Protecting the Integrity of Health Care Delivery While Undergoing Financial Transformation in Governmental Healthcare System in the Arabian Gulf Region
The recent drop in oil prices and the accompanied cut in budgets is forcing healthcare organisations in the Arabian Gulf to transform from the conventional government-led economy (not-for-profit) to productivity and investment led economy . However, such transformation requires a cultural change and involves major reform in local labour law, unfavored workplace practices, and financial management. Such reform may adversely affect health care delivery and outcomes. How to handle such a transformation without compromising on patient care is a big challenge.
Reduction in government support to public healthcare system is going to be gradual and over years, but how organisations are going to make up for that reduction through performance improvement and revenue generation without adversely affecting patient care is going to be challenging.
Major issues may include:
Un-used capacities and duplication of services e.g. many centres of excellence exist but are not be completely utilised
Over-staffing and low productivity
Improper resource utilization, mainly over utilization
Primary care is not serving its purpose and secondary and tertiary may have to deal with what is supposed to be handled by primary care
Proper utilization of resources and performance improvement is expected to be enough to make up the first stage of budget cut
Mergers or consolidation, integration of services at a national/regional levels and Improving primary care should also make up another portion of the cut
Making medical services available to cash payers and insurance companies to generate revenue should also take place
These may resemble the practical way of doing it
However, innovative solutions may provide better outcomes such as complete privatisation of governmental healthcare facilities but can be scary if such transformation is not well planned
From an organizational point of view, in a health care system that has challenges on multiple levels (payor, government, provider, patients etc.) one can get lost easily where to start. In such a volatile environment it could help to start with a quickscan plan for a 5-year strategic outlook containing at least;
-Purpose and vision of the existing organization
-External risks and opportunities and a critical evaluation of span of control on these items
-Gap analysis of operational excellence (short vs long term improvement plans)
-Analysis of current resources to achieve above goals (e.g. management execution capacity, facilities etc.)
Privatization of healthcare services with strong governance is the best way forward.
However the private operators taking over should have the right experience otherwise the privatization could lead to a disaster. A strong emphasis on the Quality of Care rendered is essential.
Health system financing (Universal healthcare models ) like the ones implemented in Abu Dhabi are best suited for the region, but with better governance on the Payers (e.g avoid monopolies) and Providers (curb over utilization, monitor quality).