A recent Colliers paper highlights that the Kingdom of Saudi Arabia (KSA) needs 20,000 to 30,000 long-term care beds by 2030 and this will create a lot of healthcare real estate demand. If translated into real estate demand, the demand will be 6 million sqm to 9 million sqm new construction or US$ 10 billion to US$ 15 billion investment in the next 10 years.
The Kingdom of Saudi Arabia with a current estimated population of approximately 35 million, as of November 2020, is the largest country in the GCC. Under Vision 2030, the country is going through fundamental structural changes in all sectors including healthcare.
The Healthcare sector in KSA is undergoing evolution on the back of rapid advancements in technology and research and development (R&D) in line with global and regional trends. However, COVID-19 has also exposed the vastly diverse structure of healthcare systems and increased the importance of R&D and the provision of specialised healthcare within generalised healthcare.
Long-term care (LTC), Rehabilitation and home care (HC) are amongst the main focal points for diversification and enhancement of the healthcare system in KSA. A key driver is the changing demographic profile through a decreased fertility rate and increased life expectancy. As a result, the population above 60 years is expected to increase from 5.5 per cent in 2020 to 11.0 per cent by 2030.
This shift will have a significant impact on disease patterns and the type of healthcare services required. As almost 80 per cent of a person’s healthcare requirements typically occur after the age of 60 years, this will increase the demand for LTC, Rehab and HC. This is especially true in the case of KSA with its high prevalence of lifestyle-related diseases including diabetes, coronary and obesity-related illnesses. These are in addition to existing demand from disabilities, which also require LTC, Rehab and HC. This article highlights the opportunities relating to LTC, Rehab and HC in KSA.
Source: Colliers Healthcare Team 2021
What is Long Term and Post-Acute Care (LTPAC)
LTPAC includes a variety of rehabilitation or palliative services that help meet the medical and non-medical needs of people with chronic illnesses or disabilities. It includes the care patients receive after, or in some cases, instead, of a stay in an acute care hospital over a relatively long period of time.
This wide array of services ranges from complex care in a long-term, acute-care hospital to personalised home care assistance. Compared to the general population, patients who receive LTPAC services typically have a broader range of conditions and more complex, chronic care needs that result in frequent transitions between their homes, acute, post-acute, and longer-term care settings.
To understand the demand for long-term, one needs to understand the complete patient care management process, from discharge from acute care to rehabilitation, through to Long Term & Post-Acute Care facilities.
Source: Colliers Healthcare Team 2021
Medical Tourism: Saving money by replacing international treatment with domestic treatment
Scarcity and quality of specialised healthcare facilities remain one of the major reasons for outbound medical treatment in the GCC. Both national and expatriate patients prefer going overseas for medical treatments mainly in Germany, UK, U.S., Canada and Asian countries. This includes treatments relating to long-term care and rehabilitation.
Historically, over 20,000 patients used to be sent abroad for treatments. However, with the introduction of PPP models, this has fallen in recent years. The plan now is that unless treatment is not available in Saudi Arabia the state will no longer pay for overseas treatment.
In the GCC, especially in the UAE, there has also been an improvement in the quality of healthcare service provision. The emergence of a number of reputed indigenous brands and the opening of internationally recognised hospitals (such as Kings College Hospital, Mediclinic, Cleveland Clinic) is expected to lead to a further decline in outbound medical tourism.
Establishing quality LTC and rehab facilities with home-based international operators can act as a catalyst to reduce expenditure on outbound treatments whilst simultaneously growing a new service sector.
The key indications/ diseases that require long-term care:
Medical wellness & preventative healthcare
In the MENA region, the prevalence of diabetes and obesity is one of the highest in the world, with almost 55 million people aged 20 to 79 years suffering from diabetes. This number is expected to double by 2045.
Eight Middle Eastern countries; Kuwait, Qatar, Egypt, KSA, Bahrain, UAE, Jordan and Lebanon have the highest ratio of obesity among adults globally with 27 per cent to 40 per cent of the total population affected. The prevalence of overweight and obesity in these countries ranges from 74 per cent to 86 per cent in women and 69 per cent to 77 per cent in men.
In GCC countries, there is a need to focus on more preventive rehabilitation care by the establishment of medical wellness treatment centres.
Projects are being developed in lifestyle retreat settings where recovery is in a relaxed and comfortable environment rather than a typical hospital setting. Colliers has also been engaged in various projects including waterfront hospitality where health and medical wellness components are incorporated within the resorts. These projects are expected to have a positive impact in the long-term by reducing the demand for both acute care hospitals and post-acute care long-term and rehabilitation facilities.
Within KSA, the Red Sea Project, Qiddiya Entertainment City and Amaala Red Sea Riviera projects could be ideal locations to develop medical wellness and preventive healthcare facilities.
Source: Saudi Gazette; Colliers Healthcare Analysis 2021
Mental Health is becoming a major issue, as presently there are around 1.4 million patients in the KSA which are expected to increase to 4.4 million by 2050. A significant percentage of mental health issues are age-related and can be accommodated through long-term care/rehabilitation facilities or even as part of home care. COVID-19 has also exacerbated mental health issues through additional life stress and isolation. Offering mental health in LTC / Rehab facilities or as part of Home Care, can significantly reduce the capital and operating expenditure and free up beds and resources in acute care hospitals and family clinics.
Due to the shortage of long-term care, rehabilitation and home care services in KSA, patients in need of long-term care utilise acute care facilities, creating a burden on acute care facilities.
Based on various reports and discussions with hospital operators, patients who could be better served in LTC and rehab facilities occupy an estimated 20 per cent to 30 per cent of public hospital beds in the KSA.
The cost of patients who need LTC and rehab but are instead treated in general hospitals is significantly higher compared to a long-term care facility. This is a crucial issue; all government budgets are under pressure while demand for healthcare continues to rise. The capital and operating costs of setting up LTC and rehab facilities are up to 30 per cent or lower when compared to an acute care hospital.
The need for infrastructure to support the provision of LTC and rehab facilities is one of the main policy drivers for various governments in the GCC. For example, Dubai has prioritised investments in setting up LTC and rehab patient services under its latest Investment Guide. As part of the privatisation process in KSA, the Ministry of Health is seeking to engage operators for LTC and Rehab facilities and HC.
So, what is the gap?
As per Colliers estimates, KSA, by 2030 would require additional 20,000 – 22,000 Long-term Care (LTC) and rehabilitative beds. However, to achieve OECD average standards, the country would require 28,000 to 30,000 additional beds by 2030.
An important aspect will be improving HC services. Presently the capabilities, resources, and efficiency of in-home care vary across regions with limited service provided. Due to a lack of efficient operational procedures and proper information systems, the utilisation of home care personnel remains low. An improved home care provision will reduce the pressure on both acute care and LTC and rehabilitation hospitals. The target under the PSP initiative is to increase home care coverage annually from 40,090 (2017) to 90,300 (2022).
In November 2020, the Ministry of Human Resources and Social Development (MHRSD) announced the implementation of a uniform model for elderly care in KSA in collaboration with the private and non-profit sectors. In Colliers’ opinion, this initiative is expected to improve the efficiency and quality of services provided to the elderly in the Kingdom with better utilisation of tertiary care, LTC and Rehab facilities.
There are number of benefits of transitioning a patient to post-acute care setting from an acute care facility instead of direct discharge to home
The greatest challenge lies in the shortage of manpower as the number of physicians and specialised nurses and allied healthcare personnel for rehabilitation is insufficient. With new hospital developments underway the competition to hire experienced and skilled physicians, nurses and allied workforce is further set to intensify.
Currently, the market is in its nascent stage and many existing LTC, Rehab and HC facilities lack advanced medical capabilities. As the market matures, more centres providing specialised comprehensive rehabilitation such as neurorehabilitation, cardiopulmonary, paediatric and musculoskeletal rehabilitation will enter the market. The Colliers healthcare team is actively working with several local, regional and international investors and operators to facilitate entry and/or expansion in KSA’s lucrative LTC, Rehab and HC sector.