By Neil King
Dr Azad Moopen, MD and chairman of Aster DM Healthcare, discusses the rapid changes to the UAE’s healthcare industry, the challenges and opportunities it has brought, and what the future holds for healthcare providers.
It’s hard to avoid the seeming omnipresence of Aster DM Healthcare.
Whether you’re in one of the many Aster pharmacies, seeing your doctor in one of its clinics, or being treated at one of the Aster or Medcare hospitals, you can’t fail to appreciate the coverage the group has established.
Present primarily in the UAE, but also in India, Saudi Arabia, Qatar, Bahrain, Oman and Jordan — with plans to enter the Philippines soon — the healthcare conglomerate is one of the most used and recognisable providers in the region.
None of which should be a surprise given its history.
Established in 1987 by managing director and chairman Dr Azad Moopen — a Kerala native — the company has expanded from a collection of small clinics to an expansive empire, comprising not only the aforementioned clinics, hospitals and pharmacies, but also research facilities, educational institutions, beauty clinics, and more.
Now the group employs more than 13,500, including 1,500 doctors, and provides 4,000 patient beds across 16 hospitals.
And things just keep growing. In 2013 the company allocated $600m to a five-year expansion programme — a project that is already bearing fruit with a number of new hospitals expected to open in the new year.
The same figure — $600m — was recorded by the company in revenues for 2014, up from $500m in 2012, with as much as 90 percent of that coming from its operations in the GCC region.
Then there’s the small matter of the IPO which has been on the horizon for sometime but yet to be finalised; a topic which is sadly, but perhaps understandably, off the table when I meet Dr Moopen at his spacious Business Bay office.
Having been in the region for almost 30 years, Dr Moopen has seen it all. The rapid development of the UAE’s healthcare industry is hard to put into a nutshell, but the chairman boils it down to one word: “Phenomenal”.
He says: “When I came here in 1987 it was nothing, just a few government hospitals and very few private doctors. I was one among them, a doctor who started my own clinic.
“People were depending very much on the government hospitals, which were very few, and there were very few government clinics too. Now, the situation has completely transformed, especially in the last 10 years. There’s been huge growth in the private sector, from hospitals to clinics, doctors, and pharmacies, there has been a significant increase in the private sector.
“So the private sector, with the help of the Dubai Government, and as a planned procedure, is having a significant role being carved out for them, and the government wants it that way. They don’t want a monopoly of government hospitals, where personalised care is a casualty. They want private hospitals which are much more personalised.”
It’s a landscape that continues to change, develop and grow, with a number of players vying for prominence in a marketplace which has become a magnet of practitioners of all types.
The numerous changes across the industry have led to many benefits, but have also provided a series of challenges, hurdles, and talking points.
The primary of which, according to Dr Moopen, is insurance.
“The problem was always the cost,” he explains.
“When you had government hospitals, they were mostly subsidised, people did not have any concerns about the payment. But when more private hospitals came in, naturally it became very expensive.
“Many people found it extremely difficult, and many times found it inaccessible. People found it very hard to pay medical bills, and insurance coverage wasn’t too great. There was some coverage in some areas but it was not very good.
“About five or six years back Abu Dhabi started universal coverage of all expats, and the local population. They were all brought under insurance. Dubai started this last year, and some amount of the population is already covered.
“By the end of 2016 they hope that all the people, both locals and expats, will be covered. So that has taken the care of the cost aspect of healthcare, and it is coming from the employers.”
In 2014 the Dubai Health Authority announced plans to ensure everybody in the emirate has mandatory health insurance by mid-2016, with the responsibility of providing insurance cover for employees falling on the employer.
Nearly two million additional people are expected to be covered as a result.
For Dr Moopen, the compulsory health insurance law is the right move by the Dubai government.
“I think that is the right thing to do,” he continues.
“If you can spend AED10,000 for getting a person’s visa and getting it stamped, an extra maybe AED1,500 or AED2,000 for that person’s healthcare is something I think all employers should be taking care of.
“Across the Middle East healthcare is going through a phase where most places will be covered by insurance. This will have a significant impact in the delivery of healthcare, and also opportunities for healthcare institutions, both government and private.
“We see significant opportunities in these places where insurance is coming into place.”
These opportunities will increase across the industry, according to Dr Moopen, who expects to see many more people coming through the doors of clinics and hospitals.
“It starts from primary care,” he explains.
“This is the type of care that will be most stretched, as there is a requirement for people to meet their doctor with either a minor or major ailment. Only rarely will they get admitted to hospital.
“We are quite strong here because we have a large number of clinics. Unlike other players in the sector who are looking at hospitals alone, we have from the very beginning met a continuum of care - starting with primary care, which are the clinics, closer to the people, and providing whatever is possible without admitting a patient.
“So we are well placed to welcome more people to the clinics, which are of different types: Neighbourhood family clinics, larger clinics, and medical centres.
“Beyond that people can go to the hospitals, and again we are well positioned here, and of course we have the pharmacies. So we have a continuum of care covering all parts of the process, meaning we are in a good position to take advantage of the new opportunities.
“We are present and strong in all areas.”
Another challenge highlighted by Dr Moopen is that of technology: Specifically IT and the digitisation of data.
He says: “There are major challenges here, and there is definitely a requirement for people in the industry to be aware of the technologies that are coming up.
“We need to look at the way insurance companies, government departments, statutory regulators, and others, are expecting information to be conveyed to them. Many clinics or hospitals don’t have a great capability to give information in a digital format, and I want to stress the importance of this: The importance of everybody looking at digitalisation of their data.
“It’s easier when it comes to the accounting of a medical bill, and things like that, but it becomes difficult when it comes to the electronic medical reports where you are writing the patient’s history, complaints, medical findings, and so on.
“Nobody has perfected how this can be assimilated and transmitted, so there are many gaps in that area and it is very important that people look at this.”
Moving away from technology, Dr Moopen adds to his list of industry hurdles by highlighting the challenge of hiring employees.
“You can build a physical infrastructure if you have the financial resources, but getting the human resources to fill the buildings is very difficult,” he points out.
“This is a major challenge as we go forward. We have a significant issue in getting people into employment.
“I find it very difficult getting people from many countries that we used to get doctors, nurses and so on, because the salary scales and the earnings of this particular profession has increased in such countries.
“So they’re not willing to come and work for what we are used to paying.”
He explains that source countries such as India used to provide Aster DM Healthcare with good quality nurses, lab technicians, pharmacists, and other technically qualified people, but that it’s now harder to convince them to relocate to the UAE, given the increase of their salaries at home.
“So we’re looking elsewhere,” he continues.
“There is now a major focus on the Philippines; we get a lot of good quality nurses from there. We’re also looking at some of the African countries where you get a good quality of medical professionals. Egypt is very good. One are that has opened up which is very unfortunate for that country, but beneficial for the UAE is Syria. A lot of people, due to the issues there, want to come to a safer country, so a lot of people are coming from there.”
Challenges aside, Aster DM Healthcare is making significant strides in terms of growth with a number new hospital projects underway in the Gulf, and plans for more clinics and pharmacies.
These include a Aster hospital in Mankhool, Bur Dubai, and a Medcare hospital on Sheikh Zayed Road, Dubai, which will be exclusively for women and children, and is expected to be finished by Q1 2016.
Another Medcare hospital in Sharjah is also scheduled to open in the early months of 2016, while two further Aster hospitals in Abu Dhabi and the Al Qusais area of Dubai are expected to be completed towards the end of 2016.
Outside the UAE, another Aster hospital project has been launched in Doha, Qatar, due to open in early 2016.
This comes on the back of an extra 52 pharmacies and nine clinics which have been established across the company’s footprint this year — part of a drive to boost the number of its units to more than 300 by 2017.
“We have significant plans,” says Dr Moopen.
“We have been growing very nicely in revenues and profits, and the reason has been the expansion of the network.
“We believe that any organisation has limits to its growth, like a human being. When you are a child you grow very well, but as you become older, the growth comes down, and maybe leads to de-growth. So if you are just focussing on a few hospitals, clinics and pharmacies, there will be no growth after some time.
“So you have to keep expanding if you are to grow. We have had expanded a lot over the past seven to eight years, and now have 260 pharmacies, clinics and hospitals. That is the reason for our growth in revenues and profits.
“We believe very strongly that there has to be growth and there has to be a pipeline of growth, and we have to continue this.”
Turning his attention to the future of the industry in general, Dr Moopen highlights three areas in which he foresees great development.
The first of this is the digital arena: “I believe healthcare will follow other industries and become much more digital,” he points out.
“We all used to go to the bank to withdraw money. It wasn’t long ago, but now nobody goes. It’s all done on the internet or mobile. The same with air travel; we used to go to the agent, but now we just sit at home and do it from there.
“Healthcare hasn’t caught up yet. It’s the same old way of meeting your doctor, going to the clinic, and so on.
“But it’s only a matter of time until healthcare is commoditised to a great extent. That’s a fact we have to accept.”
Outlining possible ways this digital shift will manifest, he says: “Many things can happen over the internet. There are ways to measure people’s blood pressure, heart rate, and basic investigations like blood sugar, and cholesterol at home. And there are methods by which you can get the information to a doctor.
"Then the doctor can send a diagnosis to your phone, send your prescriptions to pharmacy, and have it delivered to your door. It’s possible for patients to use monitors on himself, and methods for the caregiver to track everything. A lot can be done without physical contact with the doctor, or visits to the hospital.”
The chairman explains that Aster DM Healthcare is currently engaged in a pilot project with telecoms operator du, whereby Aster provides equipment, and du provides the technology to offer remote consultations.
He says: “Information is uploaded and our doctors will assess the data and provide the advice. So this is something that is actually happening; it’s not theory.
“With mobile phones and apps you don’t have to be very tech literate to make use of them. You can have simple things such as an app to help you stick to a schedule of taking medicine. If you’re getting an alert to remind you of it, this will help you a lot in getting cured.
“Technology, especially with mobiles, is going to have a significant impact on healthcare delivery.”
Another big development on the horizon could be the role of alternative medicine, says Dr Moopen.
“Definitely there is a role for many other systems,” he says.
“It’s not that modern medicine, what we call allopathic medicine, is the last word in everything. In some cases we raise our hands and say we can’t do anything further, and we find that other systems can work instead.
“By and large, a major portion of either preventative or curative medicine is modern medicine, and that is what’s most prominent, but I do personally believe there is a role for other systems to play.”
Citing a number of alternative treatments from around the world, Dr Moopen adds that the future of medicine could involve practitioners with more holistic approaches.
“In India you have Ayurveda, or you have homeopathy which comes from Germany, or you have the Chinese medicine which is another very important system.
“I think that the important thing is to decide what is appropriate for each person. What is sadly lacking is that if somebody has a serious problem and they need surgery, but that system doesn’t believe in surgery, it could be a calamity that after six months when he comes back it’s an inoperable situation. Or vice versa - when it comes to a situation that could have been solved with a non-surgical treatment.
“I believe there is a requirement for some mechanism in which somebody who has a holistic view decides that for this particular person, at this particular point of time it is better to go for this. This is the ideal utopia.
“Unfortunately now the system in most countries is that you directly go to a specialist. You have a small headache that could be treated with paracetamol, but you go to a neurologist and he will do all these tests that aren’t required. So the whole system is getting confused, and getting skewed because people want to go to the most senior person in a hospital, or in a specialism or in illness.”
In a bid to establish a more holistic approach, the chairman explains that the Aster Medcity facility in Kochi, India, is looking at ways to align different systems of medicine for the benefit of patients.
“Aster Medcity is going to be a referral centre for many of the institutions in the region,” says Dr Moopen.
“We have everything there, including robotic surgery as well as an alternate medical centre. We have already gone into partnership with a number of players and work with Ayurveda treatments has started immediately.
“So if they come there and we feel that there are certain illnesses where they could support, we look at how we could work together. Many times these different systems are kept apart as water-tight compartments. People don’t come together to test things out, so we thought we should change that.”
The final area that Dr Moopen highlights as developing apace is that of health tourism - more accurately labelled ‘medical value travel’, according to the chairman.
“The reason why people travel for medical treatment are three,” he says.
“One, the medical expertise is not available in that particular country. Then they travel. Maybe people go to the UK because the expertise is not available in their country.
“The second important area is the cost. If it is less expensive in a certain country than their own country, then people tend to travel. For example people come to India because of this. The expertise is available and cost-wise it will be only one fifth of what has to be spent in Middle East or Western countries.
“The third is waiting time. If you are on a waiting list, for example on the NHS for elective surgery, you may have to wait for two years. If it can be done immediately, then people will prefer to travel.
“So these are the three main reasons for medical value travel.”
Identifying Bangkok, Singapore and — more recently — India as examples of countries people are willing to travel to for treatment, Dr Moopen says the UAE is now one of the most sought-after countries for medical value travel.
“Dubai has taken up the initiative, with Dubai Healthcare City as the focus, to attract patients from surrounding areas to Dubai,” he continues.
“Dubai has been very successful in attracting people for trade, tourist activities, shopping, and so on, so people come for many things. But healthcare so far has not been a focus. Now they are focusing on it, and we are part of that. We’re part of that momentum.”
It’s a development that he is excited by given the scope for new patients that could come through he company’s doors.
In 2014 Dubai’s Health Authority announced plans to attract more than 500,000 medical tourists every year and boost its economy by up to AED2.6bn ($710m) by 2020.
“I think there is great potential,” continues Dr Moopen.
“If you look at the MENA region it’s about a one billion population. For them it’s logistically easier to come to Dubai — culturally and linguistically it makes a lot of sense. They can easily understand the language and can communicate with doctors here, so if there is the expertise here, then people will come here.
“It was not available here previously, but that is changing, so now we are getting a significant number of people from the Gulf countries, other Middle East countries, and from the African countries coming to Dubai.
“It’s only a matter of time for Dubai to become a hub for this medical value travel.”
As our conversation draws to a close, we briefly discuss another aspect of Dr Moopen’s business that is rooted in his desire to do good: that of philanthropy.
This July Aster DM Healthcare donated AED10m ($2.7m) to the Al Jalila Foundation, aimed at helping underprivileged children with health conditions.
The donation will help the foundation — a global philanthropic organisation dedicated to transforming live through medical education and treatment — develop cutting-edge medical research in the UAE.
Earlier that month the Aster DM Foundation donated AED1.4m ($380,000) to Nepal to rebuild 500 houses in villages struck by the recent earthquake, including 23 homes of Aster employees that were destroyed by the tragedy.
Both acts, and numerous others in previous years, show that the welfare of people remain at the heart of what the company and Dr Moopen himself stand for — an encouraging and heartening reminder that health and wealth can work together in many positive ways.