With the establishment of the National Health Regulatory Authority (NHRA), the Bahraini government aims to gradually modernize the Health system and attract private sector´s investments.
How is the demand for health care in the GCC changing?
Overall, most of the GCC countries are passing reforms in their health system, moving towards where the Health Ministries are only policy makers and regulators, this is done so in order to attract more private sector participation into the sector. In GCC given the demand for health care amidst an ageing population and prevalence of lifestyle diseases, the GCC healthcare sector is fast developing into a robust system. Governments are increasing focus on quality, while introducing regulatory changes to improve efficiency and quality of services. So far the health care sector growth was mainly driven by the GCC governments, however we are already seeing an increased participation by private players. With programs, such as mandatory insurance, there is an increasing reliance on the private healthcare sector to expand rapidly to create capacity for their growing markets. Numerous new facilities are planned in almost all GCC countries making the healthcare sector a vital allocation for many institutional investors in their overall investment strategy.
How is an introduction of Health Insurance schemes changing the industry?
We have seen some of our neighbors are now implementing reforms and changes to bring the private sector into health-care delivery in order to manage the burgeoning demand and provide a better quality of care in a more efficient manner. Regional governments are increasingly making health insurance mandatory in a bid to reduce costs and improve healthcare standards which are at different phases of implementation in the GCC countries. However, when you speak of National Health Insurance, it is not merely introducing an insurance plan, but overhauling the whole health care system. It needs to happen very gradually, by building confidence, introducing trustworthy independent bodies and so on.
One of the first steps towards liberating the sector in Bahrain, under the Vision 2030, was to create an independent regulatory body that could be partial towards public and private institutions, and outside the Ministry of Health’s scope. The decree to create National Health Regulatory Authority in Bahrain was passed in 2009, and since then we have gone through many changes and reforms to what we currently stand as.
How hard is it to change the mindset of Bahraini towards a National Health Insurance scheme?
Dr Mariam Al-Jalahma: As I mentioned, everything needs to happen gradually. There is a lot of work to be done, many regulatory and legal changes, how you hire doctors and nurses. Right now, we are implementing small changes, but in the future, there will be some dramatic changes, which will of course face some resistance, however seeing the results will help to change people’s mindset. According to the World Bank study, even if we were to status quoe, set aside the resistance we will get from the public, we would not be able to sustain the health sector in terms of financing human capital etc. Implementation needs to be done gradually.
The government has already passed the regulation to the parliament waiting for approval, once the law is in place we will see changes take place.
How are you working in partnership with other countries that have implemented similar systems?
The Supreme Council for Health before creating the regulatory framework, have visited many countries such as Turkey, South Korea, UK, Estonia UAE to see what are their experiences with implementing the system. We do not want to invent the wheel, but take the right system, amend it so it fits to our people’s needs and gradually implement it. Part of the reform for example will be that the government will not necessary be responsible anymore to build health care facility, but will encourage the private sector to do so. The government will create an independent fund that will allow PPPs, which in turn will attract private sector investment, with the government support.
As you said the regulatory reforms are going to be gradual, which means both public and private investment would be gradual as well, can you discuss what are investment opportunities available in Bahrain’s health sector right now and in the future?
We have a genuine interest from the private sector talking to us what are those key areas that either has a strong demand or growth. First and foremost, we recommend to be looking into Health Insurance and also Specialised Services. Demand for specialized centers of excellence (CoE) is growing rapidly as the burden of disease shifts from the public sector to the private sector. Most GCC public hospitals are functioning at over 80% bed capacity, which is putting pressure on the private sector and specialized clinics to service more patients.
A substantial number of patients are also seeking specialized treatment abroad, so developing more CoEs in Bahrain would help meet not only local demand but also regional, it is a unique opportunity that can reduce the need to travel overseas for treatment. Developing more CoEs would also bring in more medical tourists to Bahrain as well as attracting and retaining highly qualified and experienced clinical talent.
We are also looking into long term rehabilitation centre, alternative medicine facilities that we have recently introduced regulatory framework for this segment, specialised clinic for example women and child, rehabilitation facilities, and many more.
Bahrain should be a regional hub, being geographically well positioned and having a strong human recourse, we should be seen as a centre that can serve the rest of the region.
The government is indeed going towards an economy that is driven by the private sector growth and Health Sector could become one of those success stories. Ministry of Industry, Commerce and Trade had recently deregulated company registration, where you do not need to be a certain professional to invest in specific sector.
With similar deregulations, that are making the sector more attractive for investors how you maintain high standards?
What you are referring to is Company Registration and Company Ownership rights. Yes, you do not need to be a Doctor or have medical skills to open a Hospital or any medical facility, and you can own 100% of the company, However, to make sure the quality and safety standards are maintained, we ensure that chief of stuff or the medical director has a medical background. Or for example a pharmacy doesn’t need to be a pharmacist, but the director or the management should be skilled and experienced in that specific sector. This gives an opportunity for more private sector involvement, by allowing everyone to be a part of health care growth. However, we regulate very strongly when it comes to practice standards and ensure each institution not only meets the minimum requirement but also excels in what they do.
In all what Bahrain’s Health System represents can you tell us what are the core responsibilities of NHRA?
With the establishment of National Health Regulatory Authority, as I mentioned above the government has put an objective of modernising the sector and making it more attractive for private sector investors. The authority has the potential to significantly alter the health care landscape in Bahrain. As of early 2011, the authority has assumed certain responsibilities that were previously held by the Ministry of Health (MoH), including licensing of medical professionals and institutions, monitoring hospitals and other facilities to ensure they meet required standards, handling patient complaints and regulating the distribution of pharmaceuticals. The separator of the powers between a regulator(NHRA) and a health services provider(MoH) has been a significant stepping stone on what we should expect from the sector in the coming years, improving the quality of health care provision and facilitating private-sector expansion.
With the upcoming plans to introduce National Health Insurance Scheme, NHRA will play a key role in accommodating new entrants into the market, and will be a window of transparency for the sector.
It is also very important to state that, in 2012, the government had established the Supreme Council for Health that is considered as the board of directors of NHRA. This institution is focused on developing the strategic plan and goals for both private and public aspects of the health care sector. One of the council’s goals at present is to make all of Bahrain’s Government hospitals separate autonomous entities under the umbrella of the Ministry of Health. It also plans to launch reforms in health insurance and medical education standards, as well as enhance coordination between Bahrain and international entities over the next decade.