196/imo/mar09 cme 13 changing tomorrow - control...
TRANSCRIPT
Kuwait Medical Association
Changing Tomorrow
CME 13
at Diamond Ballroom, Sheraton Hotel, Kuwait15th & 16th March, 2009
Changing Tomorrow
196/IMO/MAR09
Category I
www.healthreform2009.com
Advanced Technology Company K.S.C.P.O. Box: 44558 Hawalli 32060, Kuwait.
Tel: (+965) 22247404 Fax: (+965) 25718383www.atc.com.kw
His Highness
His Highness Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah
Amir of the State of Kuwait
His Highness Sheikh Nawaf Al-Ahmad Al-Jaber Al-Sabah
Crown Prince of the State of Kuwait
His Highness Sheikh Nasser Al-Mohammed Al-Ahmad Al-Sabah
Prime Minister of the State of Kuwait
General Information.................................................................................................................................................................
About Kuwait.......................................................................................................................................................................................
Chairman’s Message..............................................................................................................................................................
KMA Board Members............................................................................................................................................................
Faculty..............................................................................................................................................................................................................
Abstracts......................................................................................................................................................................................................
Scientific Program......................................................................................................................................................................
Health Reform 2009 Project Task Force...........................................................................................
The Challenge & Solutions of Reforming Kuwait’s Health-Care System...........................................................................................
Kuwait Health Reform 2009..................................................................................................................................
Participants & Acknowledgment.......................................................................................................................
3
4
5
6
7
11
43
46
47
65
96
Index
Inde
x
Info
Conference Date & Venue:15th & 16th March, 2009
at Diamond Ballroom, Sheraton Hotel, Kuwait
Conference Inaugural Ceremony:15th March, 2009 at 10:00 am
Under the patronage ofHis Highness The Amir of State of Kuwait
Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabahand the attendance of Minister of Health of the State of Kuwait
Rawdhan Al-Rawdhan
Information Desk:For any inquiries or assistance, please proceed at the Information Desk, located next to Registration Counter.
Medical Exhibition:from 15th to 16th March at
at Crystal Ballroom, Sheraton Hotel, Kuwait
Lost and Found:For lost and found item/s please ask the assistance of the security staff or the organizers.
Info
rmat
ion
Gen
eral
3
Kuwait is a young country with the tiny population, yet in 40 years this
little giant of the twentieth century has been transformed at breath-
taking speed from the life style based on fishing, pearl diving and tradi-
tional desert ways of the Bedouin in to a sophisticated, modern state,
fully conversant with all aspects of technology, urbanization, industry,
architecture, commerce, financial services, education..etc.
Kuwait’s infrastructure is highly developed. Excellent road systems, so-
phisticated communications network comfortable hotels and motels,
advanced banking system, high standard of educational institution,
good transport system and there are perhaps more restaurants per
person in Kuwait than anywhere else in the world offering variety of
cuisine. The geographical location of Kuwait was a meeting point for
the civilization of the old world. Kuwait’s history was marked by stands
and sacrifices to safeguard it’s territory and tradition despite all obsta-
cle and difficulties.
In 1938 oil was first discovered in Kuwait by Kuwait Oil Company
(KOC), a London-based joint venture of the Anglo-Persian Oil Company
(now BP) and Gulf Oil (now Chevron Corporation), under a concession
granted by the then Amir of Kuwait, Sheikh Ahmad Al-Jaber Al-Sabah
On June 30th, 1946, His Highness Sheikh Ahmed Al-Jaber Al-Sabah,
turned a silver wheel to commence the flow of the first Kuwait oil
exports. This heralded the start of a new era for Kuwait, providing the
basis for its development into one of the world’s most modern nation
states.
The State of Kuwait lies at the north-west extremity of the Arabian
Gulf. The total area of the State is 17,818 square kilometers (6960 sq.
miles). Kuwait City is the capital of the State. The name Kuwait, is the
diminutive of the Arabic word “Al-Kout” which means a house built in
the form of a fortress adjacent to water.
We “invite” you to have a closer look at this country - so different from others but full of its own style, traditions and hospitality.
About
4
MessageChairman’s
On behalf of Kuwait Medical Association & Chairman of the Organizing Committee I am delighted to welcome you to Health Reform 2009 Conference to be held under the patronage of His Highness, The Amir of the State of Kuwait, Sheikh Sabah Al-Ahmad Al-Jaber Al Sabah and the attendance of His Excellency the Minister of Health – Rawdhan Al Rawdhan.
We have designed comprehensive scientific tracks which includes topics like Leadership, Strategy Management Accreditation,Financial Performance, Health Economics, Health Informatics, Medical Tourism, Hospital Performance and Best Practice Management.. etc.
The renown excellence of the technical presentations during Health reform will achieve the main goal of Health Reforms in the coming years in the State of Kuwait.
It is the one time of the year that delegates from the far corners of the region, tear themselves away from their operational responsibilities... not only to find the knowledge that will carry them through the coming year, but also build the peer relationships.
By contributing your knowledge and experience you will be directly impacting network and technology deployment here and will be able to learn, first hand, the practical issues facing current operations.
We hope that such an initiative is worthy of your time and talent and look forward to see you at Health Reform 2009.
Dr. Ali Al Mukaimi MBBS, MD, German BoardPresident of Kuwait Medical AssociationConsultant Orthopaedics
5
President:
Dr. Ali Al Mukaimi MBBS, MD, German Board Consultant Orthopaedics
Vice President:
Dr. Ahmad Al FadhliHead-Burns and Plastic Surgery, Al Babtain Center, Kuwait
Treasurer:
Dr. Nasser Bader Al HumaidiGeneral Surgery, Farwaniya Hospital
General Secretary:
Dr. Mohammed ShamsahAnesthesia, Intensive Care & Pain Management Consultant
KMA Board Members
Member:Dr. Homoud F. Al-Zuabi
Member:Dr. Noura Al Sweih
FACULTY
Facul
ty
facul
ty
Dr. Abdulrahman AlNuaim, MD, RCPC, FACP, CPEDistinguished Senior Consultant, Professor of MedicineConsultant Endocrinologist & Diabetologist King Faisal Specialist Hospital and Research Centre
Dr. Ahmed I M Al-Sagheir, MBBS, FRCP(c)Department of Medical Oncology, Juravinski Cancer Centre.
Dr. Adnan Abul, MD, FRCP(c)Assoc. Prof. Pulmonary Medicine University of Kuwait.
Dr. Abu Shafi, BSc, MBBS, LLMChairman and CEO, International Foundation for Improvement and Safety in Healthcare (IFISH).
R. Chris Christy, FACHEAssumed the world wide role of Senior Director, Healthcare Industry, SAP Business Objects.
Curtis J. SchroederGroup Chief Executive OfficerBumrungrad International, Bangkok, Thailand.
Dr. Edgar J. Jimenez, MD, FCCM Co-Chairman of the Corporate Critical Care Department, Orlando Health. Director- Medical Critical Care at Orlando Regional Medical Center, the Lucerne Institute of Medicine, the Winnie Palmer Hospital for Women and Babies. Chairman of the Corporate Pandemic Influenza Committee, Orlando, Florida, USA; Director, Critical Care Translational Research and Teaching Center.
Dr. Hani ALKhaldi, MBBS, SSC-Ped, ABP, MHI, SMENEHR (National Electronic Health record)Consultant MOH, Saudi Arabia. Member Of The Global Executive Healthcare Exchange Forum.
Dr. Hussain Nasser Al Rahma, MBBSPresident of the Emirates Intensive Care Society.
Dr. Joseph Christopher Farmer, MDB.S., Texas A&M University M.D., University of Texas Medical School at Houston. Residency, Internal Medicine, Wilford Hall Medical Center, Fellowship, Critical Care Medicine, St. Louis University and St. John’s Mercy Medical Center.
Julie B. DeckerManaging Director, LynxCom Partners – San Diego, CA, USA. Operating Partner, Director of Healthcare Practice, FocalPoint Partners-Los Angeles, CA, USA.
8
facul
ty
Dr. James A. Rice, Ph.D., FACHEVice Chairman, The Governance InstituteSan Diego California, USA, Practice Leader, Governance and LeadershipIntegrated Healthcare Strategies Minneapolis Minnesota, USA.
Dr. Khalid Shukri, MD, MHA, FCCM,FIPACCMExecutive Director, Healthcare Executives Consultants.Healthcare Management Consultant, Senior Consultant Critical Care Medicine, President-Elect Healthcare Executive Group (HEG-MENA), Affiliated Chapter American College Healthcare Executives (ACHE), Secretary-General International Pan Arab Critical Care Medicine Society.
Dr. Mohammed I. Al-Saghier, FACP, FRCSC, MBBSDepartment of Liver Transplantation and HepatobiliaryPancreatic Surgery King Faisal Specialist Hospital & Research Centre.
Dr. Mohd Abushafi, BSc, MBBS, LLMChairman and CEO, International Foundation for Improvement and Safety in Healthcare (IFISH).
Dr. Nadeem Al-Duaij, MDCo-founder & Chairperson-Kuwait Health Initiative Chairperson-International Committee American College of Medical Toxicology, Fellow-Harvard Medical Toxicology Fellowship Children’s Hospital Boston, Candidate-Master of Public Health Harvard School of Public Health
Naji Bejjani, D.B.A. & M.B.A. Professor International Management Consultant & Trainer.
Dr. Paul Hofmann, DrPH, FACHEpresident of the Hofmann Healthcare Group, Moraga, California, has worked in the health care field.
Dr. Saeed Al-Qahtani BS, DIPQM, MRSH, MQM, EFPS, CMRP, PHDHead, Planning Department and Quality Management Consultant King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Wesley Valdes D.OAssistant Professor, Clinical Surgery at the University of Illinois at Chicago in the Division of Vascular Surgery, Section of Wound Care and Tissue Repair.
9
Abstracts
Abstracts
ab
stra
cts
Dr. Abdulrahman AlNuaim, MD, RCPC, FACP, CPE
Distinguished Senior Consultant, Professor of MedicineConsultant Endocrinologist & Diabetologist
King Faisal Specialist Hospital and Research CentreRiyadh, Saudi Arabia.
Abstract:Balanced Scorecard In Data Warehouse: A Powerful Performance Monitoring Tool
There has been, traditionally, on investing significantly in collecting the data with little investment in terms of data analysis and reporting. This has suffered from gaps throughout the process that relates to data disconnect, data quality, resource limitation, and lack of standards. These are among the features of under performing organizations.
Balanced Scorecard (BSC) is a performance monitoring tool that has been used widely and for many years in non-healthcare organization. BSC allows management to communicate the mission and strategy to the staff. It is used, as well, to inspire employee for achieving specific outcome.
For BSC to succeed, it is essential to agree on a certain key performance indicators (KPi’s) with clear definition commitment for securing data collection and analysis. It is, therefore, important to educate the executives and managers on how to use KPi’s, what to measure, how to measure, how to use the mea-surement and how to interpret those measures considering other essential variables.
King Faisal Specialist Hospital & Research Centre (KFSH&RC) has adapted concept of balanced scorecard and data warehousing since 2005. It has gone through a significant evolution where it reached a reason-able mature stage.
During presentation, there will be discussion on the above-cited issues, as well as, sharing the experience of KFSH&RC with BSC.
Innovation in Medicine
Healthcare System (HCS) is a living organism that is going through evolutionary changes. It is important, therefore, to understand the current and future medical practice specifically how the HCS will look, who is the new patient, how well patient will be treated.
It is expected that medicine future will have emphasis on using stem cells to repair damaged organs in-ternet monitoring medication, fully integrated care from diagnosis to rehabilitation. The priorities in tech-nology will be in genomics and proteonomics, clinical informatics, regenerative medicine, and advanced clinical technologies.
There has been a significant healthcare paradigm shift of the HCS where it is now more inclusive network-ing, collaborative and patient centered. It is, therefore, imperative to promote transforming healthcare to fulfill the paradigm shift parameters.
During the presentation, there will be more detailed discussion on the above-cited issues related to in-novation medicine.
12
ab
stra
cts
13
Healthcare System: How to Create Order From Chaos
The challenges facing many countries, related to healthcare are how to cope and finance rising health-care costs, how to enhance quality, and universal and equal access of population to healthcare services.
It is expected that in the next two decades, many countries will be hitting crisis, as there has been signifi-cant growth in healthcare demand, more than the existing capacity and resources.
Such challenges are opportunities for significant transformation. The drivers for change in healthcare are globalization, consumerism, ageing and overweight population, the changing nature of diseases, and the new medical technologies, and new treatments. This will be faced by inhibitors such as financial constraints.
Societal expectations and the inability to balance short-term and long-term perspectives are among the rising challenges. There is a need, as well, to move away from focusing on acute care to holistic ap-proach that is including, as well, preventive and chronic care. It is imperative to focus on health services integration.
There is a need for accountability at different levels to ensure successful transformation.
Successful transformation cannot happen and will not be sustained if it is not coupled with a robust health infomediary. During presentation, these issues will be discussed in more detailed.
Essentials of Managing Complex Healthcare Organization
Globalization, ageing population, genetic revolution, advances in imaging technology and medicine, ev-idence-based practice, and greater accountability are trends affecting medical practice nowadays. The ideal health vision is based on promoting and equitable, affordable, and efficient healthcare system. In spite of expanding health expenditures, there is an inverse relation between quality and patient satisfac-tion on one hand and the increase in healthcare spending.
Managing a hospital is a complex task, as it requires a coordinated effort of complex parameters gov-erned by the strategy and the set goals and objectives to achieve. The difficulty is compounded by the fact that the strong bonds of trust between patients and their doctors are replaced by a growing distrust. Medical errors are recognized worldwide and there are means of quantitating and assessing its sever-ity. It is, therefore, imperative to have a clear direction by the governing body with effective executive councils that oversee both medical and non-medical operation.
Leadership enforce the organization agenda. It is essential to differentiate between manager and leader. Financial accountability cannot be over emphasized; emphasis is on the importance of robust and inte-grated health information system.
During the presentation, such essentials will be discussed citing examples.
ab
stra
cts
Dr. Abu Shafi, BSc, MBBS, LLM
Chairman and CEO,International Foundation for Improvement and
Safety in Healthcare (IFISH).
Short CV
Dr. Abu Shafi was born and raised in London, England. He embarked upon his undergraduate career at the
University of London with a Bachelor of Science degree (BSc) in neurosciences. His research project was
carried out in part at the Ann Arbor School of Physiology, University of Michigan, USA and this lead to 2
articles being published in the Journal of Physiology, and presentations being made at the world renowned
Physiological Society annual conference at the age of 20.
He then completed his medical degree (MBBS) at the internationally famous Guy’s Hospital, London and
embarked upon a career in general medicine. Over the next few years, he became actively involved in the
start of the clinical governance movement during the mid 1990’s in the UK and this lead him to develop
a keen interest in healthcare risk management and he become involved in many regional and national
initiatives, including the reduction of UK junior doctors working hours program.
Setting up a Hospital Patient Safety Program
Content Level: Foundation
Style: Presentation
Abstract:
“Frustrated” is a word many healthcare leaders use to describe how they feel when their ideas for im-
provement and safety fail to deliver. There is a need to explore ways to generate, assess and implement
new ideas. Patient Safety in still in its infancy, and a series of good ideas have proved to be much less
effective than expected. Management of hospitals has always been a problem, with most organisations
simply not being familiar with how to match increasing demand for quality and safe care with diminish-
ing supply of resources. Based on 3 years worth of research on the ethnography of patient safety in the
Middle East, this presentation focuses on the leadership in healthcare and outlines what is known about
transformation strategies and highlight factors that enable or hinder the implementation of a hospital
patient safety program.
14
ab
stra
cts
15
R. Chris Christy, FACHE
Short CV Chris Christy assumed the world wide role of Senior Director, Healthcare Industry, SAP BusinessObjects in 2006. He has been engaged in Healthcare for 25 years, both in industry roles and healthcare software positions. He brings 16 years of healthcare provider industry experience to the position and previously held administrative posts within both nonprofit and for profit hospitals. He served five years as Associate Administrator and Chief Operating Officer at several Hospitals that were part of American Medical Inter-national, now known as Tenet Healthcare Corporation. He also served nine years as Vice President for Professional Services at St. Paul Medical Center, a 600 bed tertiary care hospital in Dallas, Texas operated by the Daughters of Charity National Health System. Additionally, he served two years as Regional Vice President for Emcare, Inc, a US publicly traded Emergency Room physician group practice.
Over the last 10 years, Chris has served in the software industry, including three years at a SAP & seven years at Business Objects, now a part of SAP. He is a Fellow in the American College of Healthcare Execu-tives & has served as an Adjunct Professor for Healthcare Strategic Planning at Texas Woman’s University in Dallas. In addition, he is a Certified Professional in Health Information Management Systems. He received his Masters Degree in Public Health from the University of Missouri-Columbia in Columbia, Missouri.
Abstract:Using Dashboards to achieve High Performance Healthcare
Outline of Presentation20-25 minutes in durationAuthor: R. Chris Christy, FACHE
Executive Summary:This presentation is focused on the use of digital dashboards in order to bring about operating improve-ments in acute care hospitals. Evidence suggests that organizations which focus on the correct key performance indicators outperform healthcare organizations that do not. Using multiple approaches to the statistical profile of a hospital can yield early and actionable insight to changes in the healthcare environment.
Brief Abstract:The author will review selected examples using specific organizations to illustrate both the challenges and the actual results of incorporating performance improvement initiatives in the management of acute care hospitals. The focus will be on utilization of business intelligence and decision support tools to effectively build consensus among hospital stakeholders for patient care improvement.
ab
stra
cts
Different areas of hospital operational improvement dashboards will be presented such as:• Overall activity levels in the hospital • Clinical quality improvement• Departmental operation • Financial operational improvement• Real world as well as prototypical examples will be demonstrated.
Major touch point topics for the presentation include:• Current healthcare situational analysis• What’s missing – How decisions are currently made• Closed loop performance process• Cultural aspects of performance feedback• Best Practices• Practical Examples• Conclusion
Healthcare Compliance and Quality Management: An International ApproachOutline of Presentation20-25 minutes in durationAuthor: R. Chris Christy, FACHE
Executive Summary:The provision of quality healthcare is a world-wide focus for governments and private systems alike. Benchmarks exist which are both relative and absolute within healthcare systems today. This presentation will focus largely on the quality drivers in the healthcare system and the use of decision support tools-business intelligence to track and improve quality initiatives. Truly international, high quality healthcare has universal benefit.
Examples will be demonstrated from hospitals located in various international regions, including England, Australia, Singapore, and the United States, specifically: The Cleveland Clinic, The Mayo Clinic, New South Wales Health and many others.
Outline of Presentation: • Existing healthcare environment; a short summary of the state of healthcare quality in the hospital environment • Technology • Patient expectations • Government• Key threats to the provision of quality care • Resources • Healthcare provider availability • Financing• Strategies for improvement of quality of care at the facility level • Dashboards • Scorecards • Technology enablers of quality• Best Practices and Practical examples of healthcare quality dashboards and initiatives • Acute Care hospital example dashboards • Conclusion
16
ab
stra
cts
17
Dr. Joseph Christopher Farmer, MD
Short CV EDUCATION
• B.S., Texas A&M University
• M.D., University of Texas Medical School at Houston
• Residency, Internal Medicine, Wilford Hall Medical Center
• Fellowship, Critical Care Medicine, St. Louis University and
St. John’s Mercy Medical Center
NARRATIVE SUMMARY
Doctor Farmer is a critical care physician and Professor of Medicine at Mayo Clinic, Rochester, Minnesota.
He serves as Associate Dean, Mayo School of Graduate Medical Education, Associate Chair for Education,
Department of Medicine, and Associate Director for Education, Program in Translational Immunovirol-
ogy and Biodefense. He is the Supplements Editor for the journal Critical Care Medicine and is disaster
medicine section editor for the European journal Critical Care. He is an editorial board member for other
disaster medicine journals as well. In the U.S., Doctor Farmer holds several national leadership positions
related to critical care medicine, medical education, and physician certification. He is the editor and author
of numerous books related to critical care, education, and disaster medical response.
Doctor Farmer also serves as a senior health care management consultant, assisting academic and other
medical centers with strategic planning, personnel management, quality improvement program develop-
ment, programmatic education initiatives, resource utilization-efficiency, service line development, and
fiscal management.
Doctor Farmer is a retired Air Force Colonel with over 20 years of military healthcare experience, includ-
ing as a senior physician executive in the hospital, health plans-insurance, supply chain management, and
homeland security sectors. He is also experienced in health care services research, medical preparedness,
ICU casualty transport, and medical education. While in the Air Force, Doctor Farmer served as Chief of
Inpatient Services at Wilford Hall, the largest Air Force academic medical center, and as Chief Medical
Officer for TRICARE Southwest, a multi-state Federal HMO. Doctor Farmer also served as the Special As-
sistant to the Air Force Surgeon General for Homeland Defense and Medical Preparedness. Doctor Farmer
has received numerous national awards and citations as an internationally recognized educator and leader
in critical care medicine. He has also been recognized nationally for his contributions as architect, catalyst,
and implementer of the current Department of Defense global critical care casualty transport system.
‣ Critical Care
‣ Medical Transport
‣ Bioterrorism
‣ Emergency Preparedness
‣ Healthcare Operations and Leadership
‣ Training and Education
‣ Management Consulting
‣ Grants and Editorial Work
ab
stra
cts
Abstract:Health Informatics: The role of medical simulation for team-based training of hospital staffIn medical education, learners have been historically divided by school type—that is medical students train with other medical students, nursing students with other nursing students, and so forth. Furthermore, these training programs traditionally focus on learning and retaining didactic information. Unfortunately, and in an actual clinical setting, learners and care providers are grouped together and then expected to dynami-cally solve problems as a functional team. Our education system does not routinely teach these skill sets (i.e., how to perform well as a team), instead expecting these necessary team behaviors to be self-taught or assimilated at the bedside. These skill sets include communications and information sharing, synthesis of multi-source data obtained by each separate team member into a common plan of action, group problem solving techniques, and resource management during a medical emergency. Failure to properly teach these skills, and especially effective communications, results in an increased risk of medical error and patient harm. How do we ensure that our hospital staff acquire much needed training in these areas? Medical simulation provides an excellent environment to teach, learn, and practice these skills. In this talk, we will discuss: 1) why we need to change our current advanced medical education model to include team-based training; 2) the specific skills and team behaviors that should be taught; 3) effective methods to accom-plish these goals with hospital staff; and, 4) measurement of teaching effectiveness.
Hospital Performance and Best Practice Management: Altering systems of care in the hospital to improve patient safetyAdvancing care quality and improving patient safety in the hospital environment obviously extends well be-yond the initiation of care bundles and other programs. Without necessary elements that address provider compliance, education of staff, continuum of care issues, credible metrics of success, eliminating bureau-cracy, and so forth—these programs rarely effect day-to-day care processes. Furthermore, even when they are successful, this often depends on the presence of an individual who continually pushes things forward. When this individual moves on to other tasks or leaves, these initiatives usually fade, and quickly revert to the pre-change state. In this talk, we will discuss these challenges, we will enumerate methods address the issues listed here, and we will define strategies that lead to durable change in care practices that improve patient safety and quality, and are not dependent on the presence of a few passionate champions.
Hospital and Financial Performance: Improving throughput, flow, and efficiency of care for acutely ill hospitalized patientsWhen a hospital is unable to deliver high quality critical care in an efficient, predictable, reproducible man-ner, many other areas of the hospital (emergency department, operating room services, ward services) can also suffer degraded performance (quality, efficiency, financial). In order to address these issues, ex-cellent systems of care for hospitalized acutely ill patients must include integrated clinical, administrative, and quality processes “from the front door to the back door” of the hospital. In this talk, we will discuss best practices and strategies to optimize throughput, flow, and efficiency. These include clinical (product) service line development, integration of “intensivist” and “hospitalist” functionality, necessary business strategies, integrated communication strategies, demand management-demand forecasting techniques, integrated-focused quality improvement activities, and others. We will also discuss how best to implement and measure the success of these programmatic changes.
18
ab
stra
cts
19
Curtis J. Schroeder
Group Chief Executive OfficerBumrungrad International, Bangkok, Thailand.
Short CV Curtis Schroeder was appointed CEO of Bumrungrad Hospital, Bangkok in 1993 and in 2004 was pro-moted to Group C.E.O. of Bumrungrad Hospital Public Company Limited. He has worked in the field of Hospital Administration since 1973. In his 17 years with the US-based Tenet Healthcare Corporation, he opened and managed three new Hospitals in Dhahran, Saudi Arabia, New Orleans and the USC University Hospital in Los Angeles.
In1996, Mr. Schroeder commissioned the new 554 bed Bumrungrad Hospital. Bumrungrad is widely rec-ognized as Asia’s leading provider of high quality affordable health care treating over one million patients per year from over 150 countries and is Asia’s first JCIA internationally accredited hospital. Bumrungrad International owns and manages over eighty hospitals and clinics in seven countries in Asia and the Middle East.
Mr. Schroeder holds a Bachelor of Arts in Administration and a Masters in Health Care Administration from the University of Southern California and has extensive experience in both proprietary hospitals and academic medical center management.
Abstract:“The Global Patient”
The concept of “medical tourism” or “medical travel” has evolved from a curious sideshow of the health-care world to a thriving and growing multi-billion dollar industry. As a pioneer in medical travel, Bum-rungrad International based in Bangkok Thailand, has gained substantial experience in the field treating over 425,000 international patients per year from some 150 countries. Bumrungrad is also the largest provider of care to people from the Middle East outside of the Middle East and the largest provider of healthcare to Americans outside of the USA.
The rapid growth of medical travel has led to a number of misconceptions and myths that can be mislead-ing to businesses and governments interested in this sector. The core drivers for demand by individual travelers and the drivers for third party payors are diverse must be matched by certain core competencies of the providers and the host nation. As the sector evolves from a “grass roots” consumer driven business into a more structured platform involving insurance companies, employers and countries, the drivers are changing as are the required competencies of the providers.
Nations in MENA have an opportunity to participate in the medical travel arena and to reverse its role as a primary source region for medical travelers. But this direction has significant challenges which must be overcome which principally include hitting the “sweet spot” of the value equation and access to cost-effective manpower.
Copyright: Bumrungrad Hospital Public Company Limited
ab
stra
cts
“Public-Private Ventures in Healthcare”
Governments throughout the world are struggling with the challenge of delivering healthcare to their citizens with reasonable access, defendable quality, proper equity, respectful service and at a cost that their respective taxpayers can afford. A common conclusion of this process is that governments are often not well aligned for the actual provision of healthcare services and fare better at the policy making level ensuring access, monitoring quality and providing funding for those who have limited resources.
“Privatization” has become a rather overused and often misunderstood description whereby govern-ments seek to move hospitals and other public activities towards the private sector. There are in fact a range of relationships where governments and the private healthcare sector may interact. These range from straightforward management contracts to wholesale leasing of government assets, formal joint venture structures, PPP (public/private partnerships) and even “co-location” facilities where public and private hospitals exist in tandem. The selection of the proper model is dependent upon a variety of fac-tors including the ultimate level of maturity of the reimbursement system employed in the country. And, the move towards public/private ventures is not always the most desirable solution.
The pathway to public/private ventures in healthcare is complex and fraught with many bumps in the road. However, if the parties are clear and reasonable in their respective expectations, there are models that can attain the goals of both. There is significant activity in this arena within the Middle East, espe-cially in the GCC countries, notably in the U.A.E. There appears to be a strong interest to leverage the relatively high purchasing ability of the MENA countries to bring an improved level of healthcare services to their citizenry and they are uniquely positioned to consider these ventures as possible options.
Copyright: Bumrungrad Hospital Public Company Limited
20
ab
stra
cts
21
Dr. Edgar J. Jimenez, MD, FCCM
Short CV Born: San Jose, Costa Rica
Current Positions:Co-Chairman of the Corporate Critical Care Department, Orlando HealthDirector- Medical Critical Care at Orlando Regional Medical Center, the Lucerne Institute of Medicine, the Winnie Palmer Hospital for Women and Babies. Chairman of the Corporate Pandemic Influenza Committee, Orlando, Florida, USA;Director, Critical Care Translational Research and Teaching Center
Member of the Executive Council-Treasurer and US representative at the World Federation of Societies of Intensive and Critical Care Medicine Director of Telemedicine Collaboration
Associate Professor of Medicine with: University of Florida, Florida State University University of Central Florida Regent, American College of Critical Care Medicine
Medical School: University of Costa Rica School of Medicine, San Jose, Costa Rica
Residency:Internal Medicine and Pediatrics - Overlook Hospital/Columbia University College of Physicians and Surgeons, New Jersey and New York, USA
Chief Resident:Internal Medicine & Pediatrics, Overlook Hospital/ Columbia University College of Physicians and Surgeons, New Jersey and New York, USA
Fellowship: Critical Care, St. John’s Mercy Medical Center and St. Louis University Hospital, St. Louis, Missouri, USA
Abstract:New Frontiers: Tele-Presence in the ICU
Discuss current concerns that impact the delivery of care within the ICU environment, including: bed avail-ability and utilization, limited tiered referral system, specialist availability, safe hand-off, preparation of medical and nursing personnel, ICU cost and adverse events. Discuss the goals of quality ICU care delivery that reduce adverse events and are in compliance with established regulatory agencies.
Explore the utilization virtual interactive technology, to expand the reach of the intensivist. Robotic solutions have been used to improve time to exam, intervention and decrease length of stay.A demonstration of this innovative technology, endorsed by the World Federation of Societies of Intensive and Critical Care Medicine, will follow.
New Age of Collaboration: The World Presence® initiative of the World Federation of Societies of Intensive and Critical Care Medicine.
Discuss the development, composition and future goals of the World Federation.Describe the multiple components of the World Presence® initiative, facilitating the access to and sharing of information, including: best-practices, education, research collaboration, global and regional meetings and leadership development. Describe GPS-VITAL CARE® as the World Federation’s tool focused on the develop-ment of Strategic Regional Partners and outreach local networks with multiple technological platforms.A demonstration of these innovative technologies will follow.
ab
stra
cts
Dr. JAMES A. RICE, Ph.D., FACHE
Vice Chairman, The Governance Institute, San Diego California, USAPractice Leader, Governance and Leadership Integrated Healthcare Strategies,
Minneapolis Minnesota, USA
Short CV
Dr. Rice is an internationally-recognized authority on healthcare policy, governance, and strategy devel-
opment. At Integrated Healthcare Strategies, he leads the Governance & Leadership Services practice,
focusing his consulting work on strategic governance, visioning for health sector and not-for-profit orga-
nizations; leadership development for physicians; strategic capital financial planning; mergers and acquisi-
tions; and enterprise risk management analyses for physician-hospital joint ventures.
Dr. Rice serves as Vice Chairman of The Governance Institute, an organization dedicated to knowledge
generation and dissemination via research and education for health system boards and leadership teams;
and has served as a Principal in the Health Care Group of LarsonAllen, an audit and consulting firm
headquartered in Minneapolis. He also served as President of The International Health Summit, LLC, an
international knowledge management institute focused on public-private partnerships and leadership
development in health sectors throughout the world.
Dr. Rice’s career includes service as a senior officer of the largest integrated healthcare system in Minne-
sota, where he gained extensive experience in integrated system development, managed care, and HMOs.
As a consultant, he has served as an advisor to health systems, physician groups, boards of directors,
and ministries of health in over 30 countries. He has also worked with numerous US arts organizations,
colleges and universities on governance & strategy development.
Dr. Rice has authored articles in publications such as Modern Healthcare, Trustee, the Harvard Business
Review, the Toledo Law Review, the Journal of Medical Group Management, and The Journal of Health
Administration. He has lectured extensively on health policy issues, governance, and strategic planning,
and has conducted board retreats across the US.
Dr. Rice holds masters and doctoral degrees in management and health policy from the University of Min-
nesota. He has received the University of Minnesota School of Public Health Distinguished Alumni Lead-
ership Award, a National Institute of Health Doctoral Fellowship, and the American Hospital Association’s
Corning Award for excellence in hospital planning. He is a Fellow in the American College of Healthcare
Executives (ACHE), and a Fellow of Health and Life Sciences Partnership, a London, U.K. public health
policy education and advisory firm.
Dr. Rice holds faculty positions at Cambridge University, Cambridge, England; the Nelson Mandela School
of Medicine, Durban, South Africa; and the Program in Health Administration at the University of Minne-
sota’s School of Public Health. He has lectured at The Thunderbird International School of Management
in Arizona, Cornell University, and Harvard University. He serves on the boards of directors for: Children’s
Heart Fund and HeartLink, an organization committed to building cardiac care capacity in developing
countries; The Governance Committee of AUPHA;
22
ab
stra
cts
23
Abstract:
Session 1
Financing Health Services:
Balancing Sources and Uses from Public and Private Sectors
Dr. Rice will review recent international studies into alternative forms of funding healthcare services in
developed and developing economies. The session will examine common challenges faced by the leaders
in both public and private sector health care delivery systems to secure stable sources of funding for their
service delivery initiatives. His remarks will also examine global trends in the sources and uses of funds
from public and private health financing for recurrent cost for services, as well as trends in capital finance
for hospitals and related health service technologies and facilities.
Session 2
The Challenge of Global Medical Tourism
As the costs of medical and surgical care escalate across the globe, there is increasing interest for people
to seek the more cost effective package of healthcare services. While the history of cross border medical
care and health enhancement dates back to the Sumerians in 4000bc, there are many new opportunities
that move citizens from America, Europe and Asia to modern centers of excellence in Europe, The Mideast,
South Asia and The Americas. Common medical tourism procedures and services; and factors that facili-
tate and frustrate these modern movements of patients, their medical information, and their money are
explored in the session.
Draft still under development
Medical Tourism: A Long History
With many of the earliest civilizations, medical tourism manifested as trips to sacred temple baths and hot
springs. Written historical accounts of Mesopotamian, Indian, Egyptian, and Chinese cultures clearly docu-
ment bathing and healing complexes erected around therapeutic springs. As far back as the Bronze Age
(2000 B.C.), hill tribes near present-day St. Moritz, Switzerland gathered around to drink and bathe in the
iron-rich mineral springs of the region. Bronze Age implements, including votive drinking cups, have also
been found around thermal springs in France and Germany, as well as in Celtic mineral wells.
In 4000 B.C., the Sumerians constructed the earliest known health complexes alongside mineral water
springs that included elevated temples and flowing pools. Although many post-Sumerian civilizations prob-
ably understood and appreciated the healing effects of mineral-rich water, it was the Greeks who first laid
the foundation for comprehensive health care systems and medical tourism networks.
Greek Medical Tourism: Asclepius of GreeceThe Asclepia Temples (built in honor of the Greek god, Asclepius) were some of the earliest healing cen-
ters where patients from around the region congregated for therapeutic purposes. But who exactly was
Asclepius, and how did he gain so much recognition as a healer?
According to Greek mythology, Asclepius was the god of medicine who, in his pre-celestial days, had been
mentored by Chiron, a master of medicine. The young Asclepius excelled in the healing arts and was visited
by sufferers from all over Greece. Healing powers attributed to him included bringing the dead back to
life, reversing aging, and curing blindness. Most of the other gods in the Greek pantheon, many of whom
had formidable healing powers themselves, weren’t too impressed with Asclepius’ growing fame. Among
ab
stra
cts
the most distressed was Pluto, lord of the underworld. Because Asclepius’ generous healing powers cre-
ated so much jealousy, Pluto complained bitterly to the great Zeus who subsequently slew Asclepius with
a thunderbolt. Such cruelty and martyrdom only increased Asclepius’ status. By the 4th century B.C.,
Asclepian healing temples had been constructed throughout the length and breadth of the Grecian world,
from Epidaurus to Tricca and from Corinth to Pergamon.
The Rise of Greek Medical TourismThe numerous Asclepia Temples that were constructed during this time were usually established in prime
“healthful” locations, often near mineral springs. Most temple complexes also included snake nurseries
where serpents were farmed for mystic, healing rituals. At Epidaurus, the longest preserved of the Asclepia
Temples, the complex included bathing springs, a dream temple, gymnasium, palaestra (exercise area), and
a snake farm large enough to supply nearby villages. Patients at the temple were attended to by a retinue
of priests, stretcher carriers, and caretakers, before finally being granted an “appointment” with the mighty
head priest. Sacrificial payments were made according to the status of the patient – the poor left shoes;
Alexander the Great left his breastplate. Thereafter the patient retired for his or her healing sleep. The
medical tourism treatment would culminate in a dream, during which Asclepius would allegedly visit the
afflicted and recommend a remedy for the illness or injury.
The Asclepia Temples flourished well into the fourth century AD until treatments began to be less ritualistic
and more clinical. However, even at the height of alchemy and herbal medicine, the old “sleep and dream”
formula was still popular in certain parts of the Mediterranean. Other temple spas, like the Sanctuary of
Zeus at Olympia and the spa multiplex at the Temple of Delphi, flourished throughout ancient Greece,
although not on the same scale as the Asclepia Temples
Roman Medical Tourism:In ancient Rome, hot water baths (called thermae) were not only used for their obvious medicinal benefits,
but they also served as important social networking venues for some of the Empire’s most privileged
elite. The Romans were definitely not believers in Spartan healing, and those who could afford to do so
spent lavish amounts of money at the numerous baths and hot springs that surfaced. Much like the swank
health care centers of 21st century medical tourism hotspots, these elaborate Roman complexes were posh
establishments. Some treatment centers actually included theaters, lounges, art galleries, conference halls,
brothels, and even the occasional sports stadium. Some of the larger complexes could reportedly house
as many as 3,000 patients and patrons at a time.
During the early days of the Roman Empire, these thermae could hardly have been considered medical
tourism spots since most visitors were within one day’s journey. But as the Empire slowly expanded during
its 1,000 year reign, pilgrims, diplomats, beggars, and kings from all corners of the “known” world flocked
to the Mediterranean to seek medical counsel and health treatments. And as a result of active trade
with many parts of Persia, Africa, and Asia, these Roman baths necessarily expanded the healing arts.
Ayurvedic massage, Chinese medicine, and various aspects of Buddhist spiritual healing became common
features at some Roman thermae.
Persian Medical Tourism:Early Islamic civilization, known for its many contributions in the fields of medicine and healing, had a well
established health care system in place for foreigners. Probably the most famous medical tourism facil-
ity was Mansuri Hospital in Cairo (erected: 1248 AD). With a total in-patient capacity of 8,000 people,
24
ab
stra
cts
25
Mansuri Hospital was not only the largest hospital of the time, but it was also the most advanced health
care facility that the world had ever seen. The complex included separate wards for women, a pharmacy,
a library, and numerous lecture halls. There were also facilities for surgery and separate departments
for eye diseases. No patient was to be turned away on account of race or religion, and no limits were
imposed on a patient’s stay in the hospital. Progressive well ahead of its time, the governing body of the
hospital (Waqf) boldly promised the following: The hospital shall keep all patients, men and women, until
they are completely recovered. All costs are to be borne by the hospital, whether the people come from
afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed
or unemployed, blind or sighted, physically or mentally ill, learned or illiterate.
There are also numerous accounts of welfare-driven hospitals in Baghdad and Syria that catered to weary
travelers from abroad. Accommodations at these health care facilities, or bimaristans as they were known
locally, were far from cramped. Many of them were actually palaces that had been donated by nobles and
princes who were inspired by the Islamic principles of charity.
Furnishings were opulent, and these luxurious lodgings were available to an endless stream of people from
abroad. Endowments were the primary source of funding at many of these medical tourism facilities. At
Mansuri Hospital, for example, yearly revenues from generous donations were well into the millions (dir-
hams).
Japanese Medical TourismMedieval Japan discovered the healing powers of hot mineral springs (onsen) when hunters followed
fleeing prey up to bubbling pools where the animals instinctively went to relieve their pain and tend their
wounds. The healing properties of the waters, enriched by the surrounding volcanic soil, attracted tourists
from all over the country. Elderly farmers, hunters, and fishermen soon discovered that the rich waters
were effective for treating arthritic aches. It wasn’t long before members of the various warrior clans
began visiting favored hot springs to alleviate pain, heal wounds, recuperate, and replenish their energy.
There is little debate surrounding the therapeutic properties of Japanese onsen, and bathing rooms at
some onsen still display lists of the many diseases and injuries that the mineral water can treat. These
days, Japanese onsen still attract large numbers of visitors, and thanks to modern plumbing, most Japa-
nese homes have large bathtubs specially designed to simulate the onsen experience. 1,000 years after
the onsen became such a cultural phenomenon in Japan, you can still see throngs of tourists, families,
businessmen, and the elderly frequenting these revered hot springs in places like Kyushu and other regions
where volcanic activity is still present. Some onsen even have mud pools or sulfur springs where bathers
can receive rejuvenating mineral scrubs as they soak in hot, calming waters.
Some might have difficulty categorizing yoga retreats, Buddhist pilgrimages, and meditation centers as
medical tourism, but the unbelievable reach of India’s healing arts is not to be ignored. Ever since yoga’s
birth more than 5,000 years ago, India has enjoyed a constant influx of medical travelers and spiritual
students hoping to master and benefit from this most fundamental and revered branch of alternative medi-
cine. When Buddhism came along roughly 2,500 years later, this only added fuel to the fire and helped
position India as the epicenter of Eastern cultural, spiritual, and medicinal progress.
Indian Medical TourismAlthough Western clinical medicine eventually eclipsed India’s spiritually centered healing arts, the region
has remained a veritable mecca for all practitioners of alternative medicine. In the 1960s, India received
a new boost of support when the “New Age” movement began in the US. India once again became the
ab
stra
cts
destination of choice for thousands of Western pilgrims. What started as a flower child movement has
developed into a full-fledged health tourism industry, drawing les bohemes and Manhattan socialites in
equal measure. This mass influx of medical tourists was furthered helped by India’s deep commitment
to technology and health care infrastructure. Not only is India one of the world’s oldest medical tourism
destinations, but it is also one of the most popular ones as well.
European Medical Tourism
Although pilgrimages have remained central throughout much of Europe’s history, leisure travel, recre-
ational vacations, and medical tourism didn’t really come about until the 16th century when Europeans re-
discovered the Roman baths. Entire communities sprung up around spa towns like Baden Baden, Aachen,
and most notably, Bath. The emergence of Bath or Aquae Sulis (Sulis derived from the water goddess,
Sulis Minerva) as a major medical tourism destination can be attributed to the heavy royal patronage and
involvement that the city enjoyed. With heavy endorsements from members of the ruling class, it wasn’t
long before Bath became anointed as a fashionable wellness and recreation playground for the rich and
famous. By the 1720s, aristocrats and gentlemen of leisure from other parts of Europe were swarming to
Bath for cleansing and healing, while rubbing elbows with some of the continent’s elite.
As a result of this attention, Bath received a whole series of technological, financial, and social benefits,
not unlike modern medical tourism destinations of today. For example, Bath was the first city in England
to receive a covered sewer system (years before London ever did). The roads were paved, the streets
received a lighting system, and architects scrambled to beautify the facades of the many hotels, pubs,
mansions, and restaurants that cropped up thanks to increased tourism and spending. Probably the most
noteworthy medical tourist of this time was Michel Eyquem de Montaigne, French inventor of the essay.
de Montaigne traversed the continent for 9 years in search of a cure for a niggling gall bladder problem.
He is widely believed to be the father of luxury travel, helping to pen one of the earliest documented spa
guides for European tourists.
Medical Tourism in BelgiumEngland was not the only place in Europe where medical tourism flourished. In 1326, a sleepy little village
in east Belgium gained overnight fame after the discovery of iron-rich hot springs within its boundaries.
Although the Romans knew about the therapeutic waters of Ville d’Eaux (Town of Waters), it developed
into a full-fledged health resort only in the 16th century. Visitors from all over Europe flocked to Ville
d’Eaux for relief from gout, rheumatism, and intestinal disorders. Illustrious patients included Peter the
Great and Victor Hugo. The word “spa,” from the Roman “salude per aqua” (health through waters) was
coined around this time, and it applied to any health and wellness resorts that didn’t practice conventional
clinical medicine.
Health Tourism: New World
Native Americans throughout the New World were adept in various aspects of the healing arts. In fact,
their catalog of therapeutic plants rivaled much of what was known back in Europe, Africa, and Asia
at that time. Sadly, many opportunities for sharing and learning were squandered as the early settlers
focused their efforts on securing land rather than on building relationships. Who knows what medical
advancements would have surfaced if more constructive communication had taken place between Native
Americans and European settlers?
26
ab
stra
cts
27
What we know about spiritual healers, shamans, witchdoctors, and ritualistic healing is but a small scatter-
ing of all the knowledge that once existed throughout the Americas. Even still, medical tourism managed
to develop as desperate colonists and settlers frequently turned to local healers in last ditch efforts for
recovery. To this day, various branches of alternative medicine flourish as historians and believers uncover
the many ancient healing arts of the New World.
In the 1600s, English and Dutch colonists in the newly “discovered” Americas constructed log cabins near
mineral springs that were rich in medicinal properties. By the 19th century, free-thinking American reform-
ists had developed a habit of traveling to remote Western springs, presumably to drink and soak in the
bubbly hot and cold springs while pondering the future of modern civilization.
Throughout much of recorded history, health travel was restricted either to the wealthy or truly desperate.
But in today’s flattening global economy, the physical, economic, and cultural barriers that once separated
nations from one another are dissolving. International travel and more lenient trade policies make it pos-
sible for those with modest means to enjoy the benefits of world-class health care at some of the most
popular medical tourism destinations around the globe.
Medical Tourism TodayThese advancements translate into a smorgasbord of options for patients who find it difficult or impossible
to access affordable health care in their home countries. Today, Americans who suffer from grossly inflat-
ed health care costs often flock to hospitals in medical tourism destinations like Thailand for sophisticated
procedures at a fraction of the price. In countries like England, where socialized medicine is the norm, long
wait times and insufficient health care personnel have helped produce a steady stream of patients seeking
treatment abroad. These medical tourists flock to countries like India, where a highly evolved education
system produces thousands of qualified doctors and nurses (many of whom also study in the West). Low
labor costs, quality medical schools, and heavy investing are helping to transform many parts of the devel-
oping world into medical tourism hotspots that show no sign of stopping.
While affordability and time are still the main reasons why patients trudge across borders for surgery,
issues like quality and service are also important factors as well. In fact, medical procedures abroad are
often better than what you would expect from primary health care centers back home.
Most countries vying for a slice of the multi-billion dollar medical tourism pie have expanded their offerings,
invested heavily in medical infrastructure, and begun advertising aggressively. Competition has led to niche
specialties with Israel offering male infertility treatments and South Africa promoting medical safaris. With
an increase in the number of participating countries and available procedures, medical tourism is clearly a
global phenomenon that is here to stay.
ab
stra
cts
International Health Policy Work Settings for James A Rice, Ph.D.Dr. Rice has conducted consulting and/or educational seminars for public health leaders in all
of the following international settings during the past 25 plus years.
Date: City & Country: Nature of Engagement:1977 Bogota, Colombia Advise on multi hospital systems, prepare article1978 Basque Region, Spain Shared services among three teaching hospitals1983 Rome, Italy Multi-hospital systems advisory conference1984 Cali, Columbia Feasibility study for health plan with FES1984 Kingston, Jamaica Form HMO with Life of Jamaica1984 Mexico City, Mexico Public Health systems strategy development1984 Santiago, Chile Feasibility study for hospital for Caja Bancaria de Pensiones1985 Santiago, Chile Form HMO Banmedica1985 Kuala Lampur, Malaysia Public Health reform strategy for Asia Development Bank1985 London, England Public Health policy reform options advisory1985 Seoul, Korea Health insurance feasibility study1985 Singapore Fellowship in economics NUS-Stanford Program1985 Taipei, Republic of China Health insurance feasibility study1985 Trinidad-Tobago Hospital feasibility study1986 Cali, Colombia Plan Clinica Valle de Lille1986 Dhahran, Saudi Arabia Hospital management studies1989 Budapest, Hungary Public Health sector reform strategy for AIG/Ministry of Health1989 Prague, Czechoslovakia Public Health reform strategy1990 Addis Ababa Child survival programs in public health1990 Dhaka, Bangladesh Micro-enterprise development for World Vision public health programs1990 Dominican Republic Sustainability advisory World Vision1990 London, England Marketing strategies for NHS public health agencies and hospitals1990 Nairobi, Kenya Child survival public health clinics support1991 Kampala, Uganda Train World Vision child survival managers in sustainability 1991 Kiev & Odessa, Ukraine Assess reform options for US State & USAID1991 Nairobi, Kenya Sustainability advisory to World Vision Africa Public Health Projects1991 West Kalimantan, Indonesia Conduct Strategy Conference for ASEAN World Vision1992 Costa Rica World Bank regional advisory on Public-Private Mix Policies in Public Health1992 Sophia, Bulgaria Public Health policy reform strategy 1993 Santiago Chile Hospital feasibility review for IFC of World Bank1993 Kampala, Uganda Sustainability project advisory1994 Bosnia Public Health sector reform strategies1994 Bratislava, Slovak Republic Public Health sector reform strategy1994 London, England Merger of hospital trusts advisory1994 Prague, Czech Republic Health sector reform strategy1995 Siberia, Russia Public Health sector reforms1995 Almaty, Kazahkstan Health sector reform strategies1995 Moscow, Russia Public Health sector reform strategy1995 Warsaw, Poland Hospital feasibility study1996 Santiago, Chile Health sector reform strategy for ODA of United Kingdom1997-2008 Cambridge, England Public Health leadership program faculty1998 Caracas, Venezuela Health Insurance Product Review and Redesign1998 Riyadh, Saudi Arabia Conduct conference on leadership for King Faisal Hospital1999 Bosnia-London National Health Insurance design1999 Poland World Bank Advisor on health insurance2000 Turks Caicos Islands National Health Insurance design, DFID of UK2002 Mongolia WHO advisor on output based purchasing of hospital services2003 Czech Republic Health Policy Reform Advisor 2004 Durban South Africa Leadership development programming2005 Athens Greece Policy for public-private partnerships2006 Macedonia World Bank consultant on health reforms2006 Vienna Conduct workshop on chronic disease insurance, Geneva Association2008 Sri Lanka Hospital Development2008 Bosnia Hospital Manager Training
28
YIACO Medical Company
1952 Kuwait
Medical Services
Pharma Department
Medical & Scientific
Dental Department
Medical Centers
www.yiacokuwait.comP.O.Box: 435 Safat13005 Kuwait • Tel: +965 24832600 • Fax: 965 24844954 • Email: [email protected]
ab
stra
cts
Julie B. Decker
Managing Director, LynxCom Partners – San Diego, CA, USAOperating Partner, Director of Healthcare Practice,
FocalPoint Partners-Los Angeles, CA, USA
Short CV Julie Decker has been a senior level healthcare executive for the past 10 years. The scope of her experi-ence includes national sales responsibility, operations, company turnarounds, and mergers and acquisitions for leading healthcare companies. Prior to joining FocalPoint as an operating partner, Ms. Decker held the position of Senior Vice President of Sales for Crescent Healthcare, a national pharmacy provider. She was responsible for both the acute and chronic divisions, as well the development of ambulatory infusion cen-ters. Recognizing the importance of pharmaceutical partnerships, Ms. Decker has built alliances with major manufacturers and distributors. She has been integral in lobbying CMS and Congress for higher physician reimbursement and extended Medicare coverage. Prior to January 2003, Ms. Decker spent eight years at Nations Healthcare (“NHC”) and it’s successors as a Senior Vice President of Sales and Operations. NHC was an infusion pharmacy, respiratory, home health nursing and durable medical equipment company which contributed to Ms. Decker’s expertise in the integrated delivery model. While at NHC she led due diligence teams through several mergers, acquisitions and company consolidations. She had P&L respon-sibility for the Pacific Region and Midwest territories which generated a net revenue of $120 million. Ms. Decker’s responsibilities extended to commercial payers and she implemented a managed care matrix of over 300 contracts to leverage statewide and national networks.
Ms. Decker also established a Medicare certified hospice and home health program in Southern California with multi-site locations. In 1996, she established a hospice Foundation that continues to operate and until 2004 she served on the San Diego Hospice Board of Directors. A Massachusetts native, Ms. Decker earned her BA degree, cum laude, from Alaska Pacific University, and is a graduate of UC San Diego’s Healthcare Executive Leadership Program. Her current and past professional affiliations include the Bio-ethics Committee of Scripps Memorial Hospital, San Diego Women’s Healthcare Administrators, Adaptive Business Leaders Roundtable, and First Opinion E-Health Technologies.
Abstract:Capital Markets and Healthcare TrendsMergers and Acquisitions: Venture Capital and Private Equity Activity in HealthcareIn 2008, more than $220 billion USD was committed to fund healthcare mergers and acquisitions, with the healthcare technology sector (biotechnology, e-health, medical devices and pharmaceuticals) account-ing for 90% of the total. The rising cost of healthcare and the capital markets makes it necessary to evaluate the structure of care delivery systems and how they are funded. This presentation will examine the mergers and acquisitions activity in the healthcare market and issues affecting healthcare finance. The size and scope of investments made in 2008 will be discussed as well as investment criteria and the outlook for various healthcare segments in 2009 and the future.
Alternate Site of Care: Ambulatory Infusion Centers and Homecare.Reimbursement: Governmental Payers and Health PlansHospital care accounted for 30% of the United States’ $2.1 trillion total healthcare expenditure in 2006. Overcrowding in hospitals and the general rise of healthcare costs highlight the need for cost-effective care settings to help meet patient needs and improve outcomes. This presentation will provide an over-view of the traditional hospital market and define the alternate site of care. Ambulatory infusion centers, infusion pharmacy, hospice, and home health care will be discussed. This presentation will also address how payment for healthcare services differs between governmental payers and health plans in the United States, and how this influences site of care.
30
ab
stra
cts
31
Dr. Mohammed I. Al-Saghier, FACP, FRCSC, MBBS
Department of Liver Transplantation and Hepatobiliary/Pancreatic Surgery King Faisal Specialist Hospital & Research CentreRiyadh, Kingdom of Saudi Arabia
Transplant tourism (Clinical Outcomes for Saudi Patients Receiving Transplantation in China)Naglaa Allam1, Mohammed Al Saghier2, , Waleed K. Al Hamoudi3, Ayman A. Abdo3, , Norman M. Knete-man4
Department of Hepatology1, Surgery2, National Liver Institute, Menofeya University, Egypt Multi Organ Transplant program 2 King Fahed Specialist Hospital , Damamm, Saudi Arabia Department of Medicine3, King Khalid University Hospital, Riyadh, Saudi Arabia Department of Surgery4, University of Alberta, Edmonton, Canada
Corresponding Author:Ayman A. Abdo. Department of Liver Transplantation MBC: 72, King Faisal Specialist Hospital and Research Center PO Box: 3354, Riyadh 11211, Saudi Arabia. Fax: +966 1 4424817, Email: [email protected]
Key words: China, Transplantation, outcome
Abstract:Background: Long waiting lists for local transplant programs in Saudi Arabia and the shortage of cadav-eric donor have led an increasing number of patients to seek transplantation in foreign centers, especially in China Philippine , India and Pakistan. Patients are attracted by the lower costs of transplantation in these countries as well as by the shorter waiting times as compared to other foreign centers. In this paper, we describe the clinical outcomes for patients who received liver transplants in China and were subsequently followed in Egypt or in Saudi Arabia (King Faisal Specialist Hospital and Research Center (KFSH) in Riyadh Saudi Arabia and Al Salama and Mahmoud Hospitals in Egypt). Methods: All patients who obtained liver transplants in China between January 2003 and January 2007 and were followed in our centers post-transplantation were included. Available preoperative data, reports from China and follow-up charts were retrospectively reviewed to collect relevant clinical and laboratory data. Mortality and morbidity in this group of patients is described and compared to those receiving transplantation at the KFSH during the same period. Results: Seventy-four adult patients (60 males and 14 females) were included in this study. Forty-six patients were Saudi nationals, and twenty-eight were Egyptians. Indica-tions for liver transplantation were as follows: hepatitis C, hepatitis B, or hepatitis B and C co-infection cirrhosis, cryptogenic cirrhosis, , primary biliary cirrhosis, and hepatocellular carcinoma. One year, 3-year, and 5-year cumulative patient survival rates after transplantation in China were 83%, 62%, and 62%, respectively, compared to 92%, 84%, and 71% for patients treated at the KFSH. Median patient sur-vival time was significantly less than that of those transplanted in KFSH (p=0.01). One year, 3-year, and 5-year cumulative graft survival rates were 81%, 59%, and 59%, respectively, compared to 90%, 84%, and 71% at the KFSH.. The incidence of complications was significantly higher than that observed in the patients receiving transplants at the KFSH.. Conclusion: Our data clearly show that Saudi patients who received transplants in China exhibited high mortality and morbidity rates. This result could be attributed to poor selection criteria, long warm ischemia time, or poor post-transplant care. The Gulf countries need to look at local transplant program and promote donation as cost effective solution.
ab
stra
cts
Naji Bejjani, D.B.A. & M.B.A. Professor
International Management Consultant & Trainer
Short CV I am 50 years old.
University Education: Doctoral studies in Econometrics at the university of La Sorbonne, Paris-France - dou-ble “maitrise” (French master degree) in Econometrics & International Economic Relations from University Paris-Dauphine, Paris, France - M.B.A. from I.E.S.E., Barcelona, Spain (including a Master certification from HARVARD External program).
Teaching summary: Taught in Lebanese universities (e.g: NDU, LAU, USJ, CEC-UQAC, AUT, etc …), mainly in M.B.A programs and in one D.B.A. program. Research Director of several Master Theses and of Doctoral Theses in many universities.
Summary of other activities: International management consultant and trainer. Regular columnist in many magazines (Example: “Le Commerce du Levant”). Those activities are developed mainly in the manage-ment field but, on occasions, also in Marketing.
Abstract:“Applying creative thinking and critical thinking to health reform”:Creativity has traditional been the “parent pauvre” (or the forgotten child) of many economic sectors, particularly the health sector. Very little importance has been given to it. Whereas, nowadays, most - if not all – companies are desperately looking for creative people to hire, manage and develop. It is actually interesting that suddenly all those companies want those creative people because, since the dawn of time, everybody is creative. The only non-creative people are dead people! Even more so, it has been found out through studies that the average human being thinks of about 100 new ideas a day (most of them of a very small application but still new ideas). 100 ideas !! Think of a team of 6 nurses and doctors who work together for 2 days in a row. If they expressed all those ideas, we would have 1,200 new ideas to chew on ! Think of all the possibilities for better cure, better research, better patient orientation, etc … that we would have. I would not be surprised if this particular team who dares to express all his new ideas would lead any health institution to world leadership under any indicator.But the problem here is actually the eternal contradiction of the human being: common sense is the last thing we think about. The most obvious ideas are often the most important ones, and, unfortunately, also the most unseen ones.
In other words, just as we have been “hiding” our right brain for so long, until someone 12 years ago (Daniel Goleman) told us that it was socially correct to stop hiding it and even gave it a fashionable name - Emo-tional Intelligence –, we have been drowning our creativity under tons of barriers, not the least of which are our educational system, our feeling of - wrong - self-importance, and our eternal fear of being wrong.I will not only prove – with many examples - in this conference that is vitally urgent to stop doing that, especially in the health sector, but also that, in order to optimally develop our critical thinking power (the scientific intelligence that we have been so proud of for ages), we need to nurture it with its assumed eternal enemy, the creative thinking or the non-scientific intelligence that we have been hiding for ages. Emotional Intelligence will help us a lot her to strengthen our point.
32
ab
stra
cts
33
“Who can be a leader in health sector and how”
Many essential ideas about leadership in any institution and in any economic sector have been recently analyzed, discussed, and taught time again, with varied success and applicability.
However many new thoughts and new field experiences have brought about not only new light in the knowledge on leadership but also some drastical changes about how leadership should be understood and applied in daily work.
In the particular case of the health sector, it is essential nowadays (particularly in times of crises, we shall see why later on in this conference) to take into account the following issues:
Not all real leaders are the ones who have followers to whom they give direct instructions.Earning the patient’s trust is a top priority that bypasses any other. This means that whatever leadership is being used by whoever executive or medical practitioner in the hospital should always point and lead in the direction of maintaining and enhancing the patient’s trust. If it does not, then the whole leadership approach being used should be quickly changed.
Nowadays, the overwhelming approach of the so-called “holistic” approach to patient management should lead also to a “holistic” approach to the way instructions are being carried forward within the health insti-tution. This induces a drastic change in the professional communication among many stakeholders within the hospital for instance.
The widespread use of outsourcing of many previous in-house services within the institution has lead not only to more specialization of health institutions but also to the rise of what came to be called “Professional Employee Organizations” better known as PEOs. This means that many members of the staff are actually being paid, appraised, and career-developed by executives who are not part of the hospital’s hierarchy. (One example of this are the IT staff in many institutions or the administrative or research staff who are often on “loan” from specialized consulting companies). This gives a new dimension to how this staff should be led internally and a different management pressure to whoever will lead them. The same challenge and pressure applies to managing multicultural teams and remote teams (many working teams in health institu-tions are split between local members and members of that same team who are geographically far away, who do part of the work, and who report their work through Internet).
Many companies are re-discovering the meaning of creating a continuous “sense of urgency” (Re: Prof. John Kotter) within a company. Whereas this sense of urgency should be part of the historical DNA of hospitals and other health institutions as a result of the very nature of their work, too many of them are functioning and being managed as slow giants drowned in bureaucracy (it is the unfortunate and common contradiction between how many companies should function and how these companies actually work: e.g.: many universities are the slowest to learn).
In summary, being a leader nowadays in the health sector in Kuwait or elsewhere requires, among other features:FlexibilityChange Management skillsEntrepreneurship spiritCreativity and innovativenessPersonal leadership (leadership upon himself)Irrelevance of titles.Etc ..
ab
stra
cts
Dr. Paul Hofmann, DrPH, FACHE
Short CV
Dr. Paul Hofmann, president of the Hofmann Healthcare Group, Moraga, California, has worked in the
health care field for over 35 years. For the past 15 years, he has devoted a majority of his time to assisting
hospitals and health systems with accelerating their performance improvement efforts and writing, speak-
ing and consulting on ethical issues in health care. He also serves as an advisor to health care companies
and as an expert witness.
In addition to various appointments, for several years he served as Distinguished Visiting Scholar at Stan-
ford University’s Center for Biomedical Ethics. Previously, among other positions, he served as: Executive
Vice President and Chief Operating Officer of the Alta Bates Corporation, a diversified nonprofit health
care system in northern California; Executive Director of Emory University Hospital in Atlanta, Georgia;
and Director of Stanford University Hospital and Clinics in Palo Alto, California. Following his residency in
hospital administration, he began his career at the Massachusetts General Hospital in Boston.
Dr. Hofmann is a fellow of the American College of Healthcare Executives, a past member of its Leader-
ship Advisory Committee, and has served as the College’s consultant on health care management ethics
since 1994. He continues to coordinate the annual ethics conference for the College and is co-editor of
Managing Ethically: An Executive’s Guide, published in 2001 by Health Administration Press. He is also co-
editor of Management Mistakes in Healthcare: Identification, Correction and Prevention, published in 2005
by Cambridge University Press. He is a past chairman of the national advisory board for the University
of Chicago’s Center for Clinical Medical Ethics, and has held a variety of appointments with the American
Hospital Association, including chairman of the Council on Research and Development. Dr. Hofmann cur-
rently serves on the American Hospital Association McKesson Quest for Quality Prize Committee, the Joint
Commission’s International Standards Subcommittee, and the board of MedShare International. He is the
board chairman of San Francisco-based Operation Access.
An author of over 150 publications, Dr. Hofmann has held faculty appointments at Harvard, UCLA, Stan-
ford, Emory, Seton Hall University, and the University of California. His Bachelor of Science, Master of
Public Health, and Doctor of Public Health degrees are from the University of California, Berkeley.
34
ab
stra
cts
35
Abstract:Developing Appropriate Criteria for Allocating Capital ResourcesRequests for approval of major capital equipment and construction projects almost always exceed available funding sources. However, even when financial resources are not severely constrained, caution and disci-pline must be exercised to avoid authorizing payment for marginally justified projects that frequently have continuing and usually underestimated operating expenses. Initially, the number and magnitude of unin-tended consequences of unwise investments are rarely recognized or appreciated in such circumstances.
Both financial and non-financial criteria must be considered in determining which requests should be ap-proved. The conventional financial approach usually emphasizes a cost-benefit analysis. Objective criteria can and should be developed, disseminated and applied consistently to discourage inappropriate requests and to minimize the likelihood of unreasonable political influence.
Among other routine factors that should be considered are:• Meeting the needs of various constituencies (patients, physicians, employees and others)• Improving the cost-effectiveness of services affecting productivity, safety, access & clinical outcomes• Complying with legal, licensing, regulatory and similar requirements• Satisfying financial viability measures, including probability of achieving forecasted results
Deciding among competing and compelling project requests is often difficult. Applying four classic ethical principles (beneficence, nonmaleficence, fidelity and justice) will improve the decision-making process and enhance management’s credibility as viewed by those most affected by these decisions.
Acknowledging and Addressing Executive Management Mistakes in HealthcareAlthough the identification, disclosure and prevention of medical errors have been the subject of extensive discussion for many years, executive (management) mistakes have not received the same scrutiny. This lamentable vacuum has a variety of unfortunate consequences, not the least of which being the absence of a failure analysis and an objective determination of what could have been done differently increases the likelihood that others will make the mistake again. These errors can have clinical as well as non-clinical ramifications. In either case, patients, staff, organizations and even entire communities can be adversely affected.
Why have management mistakes not been acknowledged and addressed? What is the definition of a management mistake, what are the contributing factors, how can they be mitigated, and what steps should be taken to reduce mistakes?
Conceding that perfection in the practice of medicine is difficult to define, then defining error in manage-ment is especially complicated because perfection is even more elusive and standards of performance are not as well defined. We can also concede that management has far less science, precision, consen-sus and objectivity than medicine. Formal processes, decision trees and systems are not as prevalent in management as they are in medicine, resulting in fewer algorithms for enhancement. Even determining if a mistake has occurred can be problematic, particularly if decision-making processes and performance criteria are ambiguous.
What are management mistakes in a broad and generic sense? They include making a unilateral decision when consultation with others might have improved the quality of the decision. Also included are failures to delegate, to hold subordinates accountable, to collect and analyze data before making a decision, to allocate limited resources using objective criteria, and to disclose negative information fully and promptly. As in medicine, errors in management involve acts of omission and commission, and they may be the result of ignorance, incompetence, negligence or simply the inability to always make the right decision.If an executive tells subordinates that errors can and should be shared without concern for job security, he or she must not be disingenuous. Executives who espouse the concept and subsequently repudiate it by being excessively harsh in their criticism are reflecting a remarkable degree of naiveté at best or arrogance at worst. Ultimately, the question becomes-is the organizational support real or an ethical illusion? Reducing management mistakes by following specific steps will lead to greater public trust, stronger ex-ecutive performance, improved accountability, enhanced quality of patient care, and higher staff morale. It is hard to imagine a more compelling set of incentives for acknowledging and aggressively addressing management mistakes.
ab
stra
cts
Ten Critical Questions to Ask Your Hospital CEORegardless of the organizational structure and to whom the CEO reports, a variety of questions should be asked periodically to determine whether the leader is thinking imaginatively and productively about both existing and prospective challenges. At a minimum, among these questions are the following:
What are the most significant areas of potential risk to the organization, and what are the strategies 1. and contingency plans for dealing effectively with each one?
What steps are being taken to: 2. a) maximize the recruitment and retention of the best qualified staff, b) minimize compassion fatigue, c) reduce the incidence of professional tension and d) assure high staff morale?
What programs have been established to identify, support and promote staff members who can ad-3. vance professionally and make a greater contribution to the organization and those it serves?
What documentation can be provided that demonstrates the use of evidence-based management to 4. replicate the best practices of top performing organizations?
What measures have been implemented to sustain and improve the quality of patient care, & how is 5. progress being evaluated?
What policies and procedures assure that inappropriate or incompetent behavior, conflicts of interest, 6. and other problems can be reported without fear of retribution and addressed promptly and effec-tively, regardless of an individual’s organizational power and position?
How are creative management and clinical programs encouraged and rewarded, and what proven 7. incentives have been adopted to stimulate continuing innovation?
What objective criteria have been developed to assess program proposals, acquisition of new tech-8. nology and similar investments, and how have audits of previous investments improved the as sess-ment process?
How frequently are employees, physicians, patients and members of the community asked for their 9. opinion of the organization, what have been the results, what initiatives are addressing opportunities for improvement, and how much progress has been made?
How has the organization quantified its contribution to disease prevention and health promotion, as 10. well as a higher quality of treatment and care?
36
ab
stra
cts
37
Dr. Saeed Al-Qahtani, BS, DIPQM, MRSH, MQM, EFPS, CMRP, PHD
Head ,Planning Department and Quality Management Consultant King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Short CV
DR. SAEED AL-QAHTANI has obtained Master Degree on Quality Management, USA and PhD in Health In-
formation from UK and Executive Fellowship on patient safety, USA. Dr.Saeed has extensive experience on
Quality management field where he has been shared establishing Saudi network for Quality in Healthcare
in 1992. He has presented many papers inside & outside Saudi Arabia related to quality improvement is-
sues and conducted many surveys in same field. He is the coordinator for Joint Commission International
Accreditation (JCIA) projects in Ministry of Health, Saudi Arabia. Dr.Saeed has made an initiative to es-
tablish Patient Safety Center in Ministry of Health ,Saudi Arabia. Dr. Saeed has significant achievements in
case management, patient safety, utilization management, accreditation and health information manage-
ment. He is certified on patient safety from American Board of Quality Assurance and Utilization Review
Physicians, Inc. (ABQAURP(,USA , Fellow in the Royal Society for the Promotion of Health, UK, associate
fellow in Australian Association for Quality in Healthcare and many memberships in different quality as-
sociations in USA. He likes reading and wrestling. Dr ALQahtani worked as Quality Management Consultant
in different private hospitals as Consultant for the accreditation and patient safety program and now he
is working as Head of planning Department and Quality Management Consultant, King Fahad Specialist
Hospital, Dammam, Saudi Arabia.
Abstract:
The Impact of Accreditation on Patient Care in Hospitals in Saudi Arabia
The accreditation journey had started in early nineteen ninety two in ARAMCO Hospital this was then
extended to hospitals kingdom wide, currently 25 hospitals are accredited by Joint Commission Interna-
tional ( JCIA) , four by Canadian Council on Health services accreditation (CCHSA ) and one by Australian
Council on Healthcare Standards (ACHS). Indeed the value of accreditation differs from one organization
to another but for majority it has a positive impact on Quality and Safety in Healthcare. It has been ob-
served that five dimensions have more positive impact of the accreditation, as below:
1. Patient Safety: when the culture of safety is there, communication among healthcare providers, infection
control and documentation system (policies, procedures, job descriptions, plans) are all improved, whereas,
medication-errors are reduced dramatically.
2. Leadership: There is a clear strategic directions, good relationship with other departments, the account-
ability to Quality and Safety program is clear, key performance indicators are developed and implemented
and many policies and procedures are created and approved.
ab
stra
cts
3. Human Resources and Development-There is a clear communication among staff where everyone is
familiar with his/her job description and workflow processes. The competency of staff is improved through
educational activities, clear hospital vision and creating new policies and procedures. Staff is aware about
infection control guidelines, resuscitation techniques and occupational safety and how to maintain
patient, family and their colleagues in a safe environment and workload is reduced due to clear processes
and top management instructions, clearly all this makes the clients (our patients) more satisfied.
4. Patient focus-Patient as external customer is targeted by accreditation process through increasing
patient satisfaction, educating patient / family and involving them in their plan care, all of that appears
strengthened after obtaining accreditation.
5. Utilization Management-Waiting time is reduced in most of areas like Emergency department, Pharma-
cy, Outpatient, etc and length of stay is decreased as well as the inappropriate admissions are controlled
through implementation of admission and discharge criteria.
6. Financial Management-It clearly has a big impact on the private hospitals where the largest company
in Saudi Arabia (ARAMCO) pays extra Saudi Riyal as additional fees per head per patient visit for any ac-
credited hospital by JCIA. On the other hand, ARAMCO contracted with new hospitals which accredited by
JCIA directly without any evaluation.
The government hospitals get good reputation due to the accreditation in the market but it will get more
benefits once the Saudi citizens are insured (obligatory). There for it needs more efforts and commit-
ment through the organization (staff and leadership) to make an impact of accreditation in all operation
processess.
38
ab
stra
cts
39
Dr. Hani ALKhaldi, MBBS, SSC-Ped, ABP, MHI, SME
NEHR (National Electronic Health record) Consultant MOH, Saudi ArabiaMember Of The Global Executive Healthcare Exchange Forum
Short CV Director of E-Hospital Administration, CEO Consultant, Pediatric NeurologistKing Fahad Specialist Hospital, Dammam, Saudi Arabia
worked with several institutes in the fields of Health informatics, Coding, Quality Management and Health administration with 17years of experience and recognized contributions and participations internationaly. Over the last five years, he was responsible to several project including being a national consultant of the National Electronic Health of the kingdom of Saudia Arabia and introducing concepts of mobile point of ca re and Buisness Values of investment in health information technology
Abstract: Without far-reaching reforms, many health care systems will not survive the next 15 years, according to the study “HealthCast 2020”
The sustainable transformation of he alth care systems requires both a new level of quality in the coopera-tion of all players in the health care system and a significant intensification of communication and global transfer of knowledge
Increased efficiency through the transition from an institutional system to a patient-oriented informational approach will play a crucial role. This approach requires all-encompassing transparency, interoperability and standardization of the entire treatment process. Patients start healing sooner.They experience higher quality care and fewer errors.
information technology is gaining in strategic importance in the transformation of health care systems. If You cant Measure IT, You cant Manage IT is a known saying and implementing quality indicatros as early as exploring the need for a health information technology is becoming a need.
Proper investment in health information technology would Lower average length of stay, overtime expendi-ture, Lower drug expenditure, Lower form expenditure, Lower document storage cost , Greater avoidance of costs for treating adverse drug event and Fewer medical insurance claims, Faster movement of bills through Accounts Receivable, Fewer nurses leaving voluntarily within the first year of employment, Mor e Emergency Department visitors treated and all are montizble.
but there are non-monitzble nor quantifible values that can be only felt rather than measured necessat-ing the more depth of understanding return of investment in health information technologies and further recognizing there weight, these buisness valuse known as Value Dials include Patient safety, Quality of care, Patient access, Physician and staff productivity, Physician and staff satisfaction , Revenue enhancement and Cost optimization
Kuwait is also distinguishly from other gulf countries is unike in its growing population of senior citizens which mandate the selection of a platforms to meet there special needs from an advanced health informa-tion technology and so assure the best healthcare delivery.
Mobile pont of care is a concept of availbility and acess to health information at any point of time where fractions of a second to acess an inform ation can mean the difference between life and death.
But going mobile is simply the carrot that will drive reforming our health information technology infrastruc-ture as it requires a proper application on an effecient network with necessary devices which is basicly every element needed to claim an effective health information management system to enable the delivery of the best health care ever.
lets revert from the saying of that we have a 19th century health system in the presence of a 21st tech-nolgy system and bridge both side narrowing the gap to have an advance 21st Century system which is achievble.
ab
stra
cts
Wesley Valdes D.O
Short CV Wesley Valdes has been working in the healthcare field since the early 1990’s. He serves as Assistant Pro-fessor, Clinical Surgery at the University of Illinois at Chicago in the Division of Vascular Surgery, Section of Wound Care and Tissue Repair. He also serves as Clinical Assistant Professor in the Department of Biomedi-cal and Health Information Sciences at the University of Illinois at Chicago as well as the Acting Medical Director for the UIC Office of Telehealth Research.
Dr. Valdes’s experience includes developing medical educational software applications, international health-care development, conceptual business modeling, and medical informatics. Through the University of Illinois, he works in an interdisciplinary environment on multiple projects including telemedicine, innovation, patient safety, and quality processes to reduce diagnosis latency. His clinical area of expertise is in wound care and tissue repair and is the world’s first fellowship trained physician in this new specialty area. Dr. Valdes has taught medical informatics at Northwestern University and participates on a number of scientific advisory boards. He is the Co-Chair of the CHAIIM sponsored Health Informatics Workgroup Committee and holds affiliations with ANSI, Chicago Patient Safety Forum, Northern Illinois Physicians for Connectivity, and the Institute for Clinical Quality and Value.
Abstract:1. Telemedicine & remote monitoring: How technology and new business models can improve chronic care.Advances in telemedicine and related technology have developed considerably over the past decade. As evidenced by the significant amount of monies in the US economic stimulus package, these new develop-ments are envisioned to have a significant impact on the quality of healthcare in the US. In this discussion, we will talk about how the Kuwait Healthcare System can leapfrog years of development and attain a simi-lar level of infrastructure focusing on chronic disease management in a shorter amount of time.
2. Dialysis and Infusion Clinics: Bringing the eICU remote monitoring success to other clinical modelsThe eICU has clearly demonstrated improvements in clinical care in multiple installations in the US. We will discuss other clinical models where this type of centralized monitoring with decentralized care might be useful. From the monitoring of hospital wards, to remote visits in patient infusion clinics, as well as interact-ing with patients from home, this type of data management can provide a way to intervene with disease processes before they advance to where hospitalization is needed. A comment on integration with public safety departments, emergency medical response teams, and the advances in transportation science will be included as well.
3. Preparing today for leadership tomorrowMedical technology is advancing at a tremendous speed. Successful use of these technologies and their capability to impact change, rides on the backbone of a US healthcare system steeped in data gathering, protocols, and reporting of clinical outcomes. Far from an overnight success, the US has taken years to be-come comfortable with this level of transparency in the healthcare sector yet it is still burden by the limita-tions in advancement by third party payers. We will discuss how other industries achieved change to obtain highly reliable services and introduce several training programs now available for healthcare management, healthcare policy, advancement in nursing degrees, and other training services. While short term challenges need attention, a longer term solution will reside with young Kuwaiti’s. Looking 5 and 10 years out, how can Kuwait invest in training the leaders of tomorrow.
40
ab
stra
cts
41
MD Graduate King Abdul-Aziz University, Jeddah, SAUDI ARABIA completed internship in Tufts university school of medicine ,Boston ,USA completed Arab Board internal medicine program , critical care fellowship from the prestigious King Faisal specialist hospital and research center, Riyadh ,Saudi Arabia. In 2000 he was se-lected in the senior management to lay out the infrastructure foundation of King Faisal specialist hospital and Research center, Jeddah where he was responsible for developing policies and procedures for Medical and clinical operations, OPD Work flow process , recruitment process ,Admission, discharge and referral process .He was The first director of ICU in KFSH-Jeddah , where he established a new ICU System from renovation ,restructuring recruiting the highly dynamic and talented high peak performance Multidisciplinary team in 4 ICUs( MSICU,CSICU,VIP ICU, Royal ICU) to become the leading ICU in the western region with high reputation ,better outcomes ,high quality and safety care in 2000-2001. . Completed a subspecialty critical care fellowship ( Neuro , Surgery, Trauma, Obstetrics and Nephrology Critical Care) in Uni¬versity British Columbia, Vancouver, Canada and studied master health administration in UBC-Canada. In FEB 2004 ,Chairmen of critical care dept in Al-Hada armed forces hospital, with his skillful leadership he was able to save the Hospital Cost ,improve the outcomes significantly ,high ICU staff loyalty index Satisfaction rate, to be the number ONE ICU in the western region within one year. 2005-2006 he was appointed as consultant critical care and director performance improvement ,risk management ,information analysis, infection control and utilization review in Saad specialist hospital where he Was one of the leaders who successfully led the hospital to succeed in achieving the triple crown accreditation JCIA ,Canadian and Australian Accreditation within The same year to become the first hos-pital in the world to have this achievement. In 2006, he introduced as a trainer the Baldrige HealthCare Criteria for Performance Excellence to Gulf Region, a well known international Instructor in Healthcare Management in the region since 2005 where he conducts seminars in Leadership, Human resource, quality, performance and strategic management.
His expertise skills in Healthcare management include Organization Transformation, Motivation, Leadership ,ne-gotiation skills ,Scorecards, Key Indicators, Performance excellence, Mapping process Management ,Decision making ,Financial performance ,capital allocation and Innovation. Founder and past president of International Pan Arab Critical Care Medicine Society (Established and recognized by WFSICCM 2005). Considered the dy-namic playmaker and master -mind of success in expanding promoting the criti¬cal care internationally in the Arab world by research, education, training (FCCS, BICMC, FDM, Neuro Critical Care Course, CRRT Workshops, Hemodynamic and Hypothermia workshops..etc) specialty in the region. Has presented more than 200 pre-sentations in various international critical care & healthcare management conferences around world. Recently, he was selected by the World Federation societies intensive and critical care medicine among 5 critical care experts in Asia and Africa to develop a strategy to improve the intensive care system in poor countries in the two continents within the next 5 years. Member of SCCM, ESICM.. Contributed as one of the authors to FCCS 2007 4th Edition Book. , His major specialty skills are in Neuro-Critical Care, Obstetrics Critical Care, Surgical Critical Care and Critical Care Safety. The first Critical Care Physician in the Arab Region to be selected in the Editorial Board Journal Critical Care -2009.., recently written a chapter Titled: ICU Performance in the Critical Care 2009 YEARBOOK. has trained more than 1000 Residents in Critical Care world wide . consultant health-care management since 1998 and for the last 6 years as a senior business Healthcare Executive consultant to various government, ministries ,medical institutes around the globe ( Saudi Arabia, Qatar, Oman ,Bahrain ,UAE, Jordan Singapore, Malaysia, Brunei ,Hong Kong , Germany and Jordan ) as consultancy and Advisor in health policy reforms ,transformation and performance excellence . his new style of visionary strategic leadership ,transformation management, structured innovative approach and teaching skills in an Era of Hyper dynamic competition in Healthcare Market services , cost and technology has brought an extraordinary success for healthcare organizations regionally and internationally in Critical Care and Healthcare Management. Currently works as Consultant Critical Care & Director Quality Management & Development Administration in King Fahad Specialist Hospital ,Saudi Arabia. Advisor for WHO for Acute Patient Safety Project 2007-2010 and Advisor for Health Economics in for Arab League of States for Ministries of Health Council . In 2008 he Received the Prestigous Al-Razi Award for his life time Achievement in Critical Care in the Region.Member of American college of Healthcare Executives since 2000 and Currently President-Elect Healthcare executive group-Middle East & North Africa (HEG-MENA) Affiliated Chapter of American College Healthcare executives since 2008. He consid-ers leadership is an action not a title.
Dr. Khalid Shukri Quote:The ones who are crazy enough to think that they can change the world are the ones who do….
Dr. Khalid Shukri, MD, MHA, FCCM,FIPACCM
Executive Director, Healthcare Executives Consultants.Healthcare Management ConsultantSenior Consultant Critical Care MedicinePresident -Elect Healthcare Executive Group (HEG-MENA) Affiliated Chapter American College Healthcare Executives (ACHE)Secretary-General International Pan Arab Critical Care Medicine Society( IPACCMS)
ScientificProgram
Scie
ntif
icpro
gra
m
07:00-08:30
08:30-08:45
08:45-09:05
09:05-09:25
09:25-09:40
09:40-10:00
10:00-12:00
12:00-01:00
01:00-01:20
01:20-01:40
01:40-02:00
02:00-02:10
02:10-02:30
02:30-02:50
02:50-03:00
03:00-03:30
03:30-03:45
03:45-04:05
04:05-04:25
04:25-04:45
04:45-05:00
05:00-05:30
05:30-06:00
06:00-06:15
The Faculty & Scientific Topics
Registration
IntroductionKuwait Healthcare System Today
Complex Healthcare System Session Chairperson: M. Mishan/J. Rice/A. Al Mukaimi Public/Private joint venture models for healthcare Curtis Schroeder - Thailand
Healthcare system bringing order from chaos Abdulrahman Alnuaim - Saudi Arabia
How are we preparing today for leadership tomorrow Wesley Valdes - USA
Panel - Discussion
Opening Ceremony
Lunch
Medical Tourism Session Chairperson: N. Sweih/C. Schroeder/A. Al-Suhali
Medical Travel: Magnet criteria and Challenges in the Middle east Curtis Schroeder - Thailand
The challenge of Global tourism Jim Rice - USA Transplant Tourism Mohd Al-Saghier - Saudi Arabia
Panel Discussion
Health reform strategy Session Chairperson: A. Fadhli/A. Shati/J. Decker
Applying creative thinking and Critical thinking for health reform Naji Bejjani - Lebanon
Business models and Medical clinics Karman Lani - Canada
Panel Discussion
Round-Table: How to start reforming Health Care System Wesley/Decker/Duaiji/Shatti Chairperson: K. Shukri/J. Salem
Coffee Break
Healthcare leadership Session Chairperson: M. Mishaan /W. Valdes/M. Alsagheir
Executive Mistakes in healthcare Paul Hofmann - USA
Balance scorecard in healthcare, powerful performance monitoring tool Al-Nuaim - Saudi Arabia
Financial performance and Acute care: Best practice Chris. Farmer - USA
Panel Discussion
State of the Art Session Chairperson: J. Al Sultan/H. Al-Rahma/Q. Dawairi
New frontiers:Telepresence in ICU Edgar Jimenez - USA
Telemedicine and remote monitoring: how technology and new business models can improve chronic care Wesly Valdes - USA
Panel Discussion
FACULTYTOPICTIME
Sunday – Day 1, 15 March 2009
Ali Al Mukaimi/M.Shamsah/K. Shukri/N. Sweih
44
Scie
ntif
icpro
gra
m
45
08:00-08:20
08:20-08:40
08:40-09:00
09:00-09:20
09:20-09:30
09:30-09:45
09:45-10:05
10:15-10 :35
10:35-10:55
10 :55 - 1 1 : 15
1 1 : 1 5 - 1 2 : 1 5
12 :15-01 :00
01:00-01:20
01:20-01:40
01:40-02:00
02:00-02:20
02:20-02:35
02:35-02:55
02:55-03:15
03:15-03:35
03:35-04:00
04:00-04:15
04:15-04:35
04:35-04:55
04:55-05:15
05:15 - 05:35
05:35-06:00
06:00-06:30
Healthcare quality and patient safety session Chairperson
Impact of accreditation on patient care S. Al-Qahtani - Saudi Arabia
Healthcare quality and compliance: an International approach Chris Christy - USA
Setting up patient safety program Mohd Abushafi - UK
Hospital performance and best practice management Chris. Farmer - USA
Panel Discussion Coffee Break
Advances in Healthcare Technology Session ( Round Table ) Chairperson A. Nuaim/J. Al-Sultan/J. Decker
Treatement Abroad-Kuwait overview Adnan Abul - Kuwait
Oncology patients treated abroad:pro and cons Ahmed Alsaghier - Saudi arabia
Alternate site of Care Julie Decker - USA
Virtual Hospital and Medical Simulation Karman Lani - Canada
Panel Discussion
Lunch Financing healthcare session (Round Table) Chairperson J. Decker/K. Shukri/J. Al-Ghanim
Mergers And Aquisitions Julie Decker - USA
Health Finance: Equitable strategies Nadeem Duaiji - Kuwait
Global trend in financing of health services: balancing resources Jim Rice - USA
Allocating capital resources Paul Hofmann - USA
Panel Discussion
Future hospitals session Chairperson E. Jimenez/ C. Farmer/N. Al-Humaidi
21st Century hospital Engineers Society - Kuwait
Transforming healthcare: mobile point of care as an outcome of an HIT Hani Alkhalidi - Saudi Arabia
Business intelligence in modern hospital operations: key to success Chris Christy - USA
Panel Discussion
Coffee Break
Future Healthcare Challenges session Chairperson Q. Duwairi/A. Shati/A. Fadhli
Health Insurance TBA
Dialysis and Infusion Clinics Wesley Valdes - USA
New age of collaboration Edgar Jimenez - USA
Health System for Hospitals & Clinics Eng. Kuntal Shah - India
Round Table Discussion and Consensus K. Shukri/Duaiji/A. Shati/Q. Duwairi/ M. Mishan/J. Al-Sulan/K. Alsahlawi/ J. Al-Ghanim/Ali-AlMukaimi/ B. Al-Enezi/Adnan Abul/Y. AlNosif, W. AlFalah/ Physiotherapy Assoc/ Nursing Assoc/Dental Assoc/ Pharmacy Assoc & Speakers from other Countries. Closing Ceremony
FACULTYTOPICTIME
P. Hofmann/K. Alsahlawi /A. Abdulrazek
Monday – Day 2, 16 March 2009
Health Reform 2009 Project
Task ForceDr. Ali Al Mukaimi - Kuwait
Dr. Ahmad Al Fadhli - Kuwait
Dr. Khalid Shukri - Saudi Arabia
Dr. Adel Wougyan - Kuwait
Dr. Noura Al Sweih - Kuwait
Dr. Adel Abdulrazak - Kuwait
Dr. Mohammed Shamsah - Kuwait
Dr. Mahdi Fadhli - Kuwait
Dr. Adnan Abul - Kuwait
Dr. Adel Khidr - Kuwait
Dr. Nasser Bader Al Humaidi - Kuwait
Dr. Jamal Al Sultan - Kuwait
Hanaa Al Refai - Kuwait
Amnah Al Qasim - Kuwait
The Challenge & Solutions of ReformingKuwait’s Health-Care System
March, 2009
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Preface
This is one of the end products of a project by healthcare executive consultants working in collaboration
with Kuwait medical Association, Ministry of health and Higher council of ministry Planning.
Our aim is to provide sound and unbiased fact base for use in the public debate on healthcare and enable
policymakers, regulators, intermediaries, payers, providers, employers, clinicians and patients to make more
informed and therefore better decisions.
Multiple problems are threatening the sustainability of Kuwait healthcare system. For example: some pa-
tients don’t receive the most appropriate treatment. Because the system lacks control over the supply and
demand for health services. The quality of care delivered varies throughout the country and cost are not
always effectively controlled .although Kuwait has realized that is health system has problems, the steps
that it has taken has to correct them have not achieved the desired impact.
Three interrelated factors are impeding the countries ability to reform its health system: the systems
shortcomings are often misdiagnosed, many of the proposed solutions fail to address root causes. And
sequence changes of healthcare leadership considerations make its difficult for stability.
If Kuwait wants to develop an effective reform program, it must begin reaching consensus on the root
causes of the systems most pressing problems and developing a plan for overcoming obstacles that have
prevented reform till now.
It must then establish a vision for its future health system, identify potential reforms that will change the
current system in the right way, and long develop a long term implementation plan
Out greatest thanks. go to many experts and stakeholders in different sectors of the healthcare system in
Kuwait who have met with us as part of this effort and who have provided us with valuable input
Dr. Khalid Shukri, MD, MHA, FCCM,FIPACCMExecutive Director, Healthcare Executives Consultants.Healthcare Management Consultant, Senior Consultant Critical Care Medicine, President-Elect Healthcare Executive Group (HEG-MENA), Affiliated Chapter American College Healthcare Executives (ACHE), Secretary-General International Pan Arab Critical Care Medicine Society.
48
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
I. Executive Summary
Over the coming years, Kuwait is likely to experience a sharp increase in its healthcare needs. Most
observers believe that population growth, a slowly aging society, and the conditions that affluence often
exacerbates, such as obesity, diabetes, and cardiovascular diseases, as well as cancer, will create a tremen-
dous new demand for healthcare services. At present, the Kuwait government funds most of the demand
for healthcare capital and operating expenditures. However, analysts believe that government alone will
be unable to continue to meet this demand. They have concluded that the only way to ensure that Kuwait
nationals’ health needs will be met without adversely affecting economic progress is to increase private
sector participation in the health care system. Only by attracting partners from the private sector who can
bring world -class medical knowledge, management skills, and capital to the sector will be able to make
high -quality healthcare available to everyone in Kuwait society. The government has recognized this situ-
ation, and has identified healthcare as one of the key sectors targeted in its wide-ranging privatization
program.
The current study revealed that Demand for quality healthcare is strong and is growing, excessive health-
care expenditure is rising with no significant outcomes ,poor delivery of care, patients are seeking treat-
ment abroad ,Private sector resources not fully engaged; incentive/policy structure not aligned with needs
of the private sector., HealthCare costs are rising, but quality/coverage of service needs improvement,
Severe shortage of qualified (and certified) health professionals limits sectoral expansion, lack of leader-
ship skills in administrative post has led to continuous corruption in management in healthcare industry. ,
Degree of sophistication of health IT systems is low.
49
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
II. POPULATION, SOCIOECONOMICS, HEALTH AND DEVELOPMENT PopulationKuwait occupies the northwestern corner of the Arabian Gulf. It is bound in the east by the Arabian Gulf and in the southwest by Saudi Arabia and in the north and the east Republic of Iraq, with a total land area of 17818 square kilometers. The climate is intensely hot summer with short cool winter.
The 2006 estimates showed total population to be 3,051,845 of national and non-¬national (nation-als constitutes about 33% of the total population estimate compared to 37% in 2003). The population growth rate was -1.1% in 2000 but it is estimated to be 3.36% in 2004 and this is because of return to pre-Gulf crisis immigration of expatriates.
The population is distributed in 6 governorates with highest density in Hawelli (686,421 persons which represent 27.6% of the total population) in 2003. In 2006 , farwaniah had the largest density of 820439 persons. Kuwait is nearly completely urbanized with 97% of its population living in urban area, with uni-versal access to safe water and sanitation. Male; Female ratio 1.7 ;1.1
EconomyKuwait is a small, rich, relatively open economy with proved crude oil reserves of about 98 billion barrels: 10% of world reserves. Petroleum accounts for nearly half of GDP, 95% of export revenues, and 80% of government income. Kuwait’s climate limits agricultural development. Consequently, with the exception of fish, it depends almost wholly on food imports. In 2003 the GDP per capita estimated to be $18,100.
EmploymentKuwait is a wealthy country with small number of population, which gives good opportunity for employ-ment. The labor force accounted to 1.3 million in which 80% of them are non-Kuwaitis. Unemployment in 2000 was 0.4%. However, it was estimated to be 7% in 2002; these are mainly for short period of time. EducationGreat emphasis has been placed on education as a means for economic development. According to WHO, the adult literacy rate 89.3% in 2000. The female literacy rate is 86.5% Primary education is universal in which, it accounted for 100% as well as the secondary level for both male and female.
Women’s DevelopmentWith the high literacy rates in Kuwait, women have full participation in all aspects of socio-economic ac-tivities including public and private sectors. In 2005 women have been given the right to vote. The topic of a broader socio¬-cultural debate, gender inequalities in the health sector remains an issue of grave importance and should be considered in a more detailed proposal addressing the promotion of health providers and patient care.
Food and NutritionFood is available in abundance and is affordable to all sections of the population. However, there is evidence of under-nourishment, and some studies have reported a significant evidence of anemia, espe-cially among young girls. Overweight and obesity are significant health risk factors in Kuwait with a high prevalence especially among the Kuwaiti element of the population. Kuwait has ranked 7th worldwide, just after the cluster of south pacific islands and ahead of the US, in rates of overweight and obesity. This is a critical issue.
Kuwait Public OpinionIn April 2007, the Kuwait economic society conducted a survey for a sample of 1200 persons from public to assess their opinion in various issues, key findings revealed : threats to future included bad local administration (19%), general reforms are good (37%) Corruption is increased 66% compared to 57% in different ministries; healthcare concern was ranked third in public concern that should be addressed urgently in the future.
50
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
III. State of Health and Health Care
Main Health Status IndicatorsLife expectancy for the Kuwaiti population (no available data for non-Kuwaiti) at birth is 78.7, for males 77.8 and for females 79.9 in 2003. The infant mortality rate is 9.4 in 2003, and under-five mortality rate 11.8 per 1000 for males and 10.9 per 1000 for females. Maternal mortality per 100000 live births was 9.1 in 2003. Crude birth rate 17.7 per 1000, while crud death rate 1.8 perl000, and the total fertility rate in 2003 accounted to 2.2.Total population access to health services were 100% in 2003. This pertains to the Kuwaitis, not the expats who have a far more limited access to care to cardiovascular diseases, cancer, and road traffic injuries.
There was no urban- rural gap since over 95% of the population is urban. Between 2002 and 2006 there was a decline in trends in most vital indicators measured except post neonatal mortality rates which showed a slight increase in 2006 of 3.2/vs. 3/1000 births.
Cardiovascular diseases, oncology and transport accidents accounted the 3 major causes of death in 2002-2006, more deaths were accounted in Kuwaitis, male more than females in case of cardiovascular diseases and transport accidents. There is a drop in cases of Brucella,typhoid, and hepatitis A and shigella and increase in cases of gastroenteritis and hepatitis B in 2006. No data of Hepatitis C, MRSA, central line infections, ventilator associated pneumonia infections, surgical site infections, AIDS, multidrug resistance organism rate or Tuberculosis which can be benchmarked again st regional and international institutesThe data provided doesn’t follow a scorecard system for health performance, the information provided about the dimensions of an ideal high performance health system as focus on : healthy lives, quality, ,ef-ficiency ,equity, timeliness and safety is very sparse. For example the healthy lives in Kuwait focused on mortality amenable to healthcare, infant mortality rate but don’t include health life expectancy at age of 60 in which WHO base the life expectancy adjusted for time spent in poor health due to disease and/or injury. Another indicator for health lives lacking is work-age adult’s limits on activities or work because of physical, mental or emotional problems, school absences due to illness or injury based on family income and insurance. Indicators for quality in health care are categorized into effective care, coordinated care, safe care, patient centered, and timely care. The Kuwait healthcare system provides adequate immuniza-tion to adults and children. Mental health care is excessively deficient in Kuwait and represents an unrecog-nized problem which has generated to us much demand from the public Quality effective care for chronic disease are needed to be addressed Under control as diabetes and hypertension as indicators are lacking but there is good data that hospitalized patients receive recommended treatment for heart attack, heart failure and pneumonia.
Coordinated care is the 3rd category of performance indicator for healthcare system, the Kuwait health-care system distributed into 6 regional areas; each area has a population, patient’s holds a smartcard in where they are only have access to their defined area or region ,access to primary care is easy for Kuwaitis ,from 2002-2006 there was an increase visit to primary healthcare clinics and Dental clinics.
Health DevelopmentGreat strides have been made in health, since 1910 in which, curative health services were provided by American missionaries, till the time being. In 1910, the first Kuwait hospital built was the American hospital In the early 1930’s the Municipal Department was established and assumed the responsibility of upgrading Kuwait’s public health. This improvement was demonstrated in the programs to clean areas of the country, and projects to provide needed drainage were undertaken as well as health awareness and vaccination campaigns. In 1936 Health Department was established and during the 1950’s Kuwait witnessed an overall health renaissance marked by rapid progress in the construction of hospitals and health care units health indicators. In 1961 the Alamiri hospital was opened. The ministry of health was established in 1961 and since that time the healthcare system was developing rapidly. In 2002 Kuwait was in the first position in predicted .but since 1981 no governmental hospital has been built. The effort of MOH was focused on renovation of old a building, focusing more on primary healthcare clinics which was trying to accommodate the population growth but it was unable to catch up.
51
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Year 2004 2005
Patients 616 697
Companions 770 892
Health Expenditures
Kuwait’s national budget is heavily reliant on oil prices. For the is reason, funding for health has seen yearly fluctuations that have caused budget cuts, implementation of health insurance and imposition of user fees for aliens. In 2005, the total health expenditure on health was 528 million KD. As a percentage of its gross domestic product (GDP), total health expenditure was 2.2. Private sector spending accounted for 24% of the total health expenditure.
Private expenditure comprises out-of-pocket payments (89%) and health insurance (11%). The proportion of health insurance contributions has doubled since 2000.
Kuwait has transformed into a welfare state since the discovery of oil. Kuwaiti nationals enjoy subsidies from government which include free education, housing, utilities, and other social services. Free medical services are also available to all citizens and if treatment was not available in the country, the Ministry of Health (MOH) arranges treatment abroad and the state pays the costs. Statistics show that the number of persons accompanying the patient exceeded the number of patients sent abroad. (Table 1) There seems to be a tendency to abuse this practice, especially so that the Ministry of Health lacks data on the type of diseases which required treatment overseas, the hospital the patient was referred to and the duration of stay. There are also no records to verify the outcomes of these patients, their satisfaction level or any other feedback.
Table 1. Patients and Companions Sent Abroad
Reports from higher authorities has indicated that the Kuwait health office in London, UK is suffering from poor financial debt of 866,400 KD and that there was no action to stop spending for cases which has completed treatment this has led to spend Extra 175,680 Sterling pound for nothing! 114,000 KD was spent on patients sponsored by ministry of interiors and defense in 2006 which has not paid to MOH .There is an increase of patient seeking treatment abroad of 13% in 2005 and 15% for companions.
Although a full National Health Account studies was not undertaken in Kuwait, WHO Reports show govern-ment allocated 6.9% of the budget to the MOH in 2002. The expenditure of the Ministry of health as of GNP was 2.1% in 2001. While the annual budget of MOH per capita in 2001 was $463, the national health expenditure per capita was $578. However, the total expenditure on health as a percentage of GDP was 3.5. The private health expenditures on health were 21.2% of the total health expenditure; giving a mix health economyof 80:20 public/private. The private expenditure is mainly of out-of- pocket expenditure. The costs of treatment will continue to rise. Paying for care of such chronic conditions is difficult now and is likely to grow worse. For example, the spending on cardiovascular diseases, already high today, is expected to grow rapidly to reach around one fifth of healthcare expenditures by 2016. Also, modern advances in medicine are continuously bringing increasingly complex and expensive treatment. With more extensive travel, and rapidly spreading information through the media and the Internet, Kuwaitis will become increasingly de-manding in terms of the type and quality of healthcare that they expect to receive in their country. As a result,Expenditures on healthcare in Kuwait are expected to escalate very rapidly. - A National Health Account study is of extreme importance and should be one of the most important recommendations we make as data is simply absent. With the help of external resources (WHO, WB, etc.), we could perform this in a rela-tively short timeframe. This is of benefit to plan for longer term reforms.
52
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Healthcare primary clinics 2002 2006
General clinics 5.6 6.7
Dental clinics .95 .97
Mother care .33 .38
Child care 2.6 2.9
Preventive care .68 .85
Healthcare Primary Clinics 1999 2001 2003
General clinics 71 75 74
Dental clinics 65 66 64
Mother care 25 26 26
Child care 65 68 70
Preventive care 22 24 58
Diabetic clinics 21 26 31
Primary Health CareBoth public and private sectors provide health and medical care, with primary health care being provided by the public sector. Almost 100% of the population has access to primary health care services. There are 74 PHC throughout the state across 6 health regions that provide polyclinic services.
According to the Ministry of Health data, antenatal care is provided to 100% of pregnant females, trained health personnel attend all births and around 98% of the children were fully vaccinated. In 2003, the man-power rates per 10000 populations were 19 for medical doctors, 3 for dentists, 2.6 for pharmacists, 40 for nurses and mid wives, 21 for hospital beds and 3 for PHC units. Primary healthcare clinics are opened 14 hours per day. the 100% coverage pertains to Kuwaitis only. Now that expats have to pay user fees to supplement their mandatory insurance, this has likely further limited their access. The smallest ED in the public sector has a reported census of > 100,000 patients/yr
Healthcare Organizational StructureHospital and regional directors and key decision makers in MOH Lack MBA, MHA Certification, Lack of leadership & managerial skill, Lack of decision and execution skills. No interest in updating leadership course No scientific criteria for selection of Top Key decision makers i.e.: deputy ministry, regional directors and hospital directors as the current criteria is written in 1980. The MOH organizational structure founda-tion is based on 1980 regulations,the channel of communication is long from consumers to key decision makers., there is a strong need to improve leadership and managerial skills by training and obtaining higher degrees in healthcare management abroad from North America, Europe and Australia in different sectors in order to improve delivery of care to patients. No Human resource management department in the ministry of health or hospitals.
Health workforceThe MOH need to improve to improve lacks manpower planning and mechanisms to systematically assess its human resource requirements. Absence of planning mechanisms in the government makes it difficult to inform the educational system to respond to the skills shortage faced by the health sector. There is an apparent lack of coordination in the areas of healthcare, education and foreign labor outsourcing, major defects in healthcare workforce include:
53
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Physicians/Dentists15%
Pharmacists/Allied Health22%
Managers25%
Nurses28%
Technicians6%
Other Support4%
39%49%
36%
92%
57%
84%
8%
66%
9%
49%
0%
20%
40%
60%
80%
100%
Physicians Dentists Pharmacists Managers Allied HealthStaf f
Technicians Nurses Suppor t Staf f AncillaryStaff
TOTAL
Kuwaitis
Non-Kuwaitis
• Lack of manpower plan 2-5 year strategy in each hospital• Hospital director has no authority in planning manpower • Poor credentialing system with no clinical privilege process • Decision of selection is based on regional specialty meeting -no proper process or policy• Kuwait nurses 11% in 2003 and 8% in 2006• Kuwait Administrative manpower in MOH 91% and 92% in 2003 , 2006 respectively• Directors, managers lack managerial skills ,no empowerment• No clinical pharmacist• Relocation of Kuwait physicians to other neighbor countries for higher salaries and better healthcare system • MOH Lacks manpower plan in different categories of healthcare professionals• Recruiting process not well defined, looking for position filling not quality, competency or knowledge of candidate • High dependency on non-Kuwait healthcare professionals
In 2006, the nurses represented approximately 28% of the total health workforce, followed closely by managerial staff (25%). Physicians constituted only 13% of the health manpower resulting in a 2:1 nurse -to-doctor ratio.
Figure 2. Health Workforce, 2006
The distribution of Kuwaitis in different health occupations is shown in the Table 2. There is a predomi-nance of Kuwaiti managers, technicians and support staff. Jobs that are relevant to health care are oc-cupied by expatriates. Among the expatriates, there is a preponderance of Asians (54%) and Middle Easterners (43%) where Indians and Egyptians top the list, respectively. It is interesting to note that the percentage of Kuwaiti nurses has decreased by 3% since 2003.
Table 2. Distribution of Health Workforce by Nationality-2003
54
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Cadre Kuwaitis Non-Kuwaitis Total
Physicians 1718 (40%) 2537 (60%) 4255
Pharmacists 152 (29%) 380 (71%) 532
Managers 6622 (9 1%) 669 (9%) 7291
Technicians 4245 (62%) 2650 (3 8%) 6895
Nurses 984 (11%) 8013 (89%) 8997
Support Staff 511 (69%) 229 (31%) 740
Ancillary staff 82 (11%) 693 (89%) 775
Total 14314 (49%) 15171 (51%) 29485
Table 1 gives the breakdown of health human resource in Kuwait, and its distribution by Kuwait and non-Kuwait population.
Table 1: Health Human Resource Profile in Kuwait - 2003
Source: Ministry of Health KuwaitIn 2006 , the rate for recruitment for administrative jobs were highest ( 710) jobs compared to doctors( 139) ,nursing (96),pharmacist (48),dental (74). Distribution of manpower by job category for 2006 has also ranked administrative (25%), nursing (29%) Physicians accounted only 12.8%. The conclusion that’s states financial cost expenditure for salaries is mainly administrative jobs. therefore in view that the cur-rent healthcare system is not improving; one of the likely causes is ineffective administrative personal occupying post in different hospitals and ministry.
ImmunizationThere has been a substantial improvement in vaccination coverage in the last decade as it was mentioned above that almost 98% of the children are fully vaccinated. In 2003 the percentage of infants immunized against DPT was 98%, polio 98% and measles was 99% with 100% vaccination coverage against HBV. These high coverage rates could be attributed to the efforts of the MOH in reaching mothers, better provi-sion of knowledge and improved awareness of the public on diseases.
HospitalsBy visiting governmental hospitals in Kuwait, we have noticed no vision, mission, strategic goals and plans with no independent operations in resources or finance service. On interviewing staff we found the fol-lowing: lack of policies and procedures and lack of proper access to hospital regulations, no orientation program, no staffing dept plan, no formal process of communication, lack of general staff meetings, no competency programs, no job descriptions, no standards regarding handling hazardous materials. , no RACE/PASS signs posted., lack of performance improvement projects ,lack of qualified Quality persons, no patient safety goals, no scope of service..
Organizational structure for hospitals follows rules which were written in 1980; therefore it doesn’t follow the new era of healthcare system from quality, skilled leadership, patient safety, high technology, informa-tion technology and increase cost. The organizational structure lacks human resource management, qual-ity and performance management, academic affairs, information technology, patient relations, safety and security, legal affairs, internal audit, environmental health, planning dept.
There are dept which are not needed like preventive medicine, this should be replaced under infection control and health education.
55
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
2002 2003 2004 2005 2006 2007 2008
Gov. Hospital 15 15 15 15 15 15 15
Private 8 9 9 9 11 11 11
Gov clinics 74 74 74 78 78 78 78
Private Clinics 128 146 157 140 123 116 115
Military Hospita 1 1
Employees/Private Hospital 1489 1494 1652 1741 1891 2124 2770
Supplies 25,920898 45,872027 53,093325 46,666718 54,883735 72257030
Equipments 30,035465 33,796597 36,460581 45451017 53584021 64689360
Positions like deputy hospital director should be revisited and given more responsibilites if appropriate see the proposed organizational structure some dept like medical records, statistics and patient relations should be under medical director.
Secondary care is provided through six regional hospital is with 2500 bed capacity. In addition to this these are 9 specialist hospitals including maternity, infectious diseases, mental health and cancer hospitals bringing the total beds available to 4575, with total Bed occupancy around 60 percent. These hospitals consume the largest proportion of the public health budget, despite moderate bed occupancy and high pressure on primary care services. The study has revealed that Last governmental hospital built was 1981,No single governmental is internationally accredited ,Building infrastructure is poor and outdated and Infection control standards are poor.
Communicable DiseasesSubstantial epidemiological transition happened in regards of infectious and communicable diseases. This is could be attributed to socioeconomic development, and rapidly changing lifestyles. There were no re-ported cases of cholera, diphtheria, polio and tetanus in 2000. The number of malaria reported cases was 233 in 2001. There were a total of 111 of reported cases of tuberculosis in 2001 and 969 cases of HIV/AI DS in 2002.
Non-communicable DiseasesWith the decrease in the incidence of communicable diseases and the increase in life expectancy, the bur-den of disease has shifted towards non-communicable diseases. Trends are showing steady increases in the incidence of coronary heart disease, cancer and accidents and injuries (mainly road traffic accidents). In addition to this many risk of ill health are showing alarmingly high prevalence; for example, diabetes, obesity, dislipidemia and physical inactivity. Various national groups and communities have been set up to tackle these problems. We anticipate that specific targets with plan of actions to achieve target will produced.
Mental disorders also represent a major public health problem and in particular among non-Kuwaiti and non-national workers. The extent of somatization is not known, but it is expected to be high in such a mixed population as somatization may undermine the perception of psych disorders.
56
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
IV. Challenges and Barriers
Despite the admirable achievement at socio-economic, health status and provision and access to public
services, Kuwait is facing many challenges in the 21st Century which may impinge on the health of the
population if serious and systematic steps are not introduced as soon as possible:
• Poor administration and management corruption
Lack of leadership and managerial skills in healthcare has led to major catastrophic poor of delivery of
care to patients as -long waiting times for clinics, delay of surgeries, and lack of beds for admissions. This
has led the patients going to private hospitals and seeking treatment abroad.
• Old rules and regulations
Old MOH policies and organizational structure and job descriptions to the 1980 has led to various defi-
ciencies in healthcare system which we see today.
• Public Expectations
Very high expectations amongst a literate and educated public for higher quality services, accessible to
where they live, and provide all the services that meet their needs (for example a range of what is called
secondary services provided in primary care settings) are major challenges to health policy makers.
• Demographic Changes
It is projected that the population of the Kuwaitis over the age of 60 years will increase to 8% of the
population by the year 2030 and to 25% by the year 2050. The prevalence of chronic disease, therefore
will be on the increase in particular, cancers, coronary heart diseases (angina, myocardial infarction, ar-
rthymias and heart failure) and disorders of mental health
• Shift from Curative to Health improvement
Despite the substantial improvement in health, the focus is still on programs of expanding hospital services
in both public and private sector. This is a costly in the long term. The priority should be focused on reduc-
ing ill health and the burden of diseases through programs that secure the health of the whole popula-
tion. This cannot be achieved without shifting resources from curative to public health activities including
prevention of chronic diseases and reducing the risks of ill health.
• Burden of Chronic Diseases
The WHO is predicting that non-communicable diseases will constitute more than 60% of burden of dis-
ease in the EMR by the year 2010.
Current data show that Kuwait is already at this stage with trends showing steady increases in CHD, can-
cers, accidents and mental health. Indeed, some of the risks to health are already very high: overweight,
diabetes.
• Capacity Building (e.g. Public Health, PHC)
Kuwait will not be able to cope with the changing patterns of disease burden (i.e. non-communicable dis-
eases) without real and substantial investment in public health and primary care capacity, both in term of
quantity (number of practitioners) and quality of such practitioners.
• Manpower Development
Kuwait is still relaying and will continue to relay for many years to come on non-Kuwaiti health profession-
als to support the expanding health system. The variation in quality is huge and a system of recruitment to
minimize variation is urgently needed. It will take some time before such a variation could be overcome.
57
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
• Burden of Costs Gov Vs Citizens : The Health Economy
The costs of health services in all advanced countries including Kuwait are escalating. This is not because
of the of the increase unit costs, but simply due to the expansion of population coverage due to medical
advances and unmet demands. A political decision is needed on the best and the most cost-effective way
to fund the health and health care services in Kuwait. Furthermore, any decision should take into account
the very high percentage of the non-Kuwaiti population (63%) and the exceptionally high non-Kuwaiti
workforce (80% of the total workforce). In a wealthy countries like Kuwait, the social insurance which
provide comprehensive services free at time of delivery maybe the most effective method of providing
quality health services that secure the health for the whole population, alternatively following the Singa-
pore health insurance system is the best recommendation.
• Quality of Health Service
Investment in quality will reduce the unit costs in the medium and long term, increase patient, public and
professional satisfactions and certainly will minimize litigations. Patients and public safety is paramount of
any good health system.
• Health Service Management
The quality of the health system is always linked to its leadership and the management capacity to deliver
services that meet the needs of the population and use the resources available in the most cost effective
ways. Health systems are organic bodies and changes are inevitable responding to changing population
needs and medical advances. We believe that there are urgent needs to invest in management capacity
development through training, leadership program and the selection of health leaders who can deliver the
health priorities for Kuwait) and meet the many challenges of the 21st century. It is essential to stress Once
again that without good information and flow of timeless information within the health system services
cannot be managed and developed effectively.
• Shortage of Medications
Recurrent reports of complaints from patients and media regarding shortage of important medications
forcing patients and families to buy from private pharmacies. Also complaints regarding that physicians
prescribed medications are not available in governmental hospitals or primary clinics, another issue is that
if the patient is not from the same regional healthcare area then he is unable to receive a medication from
another hospital from another area.
• Healthcare professional-shortage
Education, in some ways, the most basic medical Shortage that Kuwait now faces is a shortage of Doc-
tors and nursing staff. To satisfy current needs, more medical schools and residency programs must be
developed. Accordingly the government supports the Development of more medical education facilities,
and some of these will be available for private sector
• External healthcare market competition
Neighboring countries like Saudi Arabia, UAE and Qatar are already a step ahead in advance medical
care, privatization UAE, Bahrain and Qatar is moving medical tourism, this is a major challenge for MOH to
attract their own population, their own physicians who attracted to better healthcare system and higher
salaries.
• Lack of strategic management plan
Recent estimates showed increase in Kuwait’s budgetary surplus for the fiscal year 2007/2008 to a
whopping KD 6.3 billion and Kuwaitis are responding to the new figures with new demands. The Govern-
ment must upgrade the failing infrastructure with this money ,many Kuwaitis point out to the states failing
healthcare system infrastructure as the primary area in which the MOH surplus should be allocated, the
58
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
lack of proper strategic management department in MOH and lack of strategic visionary management
leaders in hospitals has caused what it is now today because the planning is simple but when it comes to
execution ,that the failure of leadership skill causing most government officials to seek treatment in private
clinics because they know the public system is a failure.
• Poor infrastructure of e:overnmental hospitals
As the last hospital was built in 1981, poor foundation, space, traffic mix, information technology cost a lot
of finance to renovate, redesigns the hospital to a world class medical center.
• Treatment abroad on going problem
There is a big need to analyze and produce criteria for selected cases only to seek treatment abroad, to
reduce cost which is affecting the budget of MOH. The policy for treatment abroad should be revised,
• Layers of High Management Channel of Communication
The long channel of communication from front employee to hospital director to regional director to MOH
Delays the various processes for delivery of care to the patient. Up to the level of MOH Organizational
structure of assistant deputy of Minister. the jobs are occupied by old school of experience in healthcare
which is affecting the quality of patient care, delivery of care, availability of resource causing a burden of
Governmental budget yearly, this is attributed to bureaucracy and lack of effective managerial and leader-
ship skills.
• Implementation of Code of ethics & medical law in Kuwait:
There is a lack of a proper & a clear regulations that assist both the physicians and patients to deal with
major ethical issues in Kuwait health system. No organized bodies are establishing any roles. Kuwait Uni-
versity and a mini-board are setting regulations without clear vision.
This problem has created the Immigration of Kuwaiti Physicians and dentists to other countries •
especially (KSA, UAE, USA, UK, & Canada). Many doctors have resigned in the last 5 years.
There is no differentiation between academic and clinical staff. It is impossible in the current •
setting for clinical physicians to perform clinical trials or studies. He/she has to be in the Ku-
wait university i.e. has an academic position to perform research and publish papers
• Public Awareness and Health Education
No efficient methods are established to educated both the public or even the medical/dental staff in terms
of disease prevention, patient¬ physician communications, ethical & medical laws, obligations and rights
of both patients and physicians
• Insurance System
• Inefficiency and inequity of health insurance system between both citizens and
non-citizens
Inability to cut down on the health budget by involving private insurance companies•
Inability to implement the regulations due to the lack of monitoring bodies•
59
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
V. Recommendations and Solutions STRATEGIC AGENDA FOR KUWAIT FOR THE NEXT TWO- FIVE YEARS (2009¬2013) OverviewThe improvement in the population health in Kuwait and in particular amongst the Kuwaitis is the pride of all those involvement in the planning, decision-making and delivery of services to meet the population needs. However, populations and their needs are changing hence the priorities and the challenges. In today’s Kuwait there are new sets of challenges and health professionals working with the visit to Kuwait in Aug 2008, we have identified priority areas that need to be addressed in order to improve the current healthcare system in the coming 2-5 years.
HEALTH REFORM STRATEGY 2009-2012:1. Re-structure the organizational structure of MOH,
See attachment 1: current MOH Organizational structure
Identifying and selecting potential new Healthcare leaders who Demonstrate passion, enthusiasm, 1. integrity and teamwork personality
Training leaders in managerial skills through the different leadership leadership programs or sending 2. scholarships to obtain MBA In healthcare administration, healthcare informatics, health system policy and medical law, especially physicians.
Strategic cost reduction approach, starting from reducing layers of management in MOH and regional 3. directors especially the primary care and dental regional directors.
See attachment 2, 3, 4, 5( Different proposal plan for MOH organizational structure) The proposals redesigned the depts. To 6 major areas in ministry, each with deputy minister. The job for 13 assistant deputy ministers is deleted in plan A & B. Channel of communication will be from hospital directors directly to Deputy Ministers to ease the process of various issues in hospitals demand.
New organizational structure for each hospital: see attachment 64.
Setting a vision, mission and strategic objectives for each hospital aligned with MOH Vision.5.
Identifying the right performance measures by the scorecard system to benchmark against interna-6. tional standard.
Every hospital should have an independent yearly budget with independent hospital operation; the 7. hospital top management should have full empowerment regarding financial, operation and clinical performance.
Seeking international accreditation for all hospitals within a 3 year (2009-¬2012) frame period to 8. produce a solid infrastructure framework of international standards where multinational staff can comply with it for better patient care.
Studying to implement a high tech information technology to reduce errors and manual manage-9. ment and manpower cost especially the administrative jobs Revising the administrative jobs which consumes high burden on MOH Budget and cutting the jobs which are not required and following best practice in healthcare market
60
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Investment in local Kuwaiti who are interested in healthcare career by sending scholarship focusing on 10. nursing, allied support services, technicians...etc.
Introduce the mobile ROBOTIC technology into different hospital where it functions as consultancy, 11. walk rounds, where the world best experts can be on site through the robot 24/7, in this way the travelling to abroad will be reduced significantly and healthcare expenditure can be saved, reputation of Kuwait hospitals will grow in view of this partnership with world class institutes around the clock.
Revising the job descriptions and promotions which is against the market and standards in order to 12. reduce the movement of staff to neighboring countries for better salaries and healthcare system. Example cancelling the 4 papers to be written in peer review journals in order to promote to consul-tant as we are sure that if we conduct a survey, we will find the majority of consultants don’t fit this criteria.
Old hospitals has poor infrastructure, therefore redesigning and restructuring will cost more in view 13. of poor maintenance, supplies, logistics, we recommend building new hospitals with international standards with high quality architect which will last more for years and as an attraction for medical tourism.
MOH should pay any debt within the next 2-4 years. 14.
Partnership or membership with advisory board company or other organization for advice and plan of 15. different dept in hospitals for short and long term plan.
0pening MOH nursing school and medical schools linked to tertiary centers for Kuwaitis and non-Ku-16. waitis With partnership with international world class universities to produce high standard graduates, save cost and establishing high reputation
Privatization of governmental hospitals once the major hospital are accredited by 2010-2012, the fact 17. that financial burden on Ministry will increase to a stage it will not catch up with population growth, increase cost of healthcare, new medications ,high technology equipments.
Introducing medical insurance system similar to Singapore healthcare system (best in Asia) or Austrian 18. healthcare system which is considered the best healthcare system in Europe.
Unifying the health insurance system between citizens and non-citizens performing, an extensive study on how to regulate the system with significant involvement of the private sector.
Trying to alleviate the overload of patients in the public sector and shift of care towards the private sectors without placing additional financial strain on the low/middle class population.
An easy way to look at health financing is to compare outcome measures. In the OECD nations, it is the social health insurance schemes that prevail (France, Italy, Switzerland, Spain, Canada, etc..).
Create a stronger institutional set-up and effective regulatory framework to promote private sector in-19. vestment in healthcare and the production and distribution of pharmaceuticals and medical supplies,
Develop a business environment that will make Kuwait a more attractive destination for private health-20. care providers, and
Attract investors and other partners to the Middle East’s largest market for healthcare the takeaway 21. for healthcare providers and producers of pharmaceuticals and medical supplies is clear the Middle East’s largest market of healthcare consumers will become increasingly open to private investment
61
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
Example from Saudi Arabia
MOH will concentrate its healthcare provision activities on preventive And curative primary care.22.
To establish a committee or a board of directors that represent physicians, patients, ethicist, and also 23. those who are familiar with the medical law to place a well-organized ethical/medical law system
Research: Establishing committees and boards with experienced members to handle this issue. • The need of getting pharmaceutical involvement without any bias to help funding this process.
The reform should encourage the shift to private sectors with better promotions but without af-• fecting the quality of care which could potentially reduce the burden on the public health system both financially and also in terms of patients care.
A new government entity will be established; the General Organization for Hospitals, separate from 24. MOH, and all MOH hospitals assets will be transferred to this new organization to prepare the ground for increased public private partnerships in healthcare provision. A National Health Fund will be es-tablished under the Ministry of Finance, also separate from MOH, to fund directly healthcare services provided to patients the initial phase of this program will last three years, and will concentrate on modernizing the overall Government IT infrastructure, and establishing a new healthcare regulatory framework. The NHF or Social Health Insurance agency will arguably be the most important compo-nent of this proposal. Its function should solely be to fund health care in Kuwait. Funds should come from income deductions from Kuwaitis and expatriates at graded levels. Low income groups should be fully subsidized by the government. The Fund will allow for risk pooling and financial risk protection and will offer a basic package for all residents of Kuwait. Public and private health care institutions will then compete for funds through improved standards of care assessed by an independent regula-tory agency.
Tertiary care. Long waiting periods at public hospitals, bed shortages, increasing incidence of chronic 25. diseases, and the deteriorating quality of care in some areas are creating opportunities for multidisci-plinary hospitals and specialized centers of excellence including such complex disciplines as oncology and organ transplants Evolution Planned for the Kuwait Healthcare Sector
62
The Challenge & Solutions of ReformingKuwait’s Health-Care System
2009The Challenge & Solutions of Reforming Kuwait’s Health-Care System
2009March
VI. Conclusion
As Demand for quality healthcare is strong and public expectations is growing. The healthcare industry
value chain needs to be developed and continue to expand.
Kuwait is in the midst of an exciting transition to a more open, market driven economy. Over the last
several years, the government has pushed a variety of changes that have made Kuwait a better place to
do Business, including its decision to join the World Trade Organization. In fact, if present trends continue,
by 2011, we believe that Kuwait may well be one of the ten best places to do business in the world. One
crucial component in this program - for citizens individually and for the nation as a whole -is the creation
of a more market driven healthcare system and knowledge based industry, the fully nationalized system
that served an earlier era well is no longer suited for the complex, dynamic country that Kuwait is now be-
coming. For both economic and public health reasons, the government is Committed to a course of change
that will in the end create a system that is more responsive to the health needs of Kuwaiti consumers. This
transition to a market driven healthcare system will not only be good news for Kuwaitis and the Kuwaiti
Economy. For international healthcare providers and investors, the coming liberalization of the sector will
mean increased access to the largest healthcare market in the Middle East, and an exciting opportunity to
help millions of Kuwaitis live longer, healthier lives therefore we recommend several priority areas which
need which need to be focus which are; effective healthcare leadership, promoting quality by international
accreditation and patient safety, restructuring human resource management, tertiary specialized medical
centers in each regional area, privatization and insurance for governmental hospitals, primary care will be
under governmental regulations, improving the health information by information technology and targeting
Kuwait as an international hub for medical tourism in the future.
63
Health Insurance IDSpeech Recognition SystemsContact CenterVIP Services Since 1996
Public Services Company K.S.C.C Address: 27377 Al-Safat / 13104 Kuwait
Office Hours: From Sunday till Thursday (8:00 a.m. to 15:00 p.m.)
Tel: +965 1824824E-mail: [email protected] www.psc.com.kw
Executive Summary And Recommendations
KuwaitHealthReform
2009 EXECUTIVE SUMMARY AND RECOMMENDATIONS
Over the coming years, Kuwait is likely to experience a sharp increase in its healthcare needs. Most observers believe that population growth, a slowly aging society, and the conditions that affluence often exacerbates, such as obesity, diabetes, and cardiovascular diseases, as well as cancer, will create a tre-mendous new demand for healthcare services. At present, the Kuwait government funds most of the de-mand for healthcare capital and operating expenditures. However, analysts believe that government alone will be unable to continue to meet this demand. They have concluded that the only way to ensure that Kuwait nationals’ health needs will be met without adversely affecting economic progress is to increase private sector participation in the health care system. Only by attracting partners from the private sector who can bring worldclass medical knowledge, management skills, and capital to the sector will be able to make highquality healthcare available to everyone in Kuwait society.
The government has recognized this situation, and has identified healthcare as one of the key sectors tar-geted in its wideranging privatization program the current study revealed that Demand for quality health-care is strong and is growing , excessive healthcare expenditure is rising with no significant outcomes ,poor delivery of care, patients are seeking treatment abroad ,Private sector resources not fully engaged; incentive/policy structure not aligned with needs of the private sector., HealthCare costs are rising, but quality/coverage of service needs improvement, Severe shortage of qualified (and certified) health pro-fessionals limits sectoral expansion, lack of leadership skills in administrative post has led to continuous corruption in management in healthcare industry and Degree of sophistication of health IT systems is low. Kuwait is ranked 7th worldwide, just after the cluster of south pacific islands and ahead of the US, in rates of overweight and obesity. This is a critical issue.
66
KuwaitHealthReform
2009Areas for Improvement &
ActionCurrent Status and Problem Solutions
MOH Organizational structure
Leadership and managerial skills
Leadership channel of communicationFrom hospital to minister
Hospital organizational structure
Performance measures in MOH and hospitals
Hospital operations
Old organizational structure dated 1980 Not compatible with the current health care system today
1. Lack of leadership development2. Bureaucracy leading to poor quality of delivery of care to patients3. Resources used inappropriately4. The quality of the health system is always linked to its leadership and the management capacity to deliver ser-vices that meet the needs of the popu-lation and use the resources available in the most cost effective ways.
Several layers of management in MOH6 Regional directors13 assistant deputy ministers1 deputy minister
No standard organizational structure for hospitals
There is good data which are collected manually. Lack of bench mark among hospitals
Hospital directors have lack empower-ment of financial and budget
Proposed new MOH Organizational structure
1.Encourage leadership development2.Identifying leaders3. of hospital directorsScholarship for MBA-Healthcare man-agement
Proposed structure of communication 1. Include 6 deputy ministers in differ-ent category, 2. Post for assistant deputy ministers are deleted3. Regional director post is cancelled.4. Hospital directors directly report to deputy ministers
Proposed a new standard hospital Organizational structure, see attach-ment.
Introducing the Business intelligence, dashboard and balance scorecard to ease the strategic execution, selecting the right indicators and benchmarking
Each hospital should have their own budget and cost centers plus the hos-pital director and hospital board have an independent control to yearly hos-pital budget, operations and recruiting
67
KuwaitHealthReform
2009 Areas for Improvement &
ActionCurrent Status and Problem Solutions
Quality and Safety
Information TechnologyTreatment abroad
Only few private hospitals are accredited.
No single governmental hospital accredited
Last governmental hospital built 1981 therefore he infrastructure is inappro-priate for safety and quality care for patient
Medical errors are on the rise due to lack of standards
Tertiary care. Long waiting periods at public hospitals, bed shortages, in-creasing incidence of chronic diseases, and the deteriorating quality of care in some areas
MOH and Governmental hospitals are still using manualWhich leads to high rate of errors, de-lay of various process
High financial burden on government High costNo data to assess the outcome Increase the debtLack of community trust to local hospi-tals due to poor care and infrastructure.
Starting international accreditation 2009-2011
For all governmental hospitals to pro-duce a solid infrastructure framework of standards where multinational staff can comply
Building new state of art hospitals to attract the public and medical tourism.
Starting risk management and patient safety programs
creating opportunities for multidisci-plinary hospitals and specialized cen-ters of excellence including such com-plex disciplines as oncology and organ transplants Evolution Planned for the Kuwait Healthcare Sector.
Investment in quality will reduce the unit costs in the medium and long term, increase patient, public and pro-fessional satisfactions
A study to revise the current health information and establish automation and business IT in healthcare
Introduce the telepresence-robotic into different hospitals where it functions as consultancy, walk rounds where world best experts from around the world can be on site 24/7. This will reduce significantly the cost of treat-ment abroad
Introduce the remote control technol-ogy
Introduce teleconference
Partnership with international world wide renowned institutes
Encourage exchange programs
68
KuwaitHealthReform
2009
Job descriptions and promotions
Investment in for future generation of healthcare professionals
Health Insurance
Certain jobs in healthcare should be redesigned and added and deleted according to the market in the region .
Kuwaitis in medical field are moving to other countries for better income
There are currently 300 Kuwaiti in medical scholarship which is very good.
Shortage of Kuwaiti nursing and other health professionals in allied science and supporting services for healthcare
inefficiency and inequity of health in-surance system between both citizens and non-citizens
Inability to cut down on the health budget by involving private insurance companies
Inability to implement the regulations due to the lack of monitoring bodies
Redesigning the promotion criteria, job descriptions in various categories according to neighboring countries as Saudi Arabia and UAE.
Revising the administrative jobs which consumes high burden on MOH Bud-get and cutting the jobs which are not required and following best practice in healthcare market
Improving hospital operations and quality and incentives will retain the local people
Opening MOH nursing school and medical schools linked to tertiary cen-ters for Kuwaitis & non-Kuwaitis With partnership with international world class universities to produce high stan-dard graduates, save cost & establish-ing high reputation
Introducing medical insurance system similar to Singapore healthcare system (best in Asia) or Austrian healthcare system which is considered the best healthcare system in Europe. A National Health Fund should be established un-der the Ministry of Finance, also sepa-rate from MOH, to fund directly health-care services provided to patients the initial phase of this program will last three years, and will concentrate on modernizing the overall Government IT infrastructure, and establishing a new healthcare regulatory framework.
In a wealthy countries like Kuwait, the social insurance which provide com-prehensive services free at time of de-livery maybe the most effective meth-od of providing quality health services that secure the health for the whole population, alternatively following the Singapore health insurance system is the best recommendation.
Another way is to to look at health financing is to compare outcome measures. In the OECD nations, it is the social health insurance schemes that prevail (France, Italy, Switzerland, Spain, Canada, etc..).
Areas for Improvement &
ActionCurrent Status and Problem Solutions
69
KuwaitHealthReform
2009
Privatization and Investment
Financial Fund
The need for partnership between public and pri-vate sector.
The fact that financial burden on Ministry will in-crease to a stage it will not catch up with popu-lation growth, increase cost of healthcare, new medications, high technology equipments
There is a good move for accredited private hospitals to better care.
Recent estimates showed increase in Kuwait’s budgetary surplus forthe fiscal year 2007/2008 to a whopping KD 6.3 billion and Kuwaitis are responding to new de-mands for a better health system and improving the falling infrastructure with this huge budget
MOH Should pay any debt within the next 24 years as Reports from higher authorities has indicated that the Kuwait health office in London, UK is suf-fering from poor financial debt of 866,400 KD.
The expenditure of the Ministry of health as of GNP was 2.1% in 2001. While the annual budget of MOH per capita in 2001 was $463, the na-tional health expenditure per capita was $578. However, the total expenditure on health as a percentage of GDP was 3.5. The private health expenditures on health were 21.2% of the total health expenditure; giving a mix health economy of 80:20 public/private. The private expenditure is mainly of outof pocket expenditure. The costs of treatment will continue to rise. Paying for care of such chronic conditions is difficult now and is likely to grow worse. For example, the spending on cardiovascular diseases, already high today, is expected to grow rapidly to reach around one fifth of healthcare expenditures by 2016. Also, modern advances in medicine are continuously bringing increasingly complex & expensive treatment. With more extensive travel.As a result,Expenditures on healthcare in Kuwait are expect-ed to escalate very rapidly
Privatization of governmental hospitals once the major hospital are accredited by 2010-2011.
Develop a business environment that will make Kuwait a more attractive destination for private healthcare providers, and
Attract investors and other partners to the Middle East’s largest market for health-care the takeaway for healthcare provid-ers and producers of pharmaceuticals and medical supplies is clear the Middle East’s largest market of healthcare consumers will become increasingly open to private investment
A National Health Account study is of ex-treme importance and should be one of the most important recommendations we make. As accurate data is simply absent. With the help of external resources (WHO, WB, etc.), we could perform this in a rela-tively short timeframe. This will be of benfit to plan for longer term reforms.
The NHF or Social Health Insurance agen-cy will arguably be the most important component of this proposal. Its function should solely be to fund health care in Ku-wait. Funds should come from income de-ductions from Kuwaitis and expatriates at graded levels. Low income groups should be fully subsidized by the government. The Fund will allow for risk pooling and finan-cial risk protection and will offer a basic package for all residents of Kuwait. Pub-lic and private health care institutions will then compete for funds through improved standards of care assessed by an indepen-dent regulatory agency.
A new government entity should be estab-lished; the General Organization for Hos-pitals, separate from MOH, and all MOH hospitals assets will be transferred to this new organization to prepare the ground for increased public private partnerships in healthcare provision.
Shifting the system to privatization & so-cial security insurance system.
A National Health Fund will be established under the Ministry of Finance, also sepa-rate from MOH, to fund directly healthcare services provided to patients the initial phase of this program will last three years, and will concentrate on modernizing the overall Government IT infrastructure, and establishing a new healthcare regulatory framework.
Areas for Improvement &
ActionCurrent Status and Problem Solutions
70
KuwaitHealthReform
2009Areas for Improvement &
ActionCurrent Status and Problem Solutions
Public expectations
and Demographics
Very high expectations amongst a lit-
erate and educated public for higher
quality services, accessible to where
they live, and provide all the services
that meet their needs (for example
a range of what is called secondary
services provided in primary care set-
tings) are major challenges to health
policy makers.
No efficient methods are established
to educated both the public or even
the medical/dental staff in terms of
disease prevention, patient-physician
communications, ethical & medical
laws, obligations and rights of both
patients and physicians
It is projected that the population of
the Kuwaitis over the age of 60 years
will increase to 8% of the population
by the year 2030 and to 25% by
the year 2050. The prevalence of
chronic disease, therefore will be on
the increase in particular, cancers,
coronary heart diseases (angina,
myocardial infarction, arrthymias and
heart failure) .
The priority should be focused on
reducing ill health and the burden of
diseases through programs that se-
cure the health of the whole popula-
tion. This cannot be achieved with-
out shifting resources from curative
to public health activities including
prevention of chronic diseases and
reducing the risks of ill health.
Better hospital operations
New programs and services
Recruiting and retaining the best em-
ployees
Monitoring data for patient satisfac-
tion
Establishing performance data driven
organizations to benchmark
New design hospitals is to be built
we recommend building new hospi-
tals with international standards with
high quality architect which will last
more for years and as an attraction
for medical tourism
71
KuwaitHealthReform
2009 CONCLUSION
As Demand for quality healthcare is strong and public expectations is growing. The healthcare industry value-chain needs to be developed and continue to expand.
Kuwait is in the midst of an exciting transition to a more open, market-driven economy. Over the last sev-eral years, the government has pushed a variety of changes that have made Kuwait a better place to do Business, including its decision to join the World Trade Organization. In fact, if present trends continue, by 2011, we believe that Kuwait may well be one of the ten best places to do business in the world. One crucial component in this program – for citizens individually and for the nation as a whole -- is the creation of a more market-driven healthcare system and knowledge based industry, the fully nationalized system that served an earlier era well is no longer suited for the complex, dynamic country that Kuwait is now becom-ing. For both economic and public health reasons, the government is Committed to a course of change that will in the end create a system that is more responsive to the health needs of Kuwaiti consumers. This transition to a market-driven healthcare system will not only be good news for Kuwaitis and the Kuwaiti Economy. For international healthcare providers and investors, the coming liberalization of the sector will mean increased access to the largest healthcare market in the Middle East, and an exciting opportunity to help millions of Kuwaitis live longer, healthier lives therefore we recommend several priority areas which need which need to be focus which are; effective healthcare leadership, promoting quality by international accreditation and patient safety, restructuring human resource management, tertiary specialized medical centers in each regional area, privatization and insurance for governmental hospitals, primary care will be under governmental regulations, improving the health information by information technology and targeting Kuwait as an international hub for medical tourism in the future.
72
The official Journal of The Kuwait Medical Association
Read...the Latest Medical Articles and Reviews
www.kma.org.kw
75
Min
ister of H
ealth
Institute of Kuw
ait M
edical Specialities
Auditing O
fficeO
ffice of the M
inisterD
epu
ty M
inister o
f Health
Medical S
upport S
ervicesT
reatment A
broadO
ffice of the D
eputy Minister
Legal Affairs
Medical C
ouncilP
ublic Relations
Finance
Adm
inistrationQ
ualityC
ontrolLegal A
ffairsP
harmacy &
F
ood Audit
Pharm
acy &
Equipm
entD
entalP
ublic Health
Support
Services
Blood B
ank &
LaboratoryP
lanningH
ealth Care
Private
Services
Accounting
Budget
Purchasing
Contracts
General
Services
Engineering
Transportation
Insurance
Office of
Public H
ealth
Prevention of R
adiation
Infection C
ontrol
Occupational M
edicine
Arabic
Health
Relations
International O
rganization
International P
artnerships &
Agreem
ents
Regional H
ealth S
ervice
Prim
ary H
ealth Care
Em
ergency
Social
Services
Rehabilitation
Nursing
Food
Dental
Services
Medical
Store
Pharm
acy
Biom
edical E
ngineering
Investigations
Birth &
Death
Registration
Registration
of Attendance
General
Ministry
Council
Accreditation
Medical
Records
Information
Technology
Health
Developm
ent
Patient
Safety
Personnel
Adm
inistration
Career
Developm
ent
Evaluation
Training
Pharm
acy Investigation
Drug
Regulation
License of D
rugs and E
quipment
Audit
Blood
Transfusion
Laboratory
Planning and M
onitoring
Healthcare M
edia C
ampaign
Medical
License
Police
Fig
ure 1. O
rgan
ization
al Stru
cture o
f the M
inistry o
f Health
, Ku
wait
76
MIN
IST
ER
OF
HE
AL
TH
Aud
iting
Offi
ce
Offi
ce o
f the
Min
iste
r
Pub
lic R
elat
ions
Offi
ce
Dep
uty
Min
iste
rM
ED
ICA
L A
FF
AIR
SD
epu
ty M
inis
ter
OP
ER
AT
ION
SD
epu
ty M
inis
ter
FIN
AN
CE
Lega
l Affa
irs O
ffice
Dep
uty
Min
iste
rP
LA
NN
ING
Dep
uty
Min
iste
rIN
FO
RM
AT
ION
M
AN
AG
EM
EN
T
Acc
ount
ing
Bud
get
Pur
chas
ing
Con
trac
ts
Insu
ranc
e
Med
ical
Cou
ncil
Med
ical
Sup
port
Ser
vice
s
Dis
aste
r M
anag
emen
t
Mat
eria
ls M
anag
emen
t
Bio
med
ical
Eng
inee
ring
Hea
lth P
olic
y D
evel
opm
ent
Pro
gram
s an
d P
roje
cts
Wor
kfor
ce P
lann
ing
Dep
uty
Min
iste
rA
DM
INIS
TR
AT
IVE
S
ER
VIC
ES
Hum
an R
esou
rce
Man
agem
ent
Gen
eral
Min
istr
y C
ounc
il
Dat
a M
anag
emen
t /H
ealth
Sta
tistic
s
Med
ical
Rec
ords
/ H
ealth
Info
rmat
ics
Birt
h &
Dea
th R
egis
trat
ion
Pub
lic H
ealth
Labo
rato
ry &
B
lood
Ban
k
Den
tal S
ervi
ces
Pha
rmac
y
Med
ical
Sup
ply
Pha
rmac
y S
tock
s
Equ
ipm
ent
Pro
ject
Man
agem
ent
Nur
sing
Reh
abili
tatio
n
Soc
ial S
ervi
ces
Ext
erna
l Affa
irs
Inte
rnat
iona
l P
artn
ersh
ips
&
Agr
eem
ents
Ara
bic
Hea
lth
Rel
atio
nsS
urve
illan
ce a
nd M
onito
ring
Pro
po
sed
Org
aniz
atio
nal
Str
uct
ure
of
the
Min
istr
y o
f H
ealt
h, K
uw
ait
Info
rmat
ion
Tec
hnol
ogy
Tre
atm
ent A
broa
dT
rain
ing
& E
duca
tion
Inst
itute
of K
uwai
tM
edic
al S
peci
aliti
es
PLA
N A
Lice
nsin
g &
Acc
redi
tatio
n
Qua
lity
Man
agem
ent
Pat
ient
Saf
ety
/R
isk
Man
agem
ent
77
MIN
IST
ER
OF
HE
AL
TH
Auditing O
ffice
Office of the M
inister
Public R
elations Office
Dep
uty M
inister
ME
DIC
AL
AF
FA
IRS
Dep
uty M
inister
OP
ER
AT
ION
SD
epu
ty Min
isterF
INA
NC
E
Legal Affairs O
ffice
Dep
uty M
inister
PL
AN
NIN
G
Dep
uty M
inister
INF
OR
MA
TIO
N
MA
NA
GE
ME
NT
Accounting
Budget
Purchasing
Contracts
Insurance
Medical C
ouncil
Medical S
upport Services
Disaster M
anagement
Materials M
anagement
Biom
edical Engineering
Health P
olicy Developm
ent
Program
s and Projects
Workforce P
lanning
Dep
uty M
inister
AD
MIN
IST
RA
TIV
E
SE
RV
ICE
S
Hum
an Resource
Managem
ent
Licensing & A
ccreditation
General M
inistry Council
Data M
anagement /
Health S
tatistics
Medical R
ecords / H
ealth Informatics
Birth &
Death R
egistration
Public H
ealth
Patient S
afety / R
isk Managem
ent
Laboratory &
Blood B
ank
Dental S
ervices
Pharm
acy
Medical S
upply
Pharm
acy Stocks
Equipm
ent
Project M
anagement
Nursing
Rehabilitation
Social S
ervices
External A
ffairs
International P
artnerships &
Agreem
ents
Arabic H
ealth R
elationsS
urveillance and Monitoring
Pro
po
sed O
rgan
ization
al Stru
cture o
f the M
inistry o
f Health
, Ku
wait
Quality M
anagement
Information T
echnology
Treatm
ent Abroad
Training &
Education
Institute of Kuw
aitM
edical Specialities
PLA
N B
78
MIN
IST
ER
OF
HE
AL
TH
Aud
iting
Offi
ce
Offi
ce o
f the
Min
iste
r
Pub
lic R
elat
ions
Offi
ce
Dep
uty
Min
iste
rM
ED
ICA
L A
FF
AIR
SD
epu
ty M
inis
ter
OP
ER
AT
ION
SD
epu
ty M
inis
ter
FIN
AN
CE
Lega
l Affa
irs O
ffice
Dep
uty
Min
iste
rP
LA
NN
ING
Dep
uty
Min
iste
rIN
FO
RM
AT
ION
M
AN
AG
EM
EN
T
Acc
ount
ing
Bud
get
Pur
chas
ing
Con
trac
ts
Insu
ranc
e
Med
ical
Cou
ncil
Med
ical
Sup
port
Ser
vice
s
Dis
aste
r M
anag
emen
t
Mat
eria
ls M
anag
emen
t
Bio
med
ical
Eng
inee
ring
Hea
lth P
olic
y D
evel
opm
ent
Pro
gram
s an
d P
roje
cts
Wor
kfor
ce P
lann
ing
Dep
uty
Min
iste
rA
DM
INIS
TR
AT
IVE
S
ER
VIC
ES
Hum
an R
esou
rce
Man
agem
ent
Gen
eral
Min
istr
y C
ounc
il
Dat
a M
anag
emen
t /H
ealth
Sta
tistic
s
Med
ical
Rec
ords
/ H
ealth
Info
rmat
ics
Birt
h &
Dea
th R
egis
trat
ion
Pub
lic H
ealth
Labo
rato
ry &
B
lood
Ban
k
Den
tal S
ervi
ces
Pha
rmac
y
Med
ical
Sup
ply
Pha
rmac
y S
tock
s
Equ
ipm
ent
Pro
ject
Man
agem
ent
Nur
sing
Reh
abili
tatio
n
Soc
ial S
ervi
ces
Ext
erna
l Affa
irs
Inte
rnat
iona
l P
artn
ersh
ips
&
Agr
eem
ents
Ara
bic
Hea
lth
Rel
atio
nsS
urve
illan
ce a
nd M
onito
ring
Pro
po
sed
Org
aniz
atio
nal
Str
uct
ure
of
the
Min
istr
y o
f H
ealt
h, K
uw
ait
Info
rmat
ion
Tec
hnol
ogy
Tre
atm
ent A
broa
dT
rain
ing
& E
duca
tion
Inst
itute
of K
uwai
tM
edic
al S
peci
aliti
es
PLA
N C
Lice
nsin
g &
Acc
redi
tatio
n
Qua
lity
Man
agem
ent
Pat
ient
Saf
ety
/R
isk
Man
agem
ent
Ass
ista
nt
Dep
uty
Min
iste
rP
LA
NN
ING
Ass
ista
nt
Dep
uty
Min
iste
rO
PE
RA
TIO
NS
Ass
ista
nt
Dep
uty
Min
iste
rF
INA
NC
E
Ass
ista
nt
Dep
uty
Min
iste
rA
DM
INIS
TR
AT
IVE
S
ER
VIC
ES
Ass
ista
nt
Dep
uty
Min
iste
rM
ED
ICA
L A
FF
AIR
S
Ass
ista
nt
Dep
uty
Min
iste
rIN
FO
RM
AT
ION
MA
NA
GE
ME
NT
79
MIN
IST
ER
OF
HE
AL
TH
Auditing O
ffice
Office of the M
inister
Public R
elations Office
Dep
uty M
inister
ME
DIC
AL
AF
FA
IRS
Dep
uty M
inister
OP
ER
AT
ION
SD
epu
ty Min
isterF
INA
NC
E
Legal Affairs O
ffice
Dep
uty M
inister
PL
AN
NIN
G
Dep
uty M
inister
INF
OR
MA
TIO
N
MA
NA
GE
ME
NT
Accounting
Budget
Purchasing
Contracts
Insurance
Medical C
ouncil
Medical S
upport Services
Disaster M
anagement
Materials M
anagement
Biom
edical Engineering
Health P
olicy Developm
ent
Program
s and Projects
Workforce P
lanning
Dep
uty M
inister
AD
MIN
IST
RA
TIV
E
SE
RV
ICE
S
Hum
an Resource
Managem
ent
General M
inistry Council
Data M
anagement /
Health S
tatistics
Medical R
ecords / H
ealth Informatics
Birth &
Death R
egistration
Public H
ealth
Laboratory &
Blood B
ank
Dental S
ervices
Pharm
acy
Medical S
upply
Pharm
acy Stocks
Equipm
ent
Project M
anagement
Nursing
Rehabilitation
Social S
ervices
External A
ffairs
International P
artnerships &
Agreem
ents
Arabic H
ealth R
elationsS
urveillance and Monitoring
Pro
po
sed O
rgan
ization
al Stru
cture o
f the M
inistry o
f Health
, Ku
wait
Information T
echnology
Treatm
ent Abroad
Training &
Education
Institute of Kuw
aitM
edical Specialities
PLA
N D
Licensing & A
ccreditation
Quality M
anagement
Patient S
afety /R
isk Managem
ent
Assistan
t Dep
uty M
inister
PL
AN
NIN
GA
ssistant D
epu
ty Min
isterO
PE
RA
TIO
NS
Assistan
t Dep
uty M
inister
FIN
AN
CE
Assistan
t Dep
uty M
inister
AD
MIN
IST
RA
TIV
E
SE
RV
ICE
S
Assistan
t Dep
uty M
inister
ME
DIC
AL
AF
FA
IRS
Assistan
t Dep
uty M
inister
INF
OR
MA
TIO
N
MA
NA
GE
ME
NT
80
Expectations to Success...
Tel: 1828000
www.
desig
nmas
tere
vent
s.co
m
www.designmasterevents.com
Services OfferedOur experience as conference organizers has helped us achieve international stand-ards. We have our own in house graphic & web design studio and experienced AV and technical staff. This allows us to offer you a comprehensive package and ensures that you get the best quality of client service. Our unique range of confer-ence services includes but not limited to:
Accounting & Financial Management•Logistics Management•Marketing & Communication•Venue Selection•Venue Management•Online & Onsite Registration Management•Magazine Composition, •Design & Printing•Certificates Printing & Distribution•ID Cards Design, Printing, Scanning and Attendance Management•Speakers & Content Management•
/
/
–
)(
/
82
/
/
–
)(
/
83
/
/
–
)(
/
84
/
/
–
)(
/
85
)1(
–
)
(
86
:
87
KuwaitHealthReform
2009
اخلامتة
مع تزايد قوة الطلب على جودة الرعاية الصحية ومع تزايد توقعات العامة فإنه من الضروري القيام بتطوير سلسلة األنشطة اخلاصة بصناعة الرعاية الصحية واالستمرار في توسيعها.
إن الكويت تعتبر في وسط مرحلة انتقالية مثيرة تؤدي إلى اقتصاد مفتوح يحركه السوق بشكل كبير وعلى مدى باألعمال ويشمل للقيام أفضل الكويت مكانا تعديالت عديدة جعلت من األخيرة قامت احلكومة بعمل السنوات ذلك قرار احلكومة باالنضمام إلى منظمة التجارة العاملية وفي احلقيقة إذا استمرت التوجهات احلالية فإننا نعتقد أنه بحلول عام 2011 قد تكون الكويت واحدة من أفضل عشر أماكن في العالم كله للقيام بتأدية األعمال فيها. إن الصحية للرعاية إيجاد نظام وبالنسبة لألمة كلها, هو للمواطنني كأفراد البرنامج, بالنسبة الهام في هذا اجلزء يعتمد على قوة السوق ويعتمد وعلى صناعة مؤسسة على املعرفة. إن نظام التأميم الكامل الذي كان في اخلدمة في مرحلة سابقة لم يعد مناسبا لبلد ديناميكي متشابك وهو ما أصبحت عليه الكويت اآلن. إن احلكومة ملتزمة إيجاد نظام يعتبر أكثر جتاوبا مع االحتياجات الصحية للمستهلكني إلى النهاية مبنهاج للتغير سوف يفضي في صحية رعاية لنظام االنتقال هذا العامة. إن بالصحة متعلقة وأسباب اقتصادية ألسباب ذلك ويرجع الكويتيني إلى الكويتي. وبالنسبة لالقتصاد أيضا ولكن للكويتيني جيدة أخبار أنه فقط يعتبر لن السوق قوة على يعتمد مقدمي الرعاية الصحية الدوليني وكذلك املستثمرين فإن التحرير اآلتي للقطاع سوف يعني فرصة متزايدة للدخول لسوق الرعاية الصحية الكبير في الشرق األوسط وفرصة مثيرة ملساعدة ماليني من الكويتيني للعيش لفترة أطول وهي: القيادة عليها التركيز إلى حتتاج والتي لألولويات متعددة مبجاالت نوصي فإننا أكثر صحة, ولذلك حياة في الفعالة للرعاية الصحية وتطوير اجلودة من خالل االعتراف الدولي وسالمة املرضى وإعادة هيكلة إدارة املوارد البشرية الرعاية وتكون احلكومية املستشفيات وتأمني وخصخصة منطقة في كل والفرعية املتخصصة الطبية واملراكز تتحمله الذي العبء من للتقليل ذلك و األولية الرعاية بنظام اإلهتمام تركيز و احلكومية النظم مبوجب األولية
املستشفيات و األهم من ذلك املبادرة ببرنامج الوقاية و احلماية من املرض.
نوصي بتشكيل وكالة تنظيمية لإلشراف على مدى جودة النظام الصحي و مخرجاته. وحتسني املعلومات الصحية في الدولية الطبية للسياحة محورا الكويت تصبح أن هو الهدف يكون بحيث املعلومات تكنولوجيا خالل من
املستقبل.
88
KuwaitHealthReform
2009الوضع احلالي واملشكلة احللول مجاالت التحسن والعمل
التوقعات العامة والسكانية
توجد توقعات عالية جدا بني العامة املتعلمني للحصول على خدمات
ذات جودة عالية تكون متوافرة وميكن احلصول عليها في أماكن معيشتهم
وتوفر لهم جميع اخلدمات التي يحتاجون إليها (مثال مدى من اخلدمات التي ميكن تسميتها
باخلدمات الفرعية ويتم توفيرها في مراكز الرعاية األولية) وتلك حتديات
كبيرة لصانعي السياسة الصحية.
ال توجد طرق ذات كفاءة لتعليم العامة أو حتى الهيئات الطبية / وهيئات طب األسنان فيما يتعلق بالوقاية من املرض والتواصل بني
الطبيب واملريض والقوانني الطبية واألخالقية والتزامات وحقوق كل من
املرضى واألطباء.
من املفترض أن سكان الكويت فوق سن الستون عاما سوف يتزايدون
ليصلوا إلى نسبة %8 من السكان وذلك بحلول عام 2030 وإلى
نسبة %25 بحلول عام 2050 ولذلك فإن انتشار األمراض املزمنة سوف يكون متزايدا وبصفة خاصة السرطانات وأمراض القلب والتاجي القلب, (الذبحة, احتشاء عضلة
ضربات القلب غير املنتظمة, والسكتة القلبية)
يجب تركيز األولويات على خفض سوء الصحة وعبء األمراض وذلك من خالل البرامج التي تؤمن صحة جميع
السكان وهذا ال ميكن حتقيقه بدون حتويل املوارد من األنشطة العالجية
إلى أنشطة الصحة العامة ويشمل ذلك الوقاية من األمراض املزمنة
وتخفيض مخاطر الصحة السيئة.
تشغيل أفضل للمستشفيات برامج جديدة وخدمات خاصة بالتعيينات اجلديدة واستبقاء أفضل العاملني. مراقبة البيانات من أجل مصلحة
املريض.تأسيس بيانات خاصة باألداء ودفع
املؤسسات إلجراءات اختبارات مرجعية لألداء.
بناء مستشفيات ذات تصميم جديد ونحن نوصي ببناء مستشفيات
جديدة ذات معايير دولية وجودة عالية من الفن املعماري بحيث ميكن أن
تستمر لسنوات كثيرة وتعتبر عامل جذب للسياحة الطبية.
89
KuwaitHealthReform
2009الوضع احلالي واملشكلة احللول مجاالت التحسن والعمل
تظهر التقديرات احلديثة وجود زيادة الصندوق املاليفي فائض امليزانية للكويت وذلك
في العام املالي 2007 – 2008 إلى رقم ضخم يبغ 6.3 بليون دينار
كويتي, ويتجاوب الكويتيون مع املطالب اجلديدة اخلاصة بإيجاد نظام
صحي أفضل وحتسني البنية التحتية واملتهالكة باستخدام تلك امليزانية
الضخمة.
إن وزارة الصحة يجب عليها أن تدفع أي ديون في مدى العامني - 4 أعوام
القادمة ذلك ألن التقارير الواردة من اجلهات العليا قد أوضحت أن مكتب الكويت الصحي في لندن باململكة
املتحدة يعاني من دين مالي يقدر مببلغ 866.400 دينار كويتي.
إن نفقات وزارة الصحة بالنسبة للناجت القومي العام كانت 2.1%
في عام 2001, بينما كانت امليزانية السنوية لوزارة الصحة بحسب كل فرد هي مبعدل 463 دوالر أمريكي, وكانت النفقات الصحية الوطنية للفرد الواحد 578 دوالر أمريكي,
ومع ذلك فإن النفقات اإلجمالية على الصحة كنسبة من اإلنتاج احمللي
العام كان 3.5. وكانت النفقات الصحية اخلاصة التي تصرف على الصحة تبلغ %21.2 من إجمالي
النفقات الصحية وهذا يعطى اقتصاد صحي مختلط بنسبة
النفقات 80:20 عام/خاص. إن اخلاصة هي بصفة أساسية نفقات
خاصة من اجليب وسوف تستمر تكاليف العالج في االرتفاع. إن
القيام بدفع تكاليف الرعاية حلاالت مزمنة أصبح صعب اآلن ومن
احملتمل أن يصبح أكثر سوءا فمثال إن النفقات املتعلقة بأمراض القلب
واألوعية الدموية قد أصبحت مرتفعة بالفعل في هذه األيام ومن املتوقع أن تزداد بسرعة لكي تصل إلى حوالي خمس نفقات الرعاية
الصحية وذلك بحلول عام 2016. وجند أيضا أن التطورات احلديثة
في الطب جتلب تزايدا مستمرا في العالجات املعقدة وباهظة الثمن مع
املزيد من السفر على نطاق واسع.
ونتيجة لذلك فمن املتوقع أن تتصاعد نفقات الرعاية الصحية في
الكويت بشكل سريع جدا.
يجب تأسيس كيان حكومي جديد, املؤسسة العامة للمستشفيات وتكون منفصلة عن وزارة الصحة
ويتم نقل كل مخصصات مستشفيات وزارة الصحة إلى تلك
املؤسسة اجلديدة وذلك لتمهيد الطريق للشراكة املتزايدة بني القطاع
العام واخلاص في توفير الرعاية الصحية.
حتويل النظام إلى اخلصخصة ونظام التأمينات االجتماعية.
يجب تأسيس صندوق مالي للصحة الوطنية بإشراف وزارة املالية ويكون
مستقال عن وزارة الصحة وذلك للقيام بتمويل, بشكل مباشر,
خدمات الرعاية الصحية املقدمة للمرضى. وسوف تستغرق املرحلة األولى لهذه البرنامج ثالث سنوات
وسوف تركز على حتديث البنية التحتية الشاملة لتكنولوجيا
املعلومات احلكومية وتأسيس إطار جديد منظم للرعاية الصحية.
90
KuwaitHealthReform
2009الوضع احلالي واملشكلة احللول مجاالت التحسن والعمل
وصف مهام العمل والترقيات
االستثمار في اجليل القادم من املهنيني في
الرعاية الصحية
التأمني الصحي
اخلصخصة واالستثمار
يجب إعادة تصميم أعمال معينة في قطاع الرعاية الصحية ويتم
إضافة البعض أو حذف بعض األعمال وذلك طبقا الحتياجات
السوق في املنطقة.ينتقل الكويتيون العاملون في
احلقل الطبي إلى البالد األخرى وذلك للحصول على دخل أفضل
يوجد حاليا 300 كويتي في بعثات طبية وهذا شيء جيد.
يوجد نقص في الكويتيني العاملني في مهنة التمريض وكذلك في
املهنيني اآلخرين العاملني في العلوم املرتبطة واخلدمات املساندة للرعاية
الصحية
عدم كفاءة وعدم املساواة في نظام التأمني الصحي بني كل من املواطنني
وغير املواطنني.
عدم القدرة على تخفيض ميزانية الصحة وذلك بإشراك شركات
التأمني اخلاصة.
عدم القدرة على تنفيذ النظم وذلك بسبب نقص الهيئات الرقابية.
توجد حاجة للشراكة بني القطاع العام والقطاع اخلاص.
إن حقيقة أن العبء املالي على الوزارة سوف يزداد بحيث يصل إلى مرحلة لن تستطيع الوزارة حينها
أن تالحق النمو السكاني والتكلفة املتزايدة للرعاية الصحية واألدوية
اجلديدة ومعدات التكنولوجيا الراقية.
يوجد حترك جيد للمستشفيات اخلاصة التي حصلت على االعتماد
لتقدمي رعاية أفضل.
إعادة تصميم معايير الترقية ومهام العمل في الفئات اخملتلفة وذلك طبقا ملا يجري
في البالد اجملاورة مثل اململكة العربية السعودية ودولة اإلمارات العربية املتحدة.
القيام مبراجعة األعمال اإلدارية التي تشكل عبئا كبيرا على ميزانية وزارة الصحة
واالستغناء عن األعمال غير املطلوبة وإتباع أفضل األساليب املعروفة في سوق الرعاية
الصحية.
إن حتسني تشغيل املستشفيات وكذلك جودة العمل واحلوافز سوف يستبقى األفراد
احملليني.
افتتاح مدارس متريض خاصة بوزارة الصحة ومدارس طبية مرتبطة مبراكز فرعية
للكويتيني ولغير الكويتيني وذلك مبشاركة اجلامعات الدولية ذات املستوى العاملي
لتخريج خريجني ذوي مستوى عالي وتوفير التكلفة وتأسيس سمعة جيدة.
عمل الدراسات اخلاصة بالصحة احمللية (National Health Accounts) جلمع
البيانات الالزمة و ذلك للتمويل و التخطيط للمدى البعيد.
و توصي معظم الدول التي متتلك أفضل اإلجراءات و النتائج الصحية بالتأمني
Social Health) الصحي اإلجتماعيتأسيس صندوق Insurance) عن طريق مالي للصحة الوطنية وهو منفصل عن
وزارة الصحة وذلك لتمويل خدمات الرعاية الصحية بشكل مباشر .
خصخصة املستشفيات احلكومية بحيث يتم اعتماد املستشفيات الكبيرة بحلول
عام 2010 – 2011.
تطوير بيئة العمل التي سوف جتعل الكويت مقصدا يتمتع بجاذبية أكبر مبقدمي
الرعاية الصحية اخلاصة.
جذب املستثمرين والشركاء اآلخرين إلى أكبر سوق في الشرق األوسط للرعاية الصحية, ومن الواضح ضرورة احلصول
على مقدمي الرعاية الصحية ومنتجي الصيدالنيات واملؤن الطبية, إن أكبر سوق
في الشرق األوسط ملستهلكي الرعاية الصحية سوف يصبح متاحا بشكل متزايد
لالستثمار اخلاص.
91
KuwaitHealthReform
2009الوضع احلالي واملشكلة احللول مجاالت التحسن والعمل
اجلودة والسالمة
تكنولوجيا املعلومات
العالج في اخلارج
مت االعتراف بعدد قليل فقط من املستشفيات اخلاصة.
لم يتم االعتراف بأي مستشفى حكومي.
كانت آخر مستشفى حكومية قد مت بناؤها في عام 1981 ولذلك فإن
البنية التحتية غير مالئمة لسالمة وجودة الرعاية املقدمة للمرضى.
تزداد األخطاء الطبية باطراد وذلك يرجع إلى نقص املعايير.
الرعاية الفرعية: فترات انتظار طويلة في املستشفيات العامة, نقص
في عدد األسرة, حاالت متزايدة من األمراض املزمنة وتدهور جودة الرعاية
في بعض املناطق.
ال تزال وزارة الصحة وكذلك املستشفيات احلكومية األساليب اليدوية وهذا يؤدي إلى معدل عالي من األخطاء والتأخير في العمليات
اخملتلفة
يعتبر عبء مالي كبير على احلكومة.
ذو تكلفة عالية.
ال توجد بيانات لتقييم املردود.
يزيد من الديون.
يوجد نقص في ثقة اجملتمع نحو املستشفيات احمللية وذلك بسبب
سوء الرعاية وسوء البنية التحتية.
يجب البدء بعملية االعتراف الدولي لألعوام 2009 – 2011 لتشمل
جميع املستشفيات احلكومية وذلك إليجاد بنية حتتية صلبة إلطار من
املعايير تلتزم به الهيئة العاملة متعددة اجلنسيات.
بناء مستشفيات جديدة على أحدث طراز من أجل جذب اجلمهور ومن أجل
السياحة الطبية.
البدء في برامج إدارة اخملاطر وبرامج السالمة املتعلقة باملرضى.
إيجاد الفرص ملستشفيات متعددة التخصصات واملراكز املتخصصة ذات االمتياز والتي تتضمن مجمع
للتخصصات مثل طب األورام, وزراعة األعضاء,تطور خطط قطاع الرعاية
الصحية في الكويت.
إن االستثمار في اجلودة سوف يخفض من تكاليف الوحدة على املدى
املتوسط وعلى املدى الطويل وسوف يزيد من درجة الرضا لدى املريض
واجلمهور واملهنيني.
القيام بدراسة ملراجعة املعلومات الصحية احلالية وتأسيس النظام
اآللي ونظام تكنولوجيا املعلومات في العمل في الرعاية الصحية.
استخدام نظام التواجد عن بعد والنظام اآللي في املستشفيات
اخملتلفة بحيث يقوم بدور االستشاري والزيارات الدورية لألطباء حيث ميكن
أن يتواجد, في املوقع, أفضل خبراء العالم في الطب من جميع أنحاء
العالم على مدى 24 ساعة وملدة 7 أيام وخذا سوف يخفض بشكل واضح
من تكلفة العالج باخلارج.
استخدام تكنولوجيا التحكم عن بعد.
استخدام نظام عقد املؤمترات عن بعد بالفيديو.
إقامة شراكة مع املعاهد الدولية املشهورة على نطاق العالم
92
KuwaitHealthReform
2009الوضع احلالي واملشكلة احللول مجاالت التحسن والعمل
الهيكل التنظيمي لوزارة الصحة
مهارات القيادة واإلدارة
قناة االتصال بني القيادات من املستشفى
إلى الوزير
الهيكل التنظيمي للمستشفى
إجراءات األداء في وزارة الصحة واملستشفيات
تشغيل املستشفى
هيكل تنظيمي قدمي يرجع تاريخه إلى عام 1980 وال يتناسب مع نظام
الرعاية الصحة احلالي في عصرنا هذا
القيادات تطوير في 1- نقص نوعية إلى تؤدي 2- البيروقراطية
سيئة من توصيل الرعاية إلى املرضى
استخدامها بشكل يتم 3- املوارد غير مناسب
النظام ربط جودة يتم 4- دائما الصحي بقيادته وبقدرة اإلدارة
على توصيل اخلدمات التي تلبي احتياجات
املتوفرة املوارد وتستخدم السكان بأكثر الطرف توفيرا للنفقات
يوجد طبقات متعددة من اإلدارة في وزارة الصحة
للمناطق 6 مدراء وزارة مساعد 13 وكيل
وزارة 1 وكيل
ال يوجد هيكل تنظيمي معياري حديت للمستشفيات
توجد بيانات جيدة ولكن يتم جمعها يدويا.
ال يوجد اختبار مرجعي لألداء بني املستشفيات.
يوجد لدى مدراء املستشفى نقص في التفويض املتعلق بالنواحي املالية
وامليزانية
اقتراح هيكل تنظيمي جديد لوزارة الصحة
القيادات تطوير 1- تشجيع مدراء القادة من على 2- التعرف
املستشفيات املاجستير لدرجة دراسية 3- بعثات
في إدارة الرعاية الصحية
هيكل االتصال املقترح: (انظر املرفق)وزارة في 6 وكالء -1 تضمني
املصنفات اخملتلفة.الوزارة وكالء وظيفة -2 تلغى
املساعدين. املنطقة مدير -3 يلغى منصب
تابعني املستشفيات مدراء -4 يكون بشكل مباشر لوكيل الوزارة
اقتراح مبعيار جديد للهيكل التنظيمي للمستشفيات (انظر
املرفق)
استخدام التطبيقات احلديثة لتكنولوجيا العمل, وبطاقات ولوحات
الدرجات املتوازنة لتقييم األداء وذلك لتسهيل التنفيذ االستراتيجي
واختيار املؤشرات الصحيحة واالختبارات املرجعة لألداء.
يجب أن يكون لدي كل مستشفى امليزانية اخلاصة بها ومراكز التكلفة,
وباإلضافة إلى ذلك يجب أن يكون لدى مدير املستشفى ومجلس املستشفى
حتكم مستقل على ميزانية املستشفى السنوية والتشغيل
والتعيينات.
93
KuwaitHealthReform
2009
2009 الكويت في الصحة إصالح
ملخص إجرائي
من احملتمل أن تواجه الكويت, على مدى السنوات القادمة, زيادة حادة في احتياجاتها للرعاية الصحية. ويعتقد معظم املراقبني أن النمو السكاني, في مجتمع يشيخ ببطء, وكذلك احلاالت التي تساهم رفاهية العيش كثيرا في تفاقمها مثل أمراض السمنة والسكري وأمراض القلب واألوعية الدموية وكذلك السرطان سوف تخلق طلبا جديدا وكبيرا على خدمات الرعاية الصحية. حتتل الكويت املرتبة الثامنة على مستوى العالم من حيث معدالت البدانة و السمنة، متقدمة في ذلك على الواليات املتحدة و تأتي مباشرة بعد مجموعة جزر جنوب الباسفيكي و التي يعاني سكانها
.احملليون من هذا املرض
وكذلك الصحية الرعاية مال برأس املتعلق الطلب معظم بتمويل الكويت حكومة تقوم احلالي الوقت وفي الطلب. بهذا الوفاء في االستمرار لن تستطيع وحدها احلكومة أن احملللون يعتقد ذلك التشغيلية, ومع النفقات وتوصل احملللون إلى الرأي القائل بأن الطريقة الوحيدة لضمان تلبية احتياجات الرعاية الصحية للمواطنني في الكويت, بدون إحداث تأثير معاكس في تقدم االقتصاد, هو زيادة مشاركة القطاع اخلاص في نظام الرعاية الصحية. إن الطريقة املثلى لتوفير املعرفة الطبية ذات املستوى العاملي ومهارات اإلدارة ورأس املال لذلك القطاع هو جذب شركاء من القطاع اخلاص ألنهم في استطاعتهم حتقيق ذلك وسوف يتمكنون من حتقيق جودة عالية للرعاية للصحية وجعلها متوفرة
.لكل شخص في اجملتمع الكويتي
برنامجها املستهدفة في الرئيسية القطاعات الصحية كأحد الرعاية واعتبرت املوقف احلكومة هذا أدركت ولقد الرعاية الصحية ذات اجلودة قوي ومتزايد. إن الطلب على أن الدراسة احلالية تبني املدى املتسع. إن ذو للخصخصة نفقات الرعاية الصحية تتزايد بشكل مضطرد وزائد عن احلد ولكن بدون نتائج ذات مغزى فهناك سوء توزيع للرعاية ويبحث املرضى عن العالج في اخلارج ولم يتم استخدام موارد القطاع اخلاص بشكل تام ذلك ألن احلوافز والسياسةالرعاية الصحية في تزايد مستمر ولكن جودة والهيكلة ليست متوازية مع احتياجات القطاع اخلاص. إن تكاليف اجملال املهنيني في األفراد احلاد في النقص أن التحسني. وجند إلى يحتاجان اخلدمة تلك تغطيه الذي واملدى اخلدمة الصحي املؤهلني (واملعتمدين) يحد من التوسع في هذا القطاع وكذلك جند أن نقص مهارات القيادة في الوظائف اإلدارية قد أدى إلى فساد مستمر في إدارة صناعة الرعاية الصحية وجند أن درجة التطور العلمي والتكنولوجي في
.أنظمة تكنولوجيا املعلومات الصحية قد تدنت
94
www.kma.org.kw
Board MembersPRESIDENT:Dr. Ali Al Mukaimi MBBS, MD, German BoardConsultant – Orthopaedics
VICE PRESIDENT:Dr. Ahmad Al FadhliHead-Burns and Plastic Surgery, Al Babtain Center, Kuwait
TREASURER:Dr Nasser Bader Al HumaidiGeneral Surgery , Farwaniya Hospital
MEMBER:Dr. Noura Al Sweih
GENERAL SECRETARY:Dr. Mohammed ShamsahAnesthesia, Intensive Care and Pain Management Consultant
MEMBER:Dr. Homoud F. Al-Zuabi
Part
icip
ants
Ackn
ow
ledgm
ent &
Part
icip
ants
Ackn
ow
ledgm
ent
P.O.Box: 867, Safat 13009, KuwaitBlock: E- 67, Future Zone, Shuwaikh, Kuwait
Tel: +965 24610480/1/2/3/4/5/6/7 Ext. 450, Fax: +965 24610488/9
www.badersultan.com
Serving Health Care Industry Since 1965
Hope you had a wonderful time in Kuwait...We wish to see you soon...
www.healthreform2009.com
Changing Tomorrow
Des
ign
& P
rodu
ced
by:
Des
ign
Mas
ter