measure by Ω. For example, a nominal per capita measure of 100 and Ω of 0.80 produce an adjusted

measure of 125. The results in table 36 below show the adjustment factors for Dubai over time. The

population pyramid, figure 34 shows the actual and modeled population in 2011

.

Year Lower Estimates Higher Estimates

2011 0.496 0.520

2015 0.521 0.552

2020 0.516 0.551

400 300 200 100 0 100

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

Population (000)

Age Group

Adjusted Male Actual Male Actual Female

Table 36: Population Sensitivity Rates

Figure 34: Adjusted Dubai Population Compared with Actual Population for 2011


84

6.1.3 Occupancy Rate Comparison

The following table 37 illustrates the difference in demand between occupancy situations for the two

scenarios. The DCSCP used an 80% bed occupancy rate, for a total SQ surplus of 557 beds by 2025.

In comparison, a small deficit of beds is projected by 2025 at 70% occupancy. The MHI scenario’s

deficit is projected to over 1,200 beds greater in 2025 if occupancy was at 70%, compared to 80%.

Total Beds Supply by Year

2011 2015 2020 2025

3,740 5,152 5,852 6,252

Scenario 1 - SQ Demand by year

Total Beds Demand at 80% Occupancy 2,573 3,233 4,835 5,693


Scenario 1 - SQ Gap by year

Total Beds Gap at 80% occupancy 1,167 1,919 1,017 559

Total Beds Gap at 70% occupancy 799 1,457 340 -254

Absolute Gap difference 368 462 677 305

Scenario 2 - MHI Demand by year

2011 2015 2020 2025



Scenario 2 - MHI Gap by year

Total Beds Gap at 80% occupancy -226 353 -1,556 -2,476

Total Beds Gap at 70% occupancy -793 -319 -2,583 -3,723

Absolute Gap difference 567 44 1,027 1247

Table 37: Demand Comparison for 70% and 80% Bed Occupancy Rates for SQ and MHI Scenarios


85

7 Conclusions & Recommendations

International health authorities demonstrate best practices in using clinical services capacity studies to

plan for current and future developments within their respective health sectors.

The DCSCP study provides a comprehensive planning profile of the clinical capacity of Dubai through

2025, covering infrastructure and manpower supply versus projected demand based on status quo

and MHI. The study included government and private health facilities, but as per international best

practice, did not include pharmacies.

The DCSCP report will contribute significantly in planning health services so that they will be delivered

more efficiently and that additional capacity may be deployed effectively to meet expected increase in

population demands. Dubai faces a challenging and exciting future as its population grows

significantly.

7.1 Clinical Services Capacity Gap

A “traffic light” assessment is presented for Hospital Infrastructure and Medical Manpower specialties

based on capacity with the greatest growth in demand and gaps in supply. The assessment dashboard

is presented below for each scenario and 2015 and 2025 based on the following evaluation criteria.




− High Priority indicates an immediate need for planning and investment actions.

− Medium Priority indicates planning action that is to be taken within the next 12 to 24 months.

− Low Priority indicates a planning action that is to be taken within the next five years


86

7.1.1 Hospital Service Type and Clinical Specialties

Table 38 below graphically presents the DCSCP Hospital Service Type and Clinical Service

Specialties priorities for both scenarios:

Specialty SQ Priorities MHI Priorities

Psychiatry






Renal Dialysis

General Surgery

Intensive Care

Cardiology including interventions

Neonatology including NICU

Pediatrics


Endocrine, Renal, Urological


Neurosciences




General medicine & Ungrouped


LEGEND




Table 38: Hospital Service Type and Clinical Specialties Priorities for SQ and MHI Scenarios


87

7.1.2 Medical Manpower Specialties

Table 39 below graphically presents the DCSCP Medical Manpower Specialty priorities. The

assessment for sub-specialties has been separated from Primary Care and General Practice because

of the large gap in supply for this specialty:

Clinical Service SQ Priorities MHI Priorities

Primary Care & General Practice

Anesthesia

Psychiatry

Pediatrics & Child Health

General Surgery

Cardiology

Emergency Medicine

Other Surgery

Gastroenterology & Herpetology

Radiology

Ophthalmology

Orthopedic Surgery

Medical Oncology

Intensive care

Nephrology

Otolaryngology

Endocrinology

Geriatric Medicine

Neurology

Dermatology


Clinical Pathology

Plastic Surgery

General Medicine

LEGEND




Table 39: Medical Manpower Specialties Priorities for SQ and MHI Scenarios


88

7.2 Clinical Capacity Recommendations

The DCSCP provides a robust strategic planning framework for the effective development of clinical

services Infrastructure and Manpower capacity through to 2025. The following recommendations and

action steps (table 40) are recommended to advance the systematic development of Dubai’s clinical

services in line with projected demand growth.


89

Priority Areas Recommendation Action Steps

Primary Health Care and General Practice

Increase PHC as per need in identified geographic areas

Increase PHC physicians/GPs in Dubai

Increase efficiency on health professionals’ time and effort through a strong referral model that is well-known to the community

Utilize the DCSCP report to advise on establishing & licensure of new facilities to ensure accommodation in specialties/geographic gaps identified

Develop targeted programs to attract Primary Care physicians to work in Dubai

Develop an education and training model to enhance skills of National health professionals

Develop robust clinical guidelines and protocols for patient referral from primary to secondary care

Launch consistent awareness programs to educate the community on the practice of using PHCs as their first point of contact

Acute Care Hospital Services

Establish new hospitals in priority geographic areas

Encourage development in sectors 1,5 and 6

Encourage PPP and investment in hospitals, with focus on priority specialties

Develop and implement a Certificate of Need policy and protocol

Design and implement an investment guide for potential investors

Ensure DHA expansion programs are aligned to the demand in specialties/geographic areas through establishing clear business case protocols

Table 40: DCSCP recommendations & action steps


90


Mental Health Services

Understand the current status and future demand for psychiatric services in Dubai

Standardize mental health licensure and guidelines as per international practice

Raise community awareness and reduce stigma towards seeking treatment

Conduct a detailed study on the current and future demand for psychiatric services in Dubai

Design, implement and update consistent guidelines and regulations for the practice of psychiatry, psychology and social services

Enhance the process and procedures for the identification and screening of Mental Health risks among residents

Develop policy framework for the further integration of mental health services into general healthcare

Design and implement community awareness programs to educate the public on mental health issues and management

Emergency and Trauma Services

Establish a trauma and emergency center in to meet the projected increase in demand

Decrease trauma incidents from road and traffic accidents

Support workplace safety programs

Design, build and establish Emergency Trauma Center in the geographic priority area, as planned in area number 5 close to the new Al Maktoum Airport

Develop and implement a unified Injury Surveillance System and Trauma Registry

Conduct prevention and awareness programs on occupational health and safety



91


Rehabilitation and Long Term Patient Services

Reduce number of long term care patients in acute hospital settings

Establish care facilities and infrastructure to manage patients who no longer require admission in an acute setting

Establish specific facilities to manage patients who require rehabilitation services

Develop and implement structured protocol for identification & referral of long stay patients

Conduct detailed study on long-term care patients to develop discharge alternatives and business plan for long-term care facilities

Conduct detailed study on rehabilitation patients to develop a business plan for new rehab facilities

Develop a long-term medical care facility plan

Develop a structured protocol for a home-care service plan that is aligned to international best practices

Develop and implement in-patient/out-patient rehabilitation service plan

Nephrology services (renal dialysis)

Meet the increased demand for nephrology services

Reduce the prevalence of non-communicable diseases leading to renal complications (diabetes)

Conduct a detailed needs assessment for nephrology services such as dialysis and kidney transplant

Design a cost effective framework for the renal dialysis based on a networked model, i.e. training & simulation centers, satellite centers, and home based dialysis

Develop and support behavioral change programs for key modifiable risk factors for non-communicable disease such as diabetes & cardio vascular diseases

Operating Theaters, Endoscopy and Surgical Services

Encourage private development of cost effective same day and short stay facilities to ensure sufficient capacity

Conduct detailed needs assessment to identify service requirements based on types of surgery, procedures and treatment

Develop partnership framework to encourage PPPs in establishing new facilities



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Oncology Services Establish care facilities that will

manage specific areas within oncology services as per the community’s requirements

Conduct detailed planning studies to identify demand for services as per treatment classification

Carry out feasibility studies and develop business case for design, build and operate of oncology centers

Attract and retain healthcare professionals , especially physicians and nurses, to fulfill the increase in demand throughout the years

Maintain a sustainable clinical workforce in Dubai health sector as per international standards and accreditations across all specialties and sub-specialties

Conduct a survey on a random sample of healthcare professionals working in Dubai to know all their characteristics and opinions in order to develop and implement a comprehensive talent management strategy to attract, recruit and retain health professionals within identified requirement specialties and sub-specialties (Nationals and Expatriates)

Establish additional three new medical colleges and five schools of nursing in the emirate of Dubai by 2025

Expand post graduate training programs, in affiliation with local and international medical education institutes, to provide continuous skill development in identified medical specialty areas

Establish a medical education council to coordinate training and medical research process as per international best practice

Integrated Health Information and Technology (HIT) System

Enhance HIT standards and systems within all Public and Private providers to promote improvement in the collection of data and reliable reporting of performance and outcome information

Develop a HIT strategy to promote system integration, standardized data collection and reporting towards eHealth

Diagnostic Coding & Clinical Classification

Improve the practices of diagnostic coding by creating a DHA data dictionary and conducting regular hospital and clinic audits

Develop a standard clinical service-line classification system by DRG to support improve management and planning

Develop a program for the development and introduction of Guidelines and Data Dictionaries to promote improved diagnostic and procedure coding

Develop a transition strategy for the implementation of a DRG based clinical classification system



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Dubai Health Authority Dr. Awatif Abuhaliga [email protected] Dr. Meenu Mahak Sodhi [email protected] Dr. Eldaw Suliman [email protected] Mr. Altijani Haydar Altijan Hussin [email protected] Ms. Priya Sridharan [email protected]

TAHPI Mr. Aladin Niazmand [email protected] Mr. Robert Martin [email protected]

mailto:[email protected]




Report: Dubai Clinical Services Capacity Plan 2015- … Dubai Clinical Services Capacity Plan 2015-...

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