O verview of PPP O pportunities and Projects for Dubai
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O verview of PPP O pportunities and Projects for Dubai Investment and PPP Department 2020
O n Jan 4th 2019 the 50 year charter was announced by
HH Shk. Mohammed bin Rashid Al Maktoum
The Vice President and Prime Minister of the UA E, and ruler of
Dubai
Article 5: A Doctor to Every Citizen
We aim to provide citizens with medical consultations 247/ through hundreds of thousands of
doctors, specialists and medical consultants across the globe.
This will be facilitated by smart government application.
O ur goal is to transform the medical system to bring doctors closer to individuals, enhance
awareness, and
utilize top medical minds globally to serve the health of our citizens.
2
Dubai is a vibrant city of opportunity for professionals, investors
and
entrepreneurs
The Dubai Advantage
THE GATEWAY
THE CITY
Strategic location Open economy
Over 200 Nationalities THE HUB
15.8 million tourists in 2017
140 airlines 8 hrs flights
84% of population is between 15 Investor friendly destination
and 64 Yrs. 260 destinations to 2/3rd of
Quality of life and talent the world
retention
Dubai
Number 1 city for quality International
of living across the Middle Airport
east and Africa for 5 yrs in
88% of GDP is from Ranks #1 in the word Bank’s
a row
Financial Corporation logistics performance index
Top 10 financial hubs in for MENA region
the Bank2017 IFC ranking
4th most visited city
in the world
Dubai is a gateway to growth markets with recognized quality of
life and ability to retain talent
3
Dubai Health Authority oversees the healthcare sector in the Emirate of Dubai,
and the health sector has witnessed significant growth in the past decade
Snapshot of the Key Figures of Dubai’s Healthcare Sector
Regulatory Bodies The number of outpatients, inpatients as well as the number of healthcare
facilities and professionals licensed by DHA have seen significant growth in recent
years
Outpatients Inpatients
O P Volumes (2012-2017, in IP Volumes (2012-2017, in
millions) thousands)
CAGR 12-17 CAGR 12-17
+6.0% +4.8%
7.3 9. 208 263
8
2012 2017 2012 2017
Number of hospitals, per type of setting (2017, in no. of facilities)
Private
MO HA P
Hospitals Facilities Professionals
Evolution of the no. of Total number of Total number of licensed
Hospitals (2012-2017, licensed facilities by professional by DHA
Regulate in no. of facilities) DHA (2014- 2017, in (2014-2017, in thousands)
d by thousands)
DHCC
DHA +10 Hospitals CAGR 14-17 CAGR 14-17
(Private) +3.9% +8.1%
37 3.
Public 27 6
6 31 2.8 1 30.6 38.5
Public
21
Private
201 2017 2014 2017 2014 2017
0
4
Health spending in Dubai has risen by 12% p.a. from 2012 to 2017, and there
exists opportunities for investment and growth in the health sector
Health spending has risen from AED 9.9 billion in 2012 to 17.5 billion in …and the UAE is one of the top 10 economies
2017, and this is estimated to reach AED 24 billion in 2020, supported by with the most efficient healthcare sector, and
health insurance reforms… ranked on top of Middle East countries...
Source of funds Use of funds
Hong Kong
Switzerland
Singapore
Australia
Evolution of healthcare expenses, by Source of Healthcare expenses, by type of
Norway
Japan
funds (2012-2017, in AED) provider (2014, in % of total healthcare
UAE
expenses)
17.5 billion
Hospitals 47%
16.0 billion Clinics 22%
#1 #2 #7 #8 #10 #11
8% O ut of #12
Ancillary 2%
Pocke Source: Bloomberg Health-Efficiency Index, 2018
…however, despite years of positive development,
12.8 billion13% Pharmacies 9%
t Outbound there exists potential for growth in the health sector
medical tourism
9.9 14%
billion 25% Insurance &
60% Admin & Finance
Corporation 6%
52% Healthcare expenditure in Dubai vs. GCC and OECD
22% s Healthcare expenses, by type of care countries (2014, in % of the GDP)
42%
(2014, in % of total healthcare 10.0%
41% expenses)
Curative care 59%
Rehabilitative care 1%
35% 32% Ancillary services 15%
38% 34% Governmen Medical goods 14% 3.6% 3.4%
t Preventive care 5%
Admin & Finance 6%
2012 201 201 2017
4 6 Dubai GCC OECD
Source: Dubai Health Investment Guide 2018, Health Accounts System of Dubai 2013-
5 2014
Health Investments Strategy is important to Dubai (Health Investment Strategy
2017-20)
Projected Capacity Gaps in the Dubai Healthcare
Infrastructure Capacity Gap in Other Critical
Evolution of Supply-Demand Gap in Inpatient Beds in Dubai, 2020-
Infrastructure in Dubai in
Healthcare
2030
2030
In # of
beds Suppl Deman Gap: Primary care
y d
Gap: ~1,590
8,00 O versupply beds Gap: ~726 OP rooms, by
: ~654 ~311 2030
0
beds beds
6,00 Long-term care
0
Gap: ~192 beds, by
4,00 2030
0 Rehabilitation
2020 2025 2030
2,00 Gap: ~192 beds, by 2030
0
Specialties with the Largest Inpatient Bed
0 Gaps, 2025-2030 Gap by Specialty in
Gaps, in # of 2030 Procedural care / Medical
High – Orthopedics
beds imaging
241 227 – Respiratory
225
medicine
• Ultrasound
90 96 – Pediatric medicine
89 Gap: ~484 units, by 2030
– Obstetrics
– Gastroenterology • Computed tomography
Obstetric Orthopedic Pediatric – Psychiatry Gap: ~50 units, by 2030
s s medicin Mediu – Cardiology & • Mammography
e m Cardiothoraci Gap: ~43 units, by 2030
2025 c
203 General
– in surgery
By 2030, DHA foresees a gap of ~1,590 inpatient beds, mostly specialties such as orthopedics, respiratory medicine, pediatric
0
medicine, cardiology, long term care and obstetrics
6 Note: (*) Ultrasound, X-ray, Computed tomography, Mammography, Magnetic resonance, PET
scan, etc.. Source: Dubai Clinical Services Capacity Plan 2018-2030.
…leading to investment needs in certain medical specialties in terms of outpatient
rooms…
Gap analysis by specialty, in no. of outpatient rooms required (base case, 2018-
2025)
Specialty Gaps (base Specialty Gaps (base
case) case)
Primary Care 524 696 1,218 Nursing care & 357 463 761
Allied health
Orthopaedics and 77 31 75
Rheumatology Trauma and Injury 27 32 44
Respiratory Medicine 10 20 37 Neurology 1 12 35
Vascular Surgery 4 7 16
Immunology & Infections 11 15 26
Urology 41 27 12
Endocrinology 33 21 13
Renal Medicine 2 3 11
O ncology 8 4 11
Haematology 1 3 7
Neonatology 3 4 6
Gastroenterology 47 35 0 Dentistry 26 19 4
Projections are based on the following assumptions:
1. 248 operational days per year
2.8 operational hours per day
3.70% planning occupancy per consultation room
4.Adjustments for National and Non-national utilisation based on current trends
5.Nursing demand has been split between adult and paediatric Hospital modes, no
supply captured but absorbed by other consultation rooms
Source: Dubai Health Investment Guide 2018, Preliminary results from Dubai Clinical Services Capacity
7 Plan 2018-2030, developed by TAHPI… As well as acute inpatient beds in 2020 and 2025 across certain specialties and
services
Gaps by specialty, in no. of additional acute inpatient beds required (base
case)
2020
Oversupply Optimum Undersupply
coverag (investment
General Gyneaec Neuro- Neuro- Cardio. & General Obste- ENT, e needs)
olog Endocrin Cardiot. Head & neck
medicin Neona- log
Plastic surger
y
tolog
surgery ology surger surger trics
Urology 78 10
e y y y y 43
y 1 10 10 8
7 O rtho. Gastroen- Renal O nco- Resp.
51 40 35 27 23 16
81 72 & terology Psychiatry logy medicin
10
Rheum. medicine e
16 0
208 9
2025
Oversupply Optimum Undersupply
coverag (investment
e needs)
ENT, 167
General Gyneae Neuro- Endocri Neona- Neuro- Plastic
Head 96 10
medicin c surger n tology logy surger 67 77 90
ology & 43 55 8
e y ology y 18 41
neck
6 Urolog Renal Genera Cardio. & Gastroen- O bste- Resp.
30 Psychiatry
33 32 medicin l O nco- Cardiot. terology Otrics
rtho. & medicin
75 64 y
e surger logy Rheum. e
14 13 y surgery
8 5
8 Source: Dubai Health Investment Guide
2018Health Investments Strategy is important to Dubai (Health Investment Strategy 2017-
20)
Priority Investment Areas for Dubai Healthcare Infrastructure
Focus of next 2-3 years… Focus for 3-5 years…
1
11
Innovations Preventive Care &
in Pharmacy
Primary Care beyond- the-pill
2
10
Ambulatory
Long-term Care 12
Care
and Extended Precision
care Medicine
3 9 and Genetics
Urgent
Care Home-based
Clinics care 13
Population
4 8 Health
Mental Rehabilitation and Management
Health Physical Therapy
14
5 7 Nursing
Chronic Diagnostic Health
& Remote Homes and
Disease
Monitoring Palliative Care
Manageme
nt
Tertiary Care 6
for Diabetes,
Cardiology
and
Oncology
As part of its Investment Strategy 2017-2020, DHA has started identification of highest priority investment areas to fulfil its objective of
promotion and facilitation…
9 Source: DHA Investment Strategy 2017-2020,
AdventionThe Dubai Investment Guide maps the investment journey for
different types of facilities / projects for healthcare services
e.g.New facility
licensing
process map
Source: Dubai Health Investment Guide 2019
10Key Features of a PPP Model
PPP’s are unique in helping create value and transfer of risks to Private Sector
Public Private Participation (PPP) model is a partnership
structured between the Public Sector/ Government and
the Private Sector to develop infrastructure or provide
services to the population based on an agreed
allocation of risks and reward to the Private Sector.
The Key Components of a PPP Model are the following –
1. Financing – Identifying and selecting acceptable
modes of public and private funding for the project
2. Distribution of risks – assessing and designing a risk
distribution model across public and private sector
partners
3. Business case – develop a business case that is
beneficial and feasible to the public and private
sector
11 Source: DHA Investments &
PPP’sPPP Models in Healthcare - Examples
PPP models have been implemented across developed and developing regions of the
world helping drive lower capital costs, more efficiency, improved access and investment
in health
Hospitals in
Hospitals in Hospital Trusts
Spain
Canada in UK
• Hospital de La Ribera in
• $ 460 mn Women’s • 1.1 bn GBP Bart’s Hospitals in New
Alzira region for $ 91 Zealand
College Hospital – Health Trust NHS
mn. Payment through
Design, Build, Finance hospital and 430mn GBP
capitation fees
and Maintain (DBFM) Bristol Trust NHS • $ 215 mn Burwood
Hospital in Christchurch
with 230 beds
Hospitals in
Turkey
• Eur 360 mn 1,000 bed Bumrungrad
Hospitals in
hospital in Elaziğ. 26 Intl. Hospital
Australia
PPP’s planned
• $365 mn Royal
Women’s Hospital in
Victoria, Australia
Hospitals in
Canada
• $ 352 mn Joseph
Brant Hospital with
172 beds. Design, Imaging
Build and Finance Tele-radiology in
Diagnostics in
(DBF) Kenya
Brazil
• GE partnership with
• $ 40 mn project in the Kenya to deliver
State of Bahia to set up teleradiology to 46 mn
and operate 45 new people across 98
equipment across 12 hospitals
hospitals
12 Source: DHA Investments &
PPP’sPPP Law and Guidelines in Dubai
Dubai has a PPP Law and PPP Guidelines developed by the Dept. of Finance (DoF) to support
investments in healthcare, transport and other infrastructure projects for the Emirate
Dubai PPP Law and Guidelines
DHA is very focused on implementing
models that are suited and tailored to
Dubai’s needs and that are within the
framework of the PPP Law no 22 of 2015.
PPP Guidelines issued by DoF governs
different models of PPP’s for both
greenfield and brownfield facilities and we
are reviewing and proposing different
types of models that are suited to different
projects provided these allow for risk
sharing and risk transfer to the private
sector
Focus of PPP Law and Guidelines in
Dubai–
1. Description of the different types of
PPP’s allowed and level of investment
2. Evaluation and approval of PPP’s
3. The process for development and
approval of a PPP project
4. Payment Mechanisms and Risk
Allocation and transfer
13DHA is implementing a PPP Project for Cardiology CoE
The Cardiology CoE is the first healthcare PPP project to be implemented in the Emirate of
Dubai and aims to bring world-class cardiology services in partnership with private sector
Highlights of CCoE and PPP Model O bjectives of the Cardiology CoE*
• The Cardiology CoE is expected to be a 100-120 bed
dedicated cardiology hospital focusing on cardiac ER, OP One –stop-
Evidence based
and IP services; shop approach
international best
• DHA aims to implement a DBFM PPP Model with the below with integrated
practice with focus on
stated sharing of responsibilities between the Public & Pvt. care continuum
screening and early
Sectors with the term of the PPP agreement of 25 years
detection
• The CoE will be co-located
Selectedwithin the Rashid
PPP Model - DBFMHospital
Complex
Responsibility (Design-Build-Finance-and Maintain, “DBFM”)
with clinical affiliation Physician access
to clinical affiliation,
Revenues DHA Sustainable research &
and predictable technology
Capex Private Sector costs with innovation
access to
Opex Private Sector (excl. Clinical Salaries paid by DHA) financially
vulnerable
Selected medical and nursing positions by DHA segments
Clinical Staff (40-50% of clinical staff), Clinical Affiliation partner
to support recruitment & development Focus on physician
It will be flexible and
training, development
Non-Clinical Private Sector is free to recruit and deploy staff for adaptable to support
and education in Dubai
Staff the suited positions remote patient
monitoring
DHA PPP Co
Availability
Reflects capex and opex incurred by PPP Co, along
Payment
with cost of funding (debt & equity)
14DHA is also evaluating opportunities for PPP in 2020-24
O ther PPP projects range from developing new infrastructure to enhancing
existing DHA services and improving access to care for the patient
O verview of other proposed PPP projects in service enhancement and improvement
population
Imaging Diagnostics DHA is keen to improve utilization of equipment, quality and efficiency of services and
training of staff
Possibility of a risk – share partnership to manage radiology services of 3 hospitals (retaining
DHA staff) to reduce waiting times and increase revenues Improved
Training and upskilling DHA staff will be a key component Efficiencies
Dialysis Operating Agreement for managed services model to manage dialysis services for patients in
Dubai Sustainability of
Services
To focus on efficiency, patient convenience and quality of outcomes (incl. access to care)
Better Quality
Needs to interface with primary care O utcomes
Spine Operating Agreement for managed services model to manage spine services in Dubai
Hospital for patients in Dubai
To focus on cost of care, patient trust and quality of outcomes (incl. access to care) Improved Access
to Specialized Care
Objective is to bring best in class, highly qualified and experienced surgeons to Dubai
through this
Service enhancement and clinical affiliation for Dubai patients in diabetes care
Cost
Reduction and
Diabetes Control
To focus on cost of care, efficiency and quality of outcomes (incl. access to care)
In future it could include take over and turnaround of an existing center focused on UAE
Increase
in
National Revenue
patients
Long Term Concession Model or Operator Agreement for managed services model to manage LTC Grow Patient
Volumes
services for
Care
patients in Dubai
To focus on efficiency, patient experience and quality of outcomes (incl. access to care)
Expected to free up beds and critical care units in Rashid and Dubai Hospitals
15Thank You
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