The Cooperation Council for the Arab States of the Gulf, colloquially known as the GCC, has experienced unprecedented population growth over the past two decades, with the region’s population nearly doubling between 2000 and 2017. With the exception of Saudi Arabia, countries across the GCC have seen their populations double to quadruple within this time period (Figure). The increase is even more significant when compared to the 12% population growth across all other high-income countries. With the simultaneous addition of 25.7 million residents in the region, life expectancy at birth has increased by between 1.5 years (Kuwait) to 5.1 years (United Arab Emirates), creating a level of increased demand for healthcare that no other geographic region has experienced in recent years.
IIt would be nearly impossible for any country to meet such a dramatic increase in demand by itself. However, targeted infrastructural and human capital investments coupled with strategic collaborations with foreign medical schools and hospitals have helped GCC countries address their immediate healthcare needs while simultaneously creating more sustainable solutions to meet the demands on their healthcare systems. GCC countries have invested heavily in their healthcare infrastructure, with numerous new medical cities and complexes as well as specialty clinics being built over the past two decades. With such a sharp increase in the region’s population, governmental investments have expanded capacity in general acute care hospitals and primary care to address the most prevalent healthcare needs. At the same time, collaborations with foreign providers have begun to help the region address more subspecialty and tertiary care needs. One of the traditional strategies has been to create partnerships with providers in other countries, with patients traveling abroad for complex medical care that may not otherwise be available.
With medical and health sciences education expanding to address the shortage of clinicians and allied health professionals, other collaborations are filling the immediate clinical and management needs within new and existing medical facilities while simultaneously investing in human capital. These solutions have included training clinical professionals on cutting-edge, specialized diagnostics and treatments as well as leadership competencies needed to implement and sustain these new technologies. Collaborations among healthcare providers across borders take many forms, including educational offerings, advisory and consulting services, management services agreements, and capital investments. Each of these collaborations by themselves and in combination with other investments can help to both address short-term needs and increase long-term capacity.
Educational offerings can include both degree and non-degree programs. Degree and continuing education programs may require individuals to travel to the host country or have the training occur in the home country. Both clinical and non-clinical observerships, shadowing experiences for professionals to gain specialized knowledge in a particular area, are a common way to build expertise, particularly for novel treatments and diagnostics. The type of educational offering and whether it is delivered in-country or at the host institution often depends on the depth of knowledge and training required as well as the number of trainees participating at any given time. It may be more efficient and effective for an educational program to be provided within the home country if there is a cohort of trainees to participate; with only one or a few trainees, providing the training at the host organization may be more cost effective. These educational offerings can be sustained by creating capacity via “train-the-trainer” approaches, where the learners are also trained to be the future instructors in their home countries.
Advisory and consulting services include the provision of expertise about specific service lines as well as in hospital operations and facilities management, talent acquisition and human resource planning, technology and innovation, patient safety and quality, hospital planning and design, and other areas. A third strategy for developing the healthcare systems locally is through management services agreements that help to address the demand for professionally trained healthcare leaders to oversee hospitals, clinics, and individual service lines. Management service agreements bring this in-depth expertise directly into organizations in need, providing patient-centered care and value-based care in addition to clinical specializations. The fourth strategy involves international investment or ownership in healthcare or educational facilities in which a foreign organization either wholly or partially owns a local facility. All of these strategies directly address a near-term shortage or need within the home country while simultaneously providing investments in longer-term capacity building.
In our own research of the types of collaborations U.S. healthcare providers engage in with healthcare organizations abroad, we have found that the most common mode of non-patient international collaboration was via educational programs. Additionally, half of the hospital and health system members of the U.S. Cooperative for International Patient Programs (USCIPP) also engaged in consulting and advisory services with organizations outside of the United States. While addressing an immediate need within the GCC countries, these collaborations also benefit the host organization by enhancing its global reputation and brand. Most U.S. academic medical centers and teaching hospitals have a mission to promote global learning and practice opportunities for students, trainees, fellows, clinicians, and other healthcare professionals, thereby bringing their expertise to communities that need them. These non-patient collaborations are an important means for organizations to fulfill their educational mission of providing care to their communities and creating what are often life-changing experiences for the healthcare professionals themselves.
Examples of collaborations building health system capacity locally
Healthcare providers and governments in the GCC have partnered with USCIPP member health systems to design and implement a variety of initiatives aimed at ensuring access to high-quality specialty care locally, decreasing the number of patients with complex care needs who need to travel abroad.
Mayo Clinic Care Network: A network of more than 42 independent healthcare systems across the world, the Mayo Clinic Care Network includes two members located in the Gulf: the American Hospital Dubai in Dubai, UAE, and the International Medical Center in Jeddah, Saudi Arabia. Internationally, the Network provides local hospitals and physicians with electronic access to Mayo’s clinical specialists and subspecialists, including e-tumor board conferences that allow physicians abroad to discuss complex cancer cases with panels of Mayo Clinic experts and other Network providers. In a recently published analysis of the benefits of Mayo Clinic Care Network’s e-consult and e-tumor board services, second opinions provided through these services improved the final treatment plan in over one-third of challenging cancer cases.
NMC Healthcare and Cincinnati Children’s: The two institutions have an agreement by which specialized pediatric surgeons at Cincinnati Children’s provide lifesaving and life-enhancing surgeries at NMC Royal Hospital in Abu Dhabi through surgical visits. The collaboration is focused on developing pediatric surgical expertise to treat complicated congenital, neurological and musculoskeletal disorders at NMC Royal Hospital.
Al Jalila Children’s Specialty Hospital in Dubai and Children’s Hospital of Philadelphia: The two have a memorandum of understanding to establish a dedicated neurology outreach program that integrates telemedicine consultations into the program, thereby reducing the physical and financial burden of care for children and their families.
The alliance facilitates patients who have sought care for neurology-related disorders at hospitals from across the world to continue their treatment plans at Al Jalila Children’s. Pediatric neurologists from Children’s Hospital of Philadelphia provide consultation, thereby lessening the burden of traveling to and from the United States for patients and their families.
Memorial Sloan Kettering Cancer Center and the Kuwait National Mammography Screening Program: The institutions have collaborated to implement a national mammographic screening program in Kuwait. Physicians are trained in both the United States and Kuwait, and Memorial Sloan Kettering physicians provide follow-up to assess image quality, screen program results, and provide continuing education in Kuwait for Middle Eastern radiologists and technologists. Five Kuwaiti radiologists participated in a six-month breast imaging program in the United States under the instruction of a Memorial Sloan Kettering radiologist. Similarly, six Kuwaiti technologists observed nearly 600 cases over a three-month teaching period. The educational training program occurred from 2014 to 2016.
King Faisal Specialist Hospital and Research Center (KFSHRC) in Saudi Arabia and Houston Methodist: The two have cooperated since 2009. Through their latest agreement, KFSHRC and Houston Methodist explore the advancement of various projects, including providing staff with clinical and leadership training programs in Houston. The agreement also provides KFSHRC’s physicians with access to world-class experts at Houston Methodist who will offer second opinions for patient diagnoses as part of the hospital’s second opinion program.
Healthcare providers from across Europe, Asia, and beyond are also actively collaborating with providers in the GCC to help build capacity. For example, King’s College Hospital London opened a medical center in Dubai in 2017.
In many cases, these international collaborations focus on specific service lines through which partners bring their expertise to the region to address a healthcare need. University Hospital Sharjah has partnered with Himchan Hospital in Seoul, South Korea, to provide advanced spine and joint medical services locally. At the same time, Canadian institutions have helped to grow capacity for cancer care in Kuwait through clinical specialization, knowledge transfer, and education and training.
With the continued demand for complex, cutting-edge medical care, strategic collaborations between GCC providers and foreign medical schools and hospitals help to address evolving human capital and infrastructural needs. At the same time, these collaborations create longer-term capacity necessary to address the region’s healthcare demands locally.
References available on request.
International collaborations focus on specific service lines through which partners bring their expertise to the region to address a healthcare need.