InSight: Colliers’ Mansoor Ahmed looks at long-term care and rehabilitation in KSA

Long term care and rehabilitation are among the main focal points for diversification and enhancement of the healthcare system in the Kingdom of Saudi Arabia (KSA). Mansoor Ahmed, Colliers’ director (MENA region) – healthcare, education and PPP ‒ looks at how the development of these service can act as a change catalyst in both acute and post-acute care segments of the healthcare sector, and how a gradual relocation of bed-bound patients from hospitals to specialist facilities and, ultimately, home treatment, will reduce pressure on acute care hospitals

A key driver for the focus on long term care (LTC) and rehabilitation in the Kingdom of Saudi Arabia (KSA) is the changing demographic profile in the country due to a decreasing fertility rate and increased life expectancy.

The population aged above 60-years-old is expected to increase from 5.5% of the total in 2020 to 11% by 2030.

The 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-old, this will increase healthcare utilisation, especially in LTC and rehabilitation services.

Long term post-acute care beds in the KSA

Colliers estimates that KSA requires an additional 22,000–24,000 LTC and rehabilitative beds to meet the expected demand of an aging population by 2030 ‒ and as many as 30,000 additional beds if it is to achieve OECD average standards.

Currently there is a ratio of only one long term post-acute care bed (LTPAC) per 14,000 head of population in KSA. That is low compared to the provision in many other developed countries.

Based on latest Ministry of Health of KSA (MoH) statistics, a total of 14% of acute care beds in public hospitals in the Kingdom are occupied by long-stay patients. This percentage is at its maximum in the Taif region (31%) followed by Jeddah and Riyadh wherein 19% and 17% of acute care beds, respectively, are occupied by long stay patients.

In addition, out of the total long stay patients in public hospitals in 2019, about 51% were admitted to long term care and psychiatric hospitals while the remainder were admitted to general and specialised hospitals, leading to a shortage of specialised beds focusing on LTPAC.

Moreover, compared to the 50-plus physiotherapists per 100,000 population in most OECD countries, KSA only has an estimated 20‒25 physiotherapists per 100,000.

Compared to the European average of 2.96 Physical and Rehabilitation Medicine (PRM) physicians per 100,000 population, KSA has only 1.1 per 100,000.

Ministry of Health

Private sector participation

The Ministry of Health (MoH) Private Sector Participation (PSP) initiative aims to increase the private sector’s share of healthcare delivery via Public Private Partnership (PPP) and is focused on enhancing extended care by improving the overall provision and quality of services.

Key challenges:

Long term care

1. Long-term care (LTC) bed capacity is below the requirement
2. Large number of acute care treatment beds in hospitals are occupied by LTC patients, creating a burden on availability of beds
3. Some patients who occupy LTC beds can be provided home care, resulting in a significant cost reduction and greater overall utilisation
4. Shortage of advanced medical capabilities such as mechanical ventilation in many LTC facilities.

Rehabilitation

1. Inpatient rehabilitation capacity mentioned below shows the requirement in KSA
2. Shortage of rehabilitation physicians and specialized allied healthcare personnel

Homecare

1. Provision of capabilities, resources, and efficiency in home care (HC) vary across different cities in KSA
2. Limited availability of medical devices and consumables for the home-care setting
3. Utilisation of home care personnel remains low due to lack of efficient operational procedures and information systems.

Gap analysis and conclusions

Currently, due to a major shortage of long-term care and rehabilitation beds, healthcare providers are utilising acute care beds, which not only creates a burden on acute care facilities but on the overall KSA healthcare system. It is more expensive to use acute care beds compared to dedicated LTC beds.

Based on Colliers research, an estimated 20% to 30% of public hospital beds in the KSA are occupied by LTC and Rehab patients.

The need for infrastructure to support the provision of LTC and Rehab facilities is one of the main policy drivers for various governments in the GCC. Dubai, for example, has prioritized investments in setting up LTC and Rehab patient services under its latest Investment Guide.

As part of the privatisation process in KSA, the MoH is seeking to engage operators for LTC and Rehab facilities and Home Care.

As per Colliers estimates, there are currently around 6,000–6,500 LTC beds, along with 4,000-plus physiotherapists in MoH Hospitals. Data for the private sector is not available but is estimated to be similar in numbers to MoH. By 2030, Colliers estimates KSA needs at least 28,000–30,000 LTC and Rehabilitative beds, or 34,000‒36,000 beds if it were to reach the OECD average.

In addition, based on an OECD average of 93.6 physiotherapists per 100,000 head of population, some 40,000 – 42,000 physiotherapists will be required by the Kingdom by 2030.

In meeting demand for LTC and rehabilitation, improved home care services will play an important function.

Capabilities, resources, and efficiency in homecare currently vary across regions, with only limited services generally provided and due to a lack of efficient operational procedures and proper information systems, the utilisation of homecare personnel remains low. Improved home care provision will reduce the pressure on both acute care and LTC and rehabilitation hospitals.

The target under the PSP initiative is to increase home care coverage annually from 40,090 patients (2017) to 90,300 patients (2022).

Funding requirements

To build the additional 22,000–24,000 LTC and Rehabilitative beds, investment of around US$6.5–7.5bn will be required. However, to achieve OECD average standards, a sum of US$8.5–9bn is necessary. Moreover, US$1.0‒1.2bn will need to be invested in medical equipment.

As with many emerging markets, KSA is looking to PPPs and privatisation as one of the main ways to fund the bed requirement, alongside other healthcare facilities.

Government initiatives

In November 2020, the Ministry of Human Resources and Social Development (MHRSD) announced the implementation of a uniform model for elderly care in KSA in collaboration with the private and non-profit sectors.

In Colliers’ opinion, this initiative will likely improve the efficiency and quality of services provided to the elderly in the Kingdom with better utilisation of tertiary care, LTC and rehab facilities.

Key challenge

The biggest challenge is a shortage of manpower as the number of physicians, 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.

Way forward and conclusions

The market is in its nascent stage and many existing LTC, rehab and homecare facilities lack advanced medical capabilities.

As the market matures, more centres providing specialised comprehensive rehabilitation such as neurorehabilitation, cardiopulmonary, pediatric and musculoskeletal rehabilitation will enter the market.