Amidst the prevalence of lifestyle diseases, telehealth offers industry stakeholders the opportunity to seamlessly deliver high-quality healthcare to more people in more places and at a lower cost. However, despite its obvious benefits, multiple factors such as policy and cultural issues are hampering its widespread adoption in the Middle East.
The Middle East countries are currently in the grip of a healthcare crisis as the region becomes more affluent. Increased wealth, spurred by the development of the oil-and-gas sector and the liberalisation of trade policies, has resulted in irreversible changes in the lifestyle and nutritional habits of its populations which, in turn, have fuelled a rise in non-communicable diseases (NCDs) such as obesity, high blood pressure and cardiovascular disease.
The prevalence of these lifestyle-related ailments is not only driving the enormous associated costs borne by the government and private sectors, but also leading to a shortage of hospitals, clinics and other healthcare facilities in the region. This prevailing trend has led to the growth of telehealth services – the provision of healthcare remotely by means of digital information and telecommunications technologies.
Already commonplace in developed countries, such as the US and the UK, telehealth allows patients to have ‘live’ interactions with doctors via video chat, health mobile apps and remote-monitoring tools. If done correctly, telehealth can reduce unnecessary visits to clinics, specialists and hospital-based care, and significantly cut down the cost of healthcare for governments, patients and insurers while, at the same time, increase overall accessibility and clinical outcomes.
Access to healthcare
There is a general consensus that the current way which patients are able to access healthcare is both very inefficient and very expensive, said Mr Charlie Barlow, CEO of Dubai-based telehealth company Health at Hand. With around 50% of a hospital or clinic’s budget going towards human resources, “we cannot expect to combat both an unbridled medical inflation rate and a shortage of healthcare professionals by simply hiring more”, he said.
Additionally, growing populations and an increase of NCDs are placing incredible pressure on both public and private healthcare resources across the Middle East. “Telehealth helps drive efficiencies and, at the same time, alleviate the abuse surrounding the over-prescribing of medicine and unnecessary laboratory tests,” Mr Barlow said.
Across the region, there are pockets of high density urban healthcare services, with suburban and rural areas being relatively underserved, particularly in terms of specialist services, said Ms Christina Sochacki, senior associate at Al Tamimi & Company. Telehealth services are seen as a way to increase physician utilisation and population access to specialised services.
In the Middle East, telehealth can be utilised in many ways, especially as healthcare supply in the region still lags behind international benchmarks, she said. “As mandatory health insurance continues to be rolled out across the region, such as in the emirates of Abu Dhabi and Dubai, Saudi Arabia, Oman, and Bahrain, mandating the use of telemedicine as a gatekeeper model (for basic insurance holders, for example, and for non-emergency services) could greatly reduce the burden on clinics and hospitals, which often have long queues for routine healthcare concerns.
“Specifically, ‘gateway’ consultations would foster the uptake of telemedicine services, reduce the costs of care delivery, and increase early healthcare intervention, especially in areas of healthcare undersupply,” she pointed out.
Keeping up with needs
With the region’s ageing population on the rise along with incidence of hypertension and diabetes, the Middle East, which has one of the smallest shares of the global telehealth market, is expected to become a growth market for such services, said Dr Dennis Sebastian, regional director - health, RGA. In particular, telehomecare, designed for the management of chronic illnesses, could see a substantial growth in the region.
Telehomecare, which refers to the delivery of healthcare services to patients at home through the use of telecommunications technologies, “could be beneficial for the region’s ageing population’s current and long-term care needs, as specialists to manage chronic and long-term conditions are limited”, said Dr Sebastian. Presently, demand for hospital-driven telehealth services in the region is increasing, particularly services such as teleradiology and telepathology.
Need is without a doubt the main driver of telehealth growth in MENA, said Mr Jalil Allabadi, founder and CEO of Altibbi, a leading digital health platform in the MENA region. The gaps in the healthcare systems across the region have many contributing factors such as weak primary care infrastructure, over-reliance on larger secondary/tertiary hospitals, social taboos and the rise of lifestyle diseases, he said.
“People need quick access to primary care doctors. They need it delivered in a convenient manner and at a reasonable price. And this is what they can get from telehealth. It allows them to address their basic health concerns without needing to brave traffic, queue at clinics or visit the ER and incurring all the unnecessary extra time and expenditure,” said Mr Allabadi.
In the US, telehealth is resolving an ever-growing percentage of medical cases, resulting in major cost savings, “but in MENA we are overcoming problems previously thought almost impossible to solve such as providing quality care to remote geographies and educating conservative communities on topics they consider taboo. A lot of value is being unlocked through telehealth, and we believe that much of the value remains untapped”, he said.
Mr Allabadi added, “We have been listening carefully to our patients/users and reacting quickly with technology that suits the needs of the specific segments of users that showed interest. So when video conferencing proved too intensive in terms of data consumption, we switched to voice and enabled sharing of media attachments. When voice didn’t feel private enough, we enabled text consultations. And when people asked to talk to the same doctor for follow-ups, we made it possible to schedule such consultations. The real surprise is how people react so positively to such customisation with increased demand.”
Many of the cultures in the Middle East place a high value on interpersonal relationships and have an expectation of direct doctor-to-patient interactions, said Ms Sochacki. “Creating a cultural shift towards comfortability with placing trust in technology and with its applicability, will involve both the public and private sectors raising public awareness. From a provider angle, experience utilising such technology is not as widespread as other parts of the world and fears of medico-legal repercussions are more commonly seen in the Middle East,” she said.
Containing costs
Regional health authorities are also becoming increasingly supportive of telehealth, acknowledging that it is an absolutely necessary technology-enabled solution for reducing the spiralling costs of healthcare, said Mr Barlow.
“Loss ratios for payers are at all-time highs and, for the first time in nine years, we will see an increase in medical inflation amidst a backdrop of general deflation. Telehealth provides an efficient and safe cost containment solution to this problem,” he said.
Where it has been used, telehealth is a low-cost healthcare delivery model that leverages omnipresent connectivity to connect doctors with patients, said Ms Sochacki. Better access to specialists through direct patient consultations and second opinions, as well as the early triage of patients and management of chronic conditions, has helped to improve the health knowledge and behaviours of patients, leading to improved healthcare outcomes, she said.
From a regulator point of view, “we see that the regional health authorities look to telehealth as an opportunity to improve the operational and financial efficiencies of their healthcare systems, as well as their population’s access to care. These governments’ motivation for improving their healthcare systems often comes from an economic diversification and encouraging foreign investment point of view, as well as from the point of view of lowering healthcare costs and decreasing burdens on urgent care facilities”, she said.
Telemedicine is currently being used as a gatekeeper for some healthcare plans in the Middle East, and telehealth as a means of chronic disease management is being promoted by insurers and health service providers, said Dr Sebastian. “It is, however, too early to measure its effectiveness from a claims utilisation or outcome perspective, as we have not yet observed nor have any measured outcome report to justify any reduction in claims frequency or costs,” he said.
Factors to consider
For insurers considering telehealth as a service for their members, Mr Barlow said there are two key points to keep in mind: choose the right partner and focus on driving utilisation. “Telehealth works brilliantly when you have chosen to work with a telehealth company that prioritises both the quality of care and the delivery of an ethical proposition. Telehealth companies are in a privileged position whereby they are often the first to see patients. They therefore have a responsibility to triage patients in an appropriate and safe manner, act as gatekeepers and maintain continuity of care while, at the same time, being the bastions of good practice,” he said.
If used correctly, telehealth can provide not only huge convenience for patients, “but also drive considerable cost containment with a focus on preventative care”.
Mr Barlow added, “Driving utilisation is just as important since the benefits and savings can only be realised when we redirect non-emergency care from clinics and hospitals to telehealth. An increase in telehealth utilisation always shows a concomitant decrease in outpatient network utilisation, and hence in claims.”
The need and positive impact are definitely there, said Mr Allabadi, pointing out that “40% of our users are already insured yet still appreciate the convenience and added value of telehealth”.
The challenge at this point is obtaining more data from the insurer’s side to further quantify the exact impact and value added, he said. “This is why collaboration among telehealth providers, government entities and insurance companies is an area that is being developed currently by all parties involved in this ecosystem.”
While the number of consumer-targeted telehealth solutions are increasing, “I am not of the opinion that the numerous consumers who have downloaded the services are all engaged users”, said Dr Sebastian.
Based on his observation, he said most telehealth providers have focused on teleconsultation services in an attempt to replicate the success of such services in the UK or the US. Physician accessibility is not a key issue in the Middle East – the physicians-per-1,000 index for the GCC countries is 2.5, which is comparable with the OECD index of 2.9 and the US index of 2.55, “but a market where more than 70% of the total insured population are blue-collar individuals who may not even have smartphones might not fulfil the target assumptions of any business plan driven by teleconsultation”, he noted.
Effective regulations is key
There are multiple inflection points expected on the path to the widespread implementation of telehealth as with any new technology, and “we have already seen a few and are probably witnessing more right now”, said Mr Allabadi.
“The extraordinary measures taken, for example in Saudi Arabia, contribute to real impactful adoption. The Ministry of Health in Saudi Arabia has introduced its version of a free-for-all telehealth service which has taken telehealth out of the mystery zones and into ‘normality’. This has taken our service at Altibbi from the realm of explaining what telehealth is to explaining how our service adds value. We have seen our consultations in Saudi Arabia increase by more than three-fold since the government introduced its free service,” he said.
As regulatory frameworks for telehealth in Middle East countries evolve, the telehealth industry will be enabled to take steps to become more structured, usable and accountable, said Dr Sebastian. This would encourage insurers to invest in and promote telehealth, which could spur consumers to utilise it more comprehensively.
Ms Sochacki advised that laws must be developed in a way so as not to unnecessarily limit the efficacy of telehealth services. “We have seen that inefficiencies in the telehealth licensing process and excessive limitations on the scope of services reduces the efficacy of telehealth and leads to such services not reducing curative costs and improving healthcare outcomes to the extent that they can.”
She added, “The technology exists. The businesses that are able to integrate providers with such telehealth platforms exist. What’s preventing widespread implementation of telehealth, from my perspective, is mainly the underdevelopment of associated regulations (such as licensing and practice frameworks) and insurance reimbursement.
“The majority of countries in the Middle East have one or more national initiatives to adopt telehealth; however, few have adopted comprehensive telehealth policies or strategies regulating or covering its use, such as legislation that defines medical jurisdiction, liability, or reimbursements, and that promotes the protection of electronic patient data.”
There is clearly momentum behind telehealth. But for it to develop further, effective healthcare regulations are crucial to overcoming the challenges of implementing telehealth at a meaningful level across the region. M