Over the last few years at healthcare conferences, one of the main messages has been that the number of international patients coming to the UK for treatment who are sponsored by Government purchasers is contracting. Elizabeth Boultbee, Managing Director of Boultbee & Co takes a look at the facts behind the headlines.
The main government purchasers of treatment abroad are from Kuwait, Qatar, United Arab Emirates (UAE) and the Kingdom of Saudi Arabia (KSA).
Since the discovery of oil, and the wealth that this has brought, nationals of these countries have been sponsored abroad for treatment. Over the years there have been large investments into the local healthcare infrastructure and as a result services have improved dramatically. However, due to a variety of reasons, these Government purchasers still sponsor patients with complex healthcare needs for treatment abroad.
In 2012, Government purchasers from these four source markets in the Gulf sponsored 9,738 patients for treatment abroad. By 2018, this had risen to 17,742 patients, of which 5,800 are estimated to be children. An increase of 80%!
The countries that receive the most government sponsored patients are the UK, Germany and the USA. Where the patients go, however, is dependent on the purchaser. For example, in the UAE, Abu Dhabi primarily utilises services in the USA, but Dubai mainly sends patients to Germany and the UK.
The current estimated value of the patients from these purchasers is £2bn, of which the biggest purchaser is the Kuwait government with a budget of £804m, which is regularly overspent. The Kuwait figures exclude the spend by the Kuwait Military, who have a lower threshold for approval of treatment abroad when compared to the Ministry of Health.
The Qatari government spend of £263m indicated in the graph dates back to 2016, however Qatar is one of the largest purchasers of healthcare in London and has “Abroad Medical Offices” in London, Washington, Bonn, Cairo and Thailand which would indicate that the “official” number of 395 patients in 2016 is now much higher in 2019.
Can the UK attract more government-sponsored patients?
The question that is often asked is why the UK isn’t getting a larger share of the “pot”. Although the reasons can be complex, I offer the following observations:
- There is a political issue between the Governments of Abu Dhabi and the UK which has resulted in a dictate that patients will not be sponsored for treatment in the UK. As a result, the majority of the £323m spend by Department of Health Abu Dhabi is in the USA. There are some signs, however, that this position on the UK is moving in a positive direction.
- Pricing in the UK is not considered to be transparent. One of the major purchasers has said that “sending a patient to the UK is like writing a blank cheque”.
Patients are being given more choice of destination, within certain limits, than they previously experienced and this is being ignored in many marketing approaches by UK healthcare organisations.
- The KSA market has been regarded as too difficult to access, so pretty much ignored by the UK providers. The UK received 236 patients of a total of 2,400 patients sponsored for treatment abroad. Germany received 766 and the USA 1,307.
The future includes referrals abroad
The strategic aims of the Governments of the Middle Eastern countries are to continue to improve healthcare services and, in turn, to reduce the number of patients travelling abroad for treatment.
There will continue to be investment in health facilities in both the Government and private sectors. However, there are two main reasons why patients needing complex treatment will continue to be referred abroad:
The small national populations in each country cannot support the development and maintenance of complex medical services. For example, in Qatar, the population of 3.6m is made up of 432,000 (12%) nationals and 3.2m (88%) non-nationals. If a non-national is seriously ill and they can’t work, their visa is cancelled and they must return home. As a result, it is difficult to provide complex services, such as cancer, neuro and cardiac services, to such a small population.
There is a significant shortage of doctors and other clinical staff. In 2018 it was reported that the KSA needed an additional 10,000 doctors by 2020 and twice that number by 2030 to tackle critical care bed shortages and a growing population.
The region still represents a significant opportunity for UK healthcare providers, but it may be time for a different approach to the markets. UK providers need to stop competing against each other and have a much more joined up approach. The competition is Germany and the USA, not each other!