A need for long-term care

Mansoor Ahmed, director (MENA region), healthcare, education and PPP at Colliers International, looks at long term care, rehabilitation and homecare in Saudi Arabia

Saudi Arabia, with a current estimated population of approximately 35 million, is the largest country in the Gulf Cooperation Council (GCC). Under Vision 2030 the country is going through fundamental structural changes in all the sectors including healthcare.

The healthcare sector is undergoing an evolution on the back of rapid advancements in technology and R&D in line with global and regional trends. The Covid-19 pandemic, however, has also exposed the vastly diverse structure of healthcare systems and increased the importance of R&D and the provision of specialised healthcare within generalised healthcare.

A key driver is the changing demographic profile through a decreased fertility rate and increased life expectancy. As a result, the population above 60 years is expected to increase from 5.5% in 2020 to 11.0% by 2030.

This shift will have a significant impact on disease patterns and the type of healthcare services required. As almost 80% of a person’s healthcare requirements typically occur after the age of 60 years this will increase the demand for long-term care, rehab and home care. This is especially true in Saudi Arabia with its high prevalence of lifestyle-related diseases including diabetes, coronary and obesity-related illnesses.

What is long-term and
post-acute care?

Long-term and post-acute care include a variety of rehabilitation or palliative services that help meet the medical and non-medical needs of people with chronic illnesses or disabilities. It includes the care patients receive after, or in some cases, instead of a stay in an acute care hospital over a relatively long period of time.

This wide array of services ranges from complex care in a long-term, acute-care hospital to personalised home care assistance. Compared to the general population, patients who receive these services typically have a broader range of conditions and more complex, chronic care needs that result in frequent transitions between their homes, acute, post-acute, and longer-term care settings.

ESTABLISHING
QUALITY LONGTERM CARE AND
REHAB FACILITIES
WITH HOME-BASED
INTERNATIONAL
OPERATORS CAN
ACT AS A CATALYST
TO REDUCE
EXPENDITURE
ON OUTBOUND
TREATMENTS WHILE
SIMULTANEOUSLY
GROWING A NEW
SERVICE SECTOR

Medical tourism: saving money by replacing
international treatment with domestic treatment

Scarcity and quality of specialised healthcare facilities remain the major reasons for outbound medical treatment in the GCC. Both national and expatriate patients prefer going overseas for medical treatments mainly in Germany, the UK, the US, Canada and Asian countries. This includes treatments relating to long-term care and rehabilitation.

Historically over 20,000 patients used to be sent abroad for treatment, however, with the introduction of PPP models, this has fallen in recent years. The plan now is that unless treatment is not available in Saudi Arabia the state will no longer pay for overseas treatment.

In the GCC, especially in the UAE, there has also been an improvement in the quality of healthcare service provision. The emergence of a number of reputed indigenous brands and the opening of internationally recognised hospitals (such as Kings College Hospital, Mediclinic, Cleveland Clinic) is expected to lead to a further decline in outbound medical tourism.

Establishing quality long-term care and rehab facilities with home-based international operators can act as a catalyst to reduce expenditure on outbound treatments while simultaneously growing a new service sector.

Medical wellness and
preventative healthcare

In the MENA region, the prevalence of diabetes and obesity is one of the highest in the world, with almost 55 million people aged 20 to 79 years suffering from diabetes. This number is expected to double by 2045.

Eight Middle Eastern countries; Kuwait, Qatar, Egypt, Saudi Arabia, Bahrain, UAE, Jordan and Lebanon have the highest ratio of obesity among adults globally with 27% to 40% of the total population affected. The prevalence of overweight and obesity in these countries ranges from 74% to 86% in women and 69% to 77% in men.

In the GCC countries, there is a need to focus on more preventive rehabilitation care by the establishment of medical wellness treatment centres.

Projects are being developed in lifestyle retreat settings where recovery is in a relaxed and comfortable environment rather than a typical hospital setting. Colliers has also been engaged in various projects including waterfront hospitality where health and medical wellness components are incorporated within the resorts.

These projects are expected to have a positive impact in the long term by reducing the demand for both acute care hospitals and post-acute care long-term and rehabilitation facilities.

Within Saudi Arabia, the Red Sea Project, Qiddiya Entertainment City and Amaala Red Sea Riviera projects could be ideal locations to develop medical wellness and preventive healthcare facilities.

Mental healthcare

Mental health is becoming a major issue, presently there are around 1.4 million patients in Saudi Arabia which are expected to increase to 4.4 million by 2050.

A significant percentage of mental health issues are age-related and can be accommodated through long-term care/ rehabilitation facilities or even as part of home care.

The Covid-19 pandemic has also exacerbated mental health issues through additional life stress and isolation. Offering mental health in long-term care/ rehab facilities or as part of homecare, can significantly reduce the capital and operating expenditure and free up beds
and resources in acute care hospitals and family clinics.

Conclusion

Due to the shortage of long-term care, rehabilitation and home care services in the country, patients in need of long-term care utilise acute care facilities, creating a burden on acute care facilities.

Based on various reports and discussions with hospital operators, patients who could be better served in long-term care and rehab facilities occupy an estimated 20% to 30% of public hospital beds in Saudi Arabia.

The cost of patients who need long-term care and rehab but are instead treated in general hospitals is significantly higher compared to a long-term care facility. This is a crucial issue; all government budgets are under pressure while demand for healthcare continues to rise.
Capital and operating costs of setting up these facilities are up to 30% lower when compared to an acute care hospital.

The need for infrastructure to support the provision of long-term care and rehab facilities is one of the main policy drivers for various governments in the GCC. For example, Dubai has prioritised investments in setting up patient services under its latest investment guide.

As part of the privatisation process, the Ministry of Health is seeking to engage operators both for long-term care and rehab facilities as well as homecare.

So, what is the gap?

As per Colliers estimates, Saudi Arabia, by 2030 would require additional 20,000 – 22,000 long term care and rehabilitative beds. To achieve OECD average standards, however, the
country would require 28,000 – 30,000 additional beds by 2030.

An important aspect will be improving homecare services. Presently the capabilities, resources, and efficiency in home care vary across regions with limited service provided. Due to a lack of efficient operational procedures and proper information systems, the utilisation of home care personnel remains low. Improved homecare provision will reduce the pressure on both acute care and long term care and rehabilitation hospitals.

The target under the Ministry of Health’s PSP initiative is to increase homecare coverage annually from 40,090 (2017) to 90,300 (2022).

In November last year, the Ministry of Human Resources and Social Development (MHRSD) announced the implementation of a uniform model for elderly care in the country in collaboration with the private and non-profit sectors. In Colliers’ opinion, this initiative is expected to improve the efficiency and quality of services provided to the elderly in Saudi Arabia with better utilisation of tertiary care, long term care and rehab facilities.

The greatest challenge lies in the shortage of manpower as the number of physicians and specialised nurses and allied healthcare personnel for rehabilitation is insufficient. With new hospital developments underway the competition to hire experienced and skilled physicians, nurses and allied workforce is further set to intensify.

Currently, the market is in its nascent stage and many existing long term care, rehab and home care facilities lack advanced medical capabilities. As the market matures, more centres providing specialised comprehensive rehabilitation such as neurorehabilitation, cardiopulmonary, paediatric and musculoskeletal rehabilitation will enter the market. Colliers International healthcare team is actively working with several local, regional and
international investors and operators to facilitate entry and/or expansion in Saudi Arabia’s lucrative long-term care, rehab and homecare sector.