The 20th century discovery of oil and natural gas has driven rapid economic growth in the countries that form the Gulf Cooperation Council (GCC): the Kingdom of Bahrain, the State of Kuwait, the Sultanate of Oman, the State of Qatar, the Kingdom of Saudi Arabia, and the United Arab Emirates (UAE). After having successfully controlled communicable diseases and made advanced acute care accessible locally, the GCC countries now face the challenge of orienting their health care systems toward prevention and treatment of chronic diseases, which their populations experience at higher rates than in nearly any other part of the world. The countries find themselves at a crossroads—they can emulate the models of Western countries, with their well-known limitations, or embark on an ambitious endeavor to create an innovative and sustainable model. In this study, we argue that the GCC countries should choose the second option and design and implement a health care system based on population health management (PHM) principles and sophisticated health information technology (IT). Taking this path can yield a triple dividend for GCC countries: Health care will help provide meaningful employment to highly educated citizens, diversify the GCC economies, and provide a model that incorporates Islamic principles as a source of emulation for other Islamic countries and the world.
The Increase of Lifestyle-Related Diseases Is Overwhelming the Health Care Systems of GCC Countries
Economic growth like the kind experienced in the GCC countries is typically accompanied by what health researchers call the epidemiological transition from acute to chronic disease: Better living conditions and improved access to medical care allow people to survive infectious diseases and age into chronic diseases, such as cancer and cardiovascular disease. The GCC countries, however, present a demographic and epidemiological paradox in that their populations are developing chronic diseases prior to undergoing the typical shift in age structure. Perhaps the most well-known and troubling health issue is diabetes: GCC countries have among the highest prevalence of diabetes in the world. High rates of diabetes and subsequent cardiovascular disease among GCC populations are driven in part by higher genetic risk, as well as a high prevalence of several metabolic risk factors. Obesity is the most important of these factors, which can be explained by major shifts in health behaviors, particularly changes in diet.
Unfortunately, the higher burden of disease and disability has not yet been matched by increased health system capacity. To address this mismatch, GCC countries will need to repeat their successes in achieving high standards in combating infectious diseases, improving maternal and child health, and making acute care accessible locally. But reaching similar standards in chronic care will require a transformational approach rather than an incremental one. The growth in chronic disease prevalence is on a path to overwhelm the health care system in its current form. Without such transformation, the GCC countries will face sicker populations, threatening not only civic contentment but also economic development.
The Economic Opportunity in Health Care Transformation
In this study, we argue that the GCC countries have a unique opportunity to design and implement a health care system that meets the needs of the 21st century—one that is built on evidence and operated with industrial principles of process optimization and use of advanced IT. Legacy infrastructure and entrenched interests are holding back health care transformation in Western countries; GCC countries are less encumbered by these and can adapt an innovative model for health care delivery that is purposefully designed for the 21st century, rather than emulating inefficient models that exist elsewhere. This novel type of health care system could avoid past mistakes and enable the GCC countries to focus on what has been referred to as the three-part aim: better care, better health, and lower cost.
Transforming health care has the potential to provide meaningful employment to highly educated citizens, advancing stated GCC policies of workforce localization. Investment in health care can also enable economic diversification and transition toward knowledge-based industries. Opportunities include not just health care provision but also innovative technologies, such as mobile health, big data analytics, and care management services. In addition, implementing a model of health care that responds to the needs of GCC populations could lead the way toward principled care for the rest of the Islamic community and world.
Population Health Management as the Pioneering Model for World-Class Health Care
We argue that the GCC countries' future health care systems should follow two design principles. First, to cope with the relative shortage of health care professionals, GCC countries need to leverage highly skilled workers through sophisticated health IT and by shifting tasks to less-trained workers. Second, the countries should adopt a PHM model, which unites the public health perspective of improving health at the population level and the medical care perspective of individual care delivery.
The PHM model is characterized by three key principles: a focus on the health outcomes of the entire population; coordination of health and medical services through the continuum of care needs, from prevention and health promotion to curative care, disease management, and palliative care; and proactive management of care needs. PHM addresses health care needs from health and wellness to coping with the end of life, and encompasses all dimensions of health, including physical, mental, and social well-being (Figure 1). Our proposed PHM blueprint for the GCC countries' future health care systems has six interrelated components (Figure 2):
- A sophisticated IT infrastructure will serve as the central cog for the model, as its data and decision support will drive the other components.
- Data-driven optimization of care processes will allow evidence-based care delivery and will perform gap analysis to identify future research needs.
- Performance monitoring at all levels of accountability will permit benchmarking, investigation of root causes for underperformance and remediation, and identification of best and worst performers to identify best practices.
- Effective deployment of health professionals will maximize the productivity of highly skilled professionals by task-shifting, allowing paraprofessionals to perform tasks requiring less skill and training while the country begins to develop the needed health care workforce. Assisting effective deployment will be care team formation and use of a model featuring health navigators, specialized paraprofessionals who guide patients through the system.
- Alignment of incentives with policy goals—namely, better health processes and outcomes and lower cost—will require several considerations. Payment cannot be tied to care settings, but must follow patients. The payment system must be based on value, not volume.
- Consumer engagement and education means patients must have some accountability for their care: They must be informed of their choices as well as the consequences of those choices.
Figure 1. Health Needs and the Full Continuum of Care
| Staying Healthy | Getting Better | Living with Chronic Illness and Disability | Coping with the End of Life |
|---|---|---|---|
Prevention
|
Acute care
|
Chronic care
|
End-of-life care
|
The components span physical, mental, social needs |
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Figure 2. The Interdependent Components of the PHM Model
Conclusion
The GCC countries' economic progress and epidemiologic transition over the past 50 years have outpaced their health care systems. The health of the populations is being influenced simultaneously by their greater reliance on food of poor nutritional value, low physical activity, growing wealth, and migration from rural to urban living. The result is a large and expanding burden of chronic disease—especially diabetes—and disability, even as mortality due to acute illness wanes. To handle the new challenge, the GCC countries' health systems must undergo a transformation.
Their current delivery systems are handicapped by underinvestment, a severe workforce shortage (especially of nurses), a hospital bed shortage, and lack of robust, interoperable IT. A large, well-integrated primary care delivery system is also lacking. At the same time, the GCC countries have the unique opportunity to leapfrog other countries: Their relative freedom from legacy infrastructure and entrenched interests mean they can adapt an innovative model for health care delivery that is purposefully designed for the 21st century, rather than emulating inefficient models that exist elsewhere.
Visionary leaders who embark on this ambitious agenda will be remembered for three accomplishments: first, for implementing a high-performing health care system that is centered on the needs of citizens and offers continuous support at all stages of health, thereby promoting civic contentment; second, for promoting economic diversification into knowledge industries; and third, for providing inspiration to the Ummah and the rest of the world and for restoring the leadership role of Arab medicine.
This research was conducted by RAND Health Advisory Services, the consulting practice of RAND Health.
