A concerted effort to improve health care delivery in Qatar has created a system characterised by strong public and private investment, innovative technologies and a high standard of care. In the 2021 Legatum Prosperity Index, published by the UK think tank Legatum Institute, Qatar ranked 39th out of 167 countries and second in the MENA region in terms of health. The ranking was an improvement on 48th place in 2019, reflecting the health system’s successful navigation of the challenges posed by the Covid-19 pandemic.
Even as Qatar focused on a Covid-19 vaccine campaign in 2021, initiatives to further develop the sector continued apace, including efforts to address the increasing incidence of lifestyle diseases. At the same time, the wider adoption of telehealth and other innovative technological solutions has facilitated access to care amid social-distancing measures.
Oversight
The Ministry of Public Health (MoPH) is responsible for health strategy and policy, and regulates both public and private providers. It ensures care meets international standards and national performance targets, and encourages research and development (R&D) of new treatments. There are 23 departments and centres that operate under the MoPH, including the Healthcare Quality and Patient Safety Department (HQPSD), the Medical Commission Department (MCD), the Health Financing and Insurance Department (HFID) and the eHealth Department. The HQPSD manages the quality and effectiveness of health services, as well as patient safety, risk management, infection prevention and control, and antimicrobial resistance. The MCD is responsible for screening individuals who enter Qatar for infectious diseases including hepatitis B and C, tuberculosis and HIV/AIDS. It also issues medical certificates for expatriates who wish to work in Qatar. The HFID develops health financing and insurance programmes; settles disputes; registers health care providers and insurers; and establishes compulsory levels of coverage, pricing of services and premium.
The eHealth Department, for its part, aims to improve health care provision through the adoption of modern information systems, technologies and digital solutions. The department proposes legislation to facilitate the use of electronic solutions in health care, coordinates with service providers to ensure compatibility between systems, trains medical personnel on e-health systems, and operates a database for indexing and maintaining patient data. It also works with other government agencies on digitalisation efforts, such as the Smart Qatar Programme – commonly known as TASMU – which is led by the Ministry of Communications and IT. TASMU launched its first virtual health consultation in March 2020, and by April 2021, 188 virtual clinics had been opened under the auspices of the programme, located in both public and private facilities.
Strategy
The MoPH is tasked with implementing health initiatives associated with Qatar National Vision 2030, the country’s long-term economic development programme launched in 2008. The framework aims to establish a modern health care system based on international standards, with high-quality practitioners and facilities supported by strong R&D programmes.
The ministry also executes the National Health Strategy (NHS) 2018-22, which seeks to build on the success of previous initiatives to create a modern, patient-focused health care sector. The plan includes five priorities: the creation of an integrated model of quality care and service delivery; enhanced health promotion and disease prevention; improved health protection measures; the adoption of an inter-sectoral collaborative approach to include health considerations in policy-making; and effective governance.
The NHS emphasises sharing information between providers, addressing mental health issues and combatting the rise of non-communicable diseases (NCDs). Specifically, over the course of its implementation the plan aims to lower the 30-day readmission rate for patients with chronic conditions by 25%, smoking prevalence by 30%, mortality from chronic diseases by 15% and obesity rates by 5%. These goals are important considering that when the NHS was implemented in 2018, 70% of Qataris were overweight and 69% of deaths occurred from chronic conditions such as cardiovascular disease, cancer and diabetes. “As part of the efforts to reduce the prevalence of NCDs in Qatar, we are focusing on preventive health care solutions, which can improve the quality of life of our citizens and minimise possible health risks in the future,” Mariam Ali Abdul Malik, managing director of the Primary Health Care Corporation (PHCC), told OBG.
Budget & Expenditure
Qatar allocated QR16.5bn ($4.5bn) in the 2021 budget to health care, representing approximately 8.5% of the total QR194.7bn ($53.4bn) in spending for that year. While still a large portion of public spending, the absolute figure was down from the QR22.7bn ($6.23bn) and QR22.6bn ($6.2bn) allocated in 2019 and 2020, respectively. The 2021 budget amount provided funding for priorities such as the expansion of Hamad Medical Corporation (HMC) facilities and the construction of new primary care centres. Indeed, HMC was allocated the largest portion of the health care budget, at QR890m ($244.3m), followed by the PHCC, with QR270m ($74.1m); the MoPH (QR100m, $27.4m); and the Naufar Centre (QR80m, $22m). The last of these caters to wellness and recovery.
Health expenditure accounted for 2.5% of Qatar’s GDP in 2018, which was below the spending of its GCC counterparts Saudi Arabia (6.4%), Kuwait (5%), the UAE (4.2%), and Bahrain and Oman (4.1% each). That year Qatar had the second-highest per capita health expenditure in the GCC, according to the most recent World Bank data. The country’s health expenditure reached $1716 per person in 2018, behind the UAE ($1817) but ahead of Kuwait ($1711), Saudi Arabia ($1485), Bahrain ($994) and Oman ($678). Qatar’s figure is expected to reach $3900 by 2024. Out-of-pocket expenditure accounted for 9.5% of total health care costs, compared to 30% in Bahrain, 14.4% in Saudi Arabia, 12.7% in the UAE and 10.8% in Kuwait. Only Oman had a lower share of out-of-pocket expenditure in relation to total health care expenditure (6%), illustrating the range of covered health care services available to the Qatari public.
Private health expenditure has risen in recent years, from 13.7% of total health spending in 2014 to 25.3% in 2018, reflective of government initiatives to improve the provision of care at private facilities. “The government has taken important steps over the last few years to improve the ease of doing business,” Jassim bin Mohamed bin Hamad Al Thani, vice-chairman of Mohamed Bin Hamad Holding, told OBG. “In the health care sector, further efforts to improve the process for opening medical centres would help accelerate developments.” Overall, Qatar’s health care industry is expected to grow from $8bn in 2020 to $12bn by 2024. This is in line with higher levels of overall expenditure, which is set to rise from QR19.9bn ($5.5bn) in 2020 to QR24.9bn ($6.8bn) in 2025 at a compound annual growth rate of 4.6%, according to Fitch Solutions.
Workforce
According to the most recent data from the Planning and Statistics Authority (PSA), in 2019 there were 7644 physicians in Qatar – 5558 of which worked in government facilities and 2086 in private ones – up from 5658 in 2015. As a result, the number of residents per physician fell over the period, from 431 to 336 individuals. A similar trend was seen with nurses: in 2019 there were 22,684 nurses – 16,838 of which were at public health institutions, compared to 5846 at private ones – up from 14,951 in 2015. This improved the rate of population per nurse from 163:1 to 123:1 over the same period. The PSA also noted an increase in the number of other types of medical personnel between 2015 and 2019, including allied health professionals (8145 to 9318) and pharmacists (997 to 1034). However, the number of dentists fell slightly, from 1898 to 1827. The majority of professionals working in the health sector are expatriates.
General Indicators
Life expectancy in Qatar was an average of 80.2 years in 2019, up from 72.9 in 1980, according to the latest data from the World Bank. Qatar’s life expectancy was higher than the MENA average of 74.3 years in 2019 and the highest in the GCC. Life expectancy is forecast to rise to 82.2 years in 2030 and 83 years in 2050, per a 2020 report from market research firm Frost & Sullivan and Middle Eastern bank Mashreq. These figures are above the forecast global averages of 74.8 and 76.8 years, respectively.
The infant mortality rate in Qatar fell from 17.7 per 1000 live births in 1990 to 5.6 in 2019, while the underfive mortality rate dropped from 20.8 per 1000 live births to 6.5 over the same decades. These improvements were supported by high levels of vaccination: in 2019 over 98% of children had been vaccinated for diseases including tuberculosis; polio; hepatitis B; measles, mumps and rubella; conjugated pneumococcal; and diphtheria, pertussis and tetanus. Meanwhile, the modelled estimate of the country’s maternal mortality ratio also showed a decline, from 14 per 100,000 live births in 2000 to 9 as of 2017, the most recent year for which information was available.
The incidence of globally targeted communicable diseases is low in Qatar. In 2019 the country reported zero cases of measles and 0.1 cases of leprosy per 10,000 people. That year there were 1.5 cases of malaria per 10,000 people, down from 1.9 cases in 2015. However, the incidence of both hepatitis B and tuberculosis per 10,000 people rose between 2015 and 2019, moving from 1 to 2.9 and from 2.2 to 2.9, respectively.
The positive trend in indicators has been facilitated by an effort to enhance access. The most recent statistics from the PSA show that there were 19 hospitals in 2019. While the number of hospitals was unchanged from 2017, the number of beds rose from 2550 to 3134 – 2778 of which were in public facilities. As a result, the ratio of population per hospital bed improved from 1068:1 to 893:1 between 2017 and 2019. In addition to hospitals, Qatar had 417 private pharmacies, 245 private clinics, 82 Hamad General Hospital outpatient clinics, 27 health care centres, 21 private laboratories and x-ray centres, 19 clinics managed by Qatar Petroleum – which has since changed its name to Qatar Energy – five paediatric emergency centres, four medical commission offices and one sports medical centre.
Lifestyle Diseases
While basic health indicators have improved in recent decades, the incidence of NCDs has risen. As the economy developed and urbanisation ramped up, many Qataris adopted a more sedentary lifestyle, which fuelled an increase in diseases such as obesity, diabetes and hypertension. According to the most recent figures from the World Health Organisation (WHO), published in 2018, NCDs accounted for 69% of all deaths in the country, with cardiovascular diseases representing the largest portion (27%), followed by cancers (16%) and diabetes (9%).
Lowering the incidence of NCDs is a key focus of the NHS, and the authorities have worked to raise awareness about the importance of a healthy lifestyle and build dedicated treatment facilities. In December 2021 HMC announced that it would open a 90-bed dialysis and diabetes centre to combat what officials consider one of the most significant medical issues in Qatar. Indeed, it is estimated that up to 20% of the country’s adult population has either type 1 or type 2 diabetes.
Insurance
Both citizens and residents are eligible for free universal health care (UHC) at all public facilities. Qatar scored 74 out of 100 in the UHC Service Coverage Index issued by the WHO in 2019, up from 50 in 2010 and above the global average of 67. While UHC has helped bolster access to care, it has also come at a considerable cost to the government. To address this, Seha – a public national health insurance programme – was launched in 2013 to shift some of the cost to the private sector. After Seha was discontinued in 2015 the government turned to private insurers to fill the gap.
In October 2021 the government mandated that employers provide private health insurance to expatriate workers and their families, and that all visitors purchase a private health insurance plan to come to Qatar. These decrees shift some burden of care from government-run centres to private providers and the PHCC. The new rules envision HMC mainly providing care to Qataris, as well as to foreigners who need treatments that are unavailable at private centres.
The mandate becomes effective in May 2022 and is expected to reduce wait times at government-managed clinics. The executive regulations for the reform were still being finalised in December 2021, but the framework is expected to include a standard contract between insurance companies and health facilities on factors such as timing and mechanisms for payments, as well as guidelines for dispute resolution.
Public Providers
There are two entities responsible for public health care provision: HMC, a non-profit organisation that provides inpatient care, and the PHCC, an independent agency that provides primary care. Together, these serve over 90% of the population.
As of late 2021 HMC had 12 hospitals in its portfolio, of which nine were specialist and three were community hospitals. It also manages the National Ambulance Service and home care. HMC is the first hospital system in the Middle East to be accredited by ACGME International, a non-governmental organisation based in the US, in August 2021. It has plans to expand its capacity in the coming years with new facilities to help meet the growing demand for care. In October 2021 HMC finalised plans to build the Al Daayan Health District. First announced in 2020, the district will include a tertiary teaching hospital, an ambulatory diagnostics centre, and a women and children’s hospital for a total of 1400 beds. In addition to the medical facilities, Al Daayan Health District will have an underground transport system and dedicated logistics centre.
The PHCC, for its part, was originally founded as the Department of Primary Health Care in 1954, and in 1978 the MoPH announced that it would play a central role in a scheme to build a comprehensive primary health care system in the country. It was officially renamed the PHCC in early 2012. The PHCC provides a wide range of care, including women’s health, mental health, wellness, dentistry, health screenings, home health and pharmaceutical needs. It operated 28 health centres across Qatar in 2021 – up from 27 the previous year – and in December 2021 the PHCC announced plans to build three new health centres in Al Mashaf, Umm Al Seneem and Al Sadd. As of 2019 the corporation employed over 4000 clinicians that serviced nearly 877,000 active patients in more than 50 specialisations, according to the entity’s most recent data. That year the PHCC’s family medicine clinics received the most patient visits, at nearly 2.4m, followed by 385,155 visits to dental clinics, 186,753 visits for infant care and 152,170 visits related to allied health.
Private Sector
The private health care system has grown rapidly in recent times, driven by a burgeoning population that has strained public facilities. Both public and private facilities offer quality care, but private centres often provide more specialised services and freedom in choosing a physician, as well as shorter wait times. As of 2019 there were six private hospitals in Qatar, up from four in 2015, according to the most recent figures from the PSA. However, the number of private clinics fell significantly over those years, from 642 to 245. Even so, the private sector plays an important role in meeting the demand for health services, as well as easing the financial burden on public providers through public-private partnerships. While an April 2021 report from Fitch Solutions forecasts low growth in private health expenditure for that year, it expected that private health spending would account for 37% of the total spend by 2030, up from 25% in 2020.
Pharmaceuticals
Qatar is home to a handful of domestic pharmaceutical companies but still largely relies on imported medications and medical devices. Underscoring this constraint, the sole domestic manufacturer of medicines, Qatar Pharma, requires most active ingredients from abroad. Branded drugs comprise 80% of sales in the country – a trend that leads to high health spending and limits the development of generic alternatives at home.
There have been efforts to address the reliance on imported medications recently. In August 2021 HMC and Qatar Pharma signed an agreement that included a three-year roadmap to reach self-sufficiency in pharmaceuticals. Higher production levels as a result of the agreement are also expected to bolster the pharmaceutical company’s export capacity.
Covid-19 Response
After the first case of Covid-19 in Qatar was confirmed in late February 2020, the country moved quickly to impose restrictions to limit the spread of the virus. In late May the government issued a four-phase reopening plan and moved into the fourth phase in October of that year. Similar to other Gulf countries, Qatar rolled out a vaccination campaign after receiving its first shipment of Pfizer-BioNTech vaccines in December 2020. By November 2021 an estimated 87% of the country was fully vaccinated.
Even so, in January 2022 the government reimposed some restrictions in response to the highly transmissive Omicron variant. The measures included remote learning through at least the end of that month, and reduced capacity for public transport, cinemas, theatres, shopping malls, social gatherings and cultural events. On January 9, 2022 the seven-day rolling average of daily new confirmed cases was 2613, up from 158 cases on the same day a month prior. Same as was seen in other countries, however, the swift rise in cases did not result in a significant rise in deaths.
E-Health
The Covid-19 pandemic underscored the importance of e-health services, as social-distancing measures curtailed in-person medical appointments. Qatar had already digitalised all medical records prior to the health crisis, although they had not been fully integrated into a centralised system. The country had also introduced disease registries, and has plans to create a cancer and diabetes registry. According to a report published by the Netherlands Enterprise Agency in February 2021, while Qatar has a relatively long history of telehealth and e-health initiatives, the segment faces several challenges that include a low appetite for risk, the absence of an overarching framework for e-health implementation and difficulties complying with data security laws.
Even so, Qatar’s e-health segment offers opportunities related to its centralised database, remote monitoring initiatives, the improvement of services launched during the pandemic and workflow implementation. The government’s emphasis on technology has paid off: a 2021 report from Dubai-based research and consulting firm ValuStrat noted that Qatar had “rapidly diversified and expanded” its telehealth services in recent years, reflecting its accelerated push to develop digital medical solutions amid the pandemic.
Outlook
Sustained high levels of public funding ensures that new facilities and innovative tools will continue to come on-line in the coming years to help meet the demand for care. The role of the private sector remains substantial, however, as efforts to shift some of the cost burden from the government to private actors was most recently bolstered by the decision to mandate the country’s large expatriate population obtain private health coverage. These factors should contribute to healthy sector growth in the medium term.
Read More from OBG
