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Tue 1 May 2007 12:05 PM

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The business of medicine

Dr Azad Moopen has built one of the largest healthcare groups in the UAE. He tells Medical Times why he believes the private sector is the future of healthcare in the Middle East.

Twenty years ago, Dr Azad Moopen launched his first clinic in the GCC. Since then, as chairman of Dr Moopen's group, he has gone on to build one of the largest networks of private healthcare facilities in the UAE, culminating in last month's launch of the multispecialty Medcare Hospital, Dubai.
Medical Times

caught up with the physician-turned-entrepreneur to hear how, for Dr Moopen, profit comes second to care, and why the future of healthcare is a private affair.

How big is the Moopen Group?

We have about 40 establishments in the GCC, and Medcare is our largest facility.

The majority of our facilities are neighbourhood family clinics, which provide basic primary care. And then we have larger, multispeciality clinics that house 10 to 15 doctors, and offer additional diagnostic services such as laboratory and radiology.

As a healthcare model, these clinics work well for us because they bridge the gap between hospitals and primary care. The patient receives care closer to home, and the charges are lower when compared to those in a hospital. Our other interests include a 600-bed hospital in India, and a healthcare consultancy firm, which we set up in Dubai Healthcare City, called EuroHealth.

What prompted you to open Medcare Hospital?

Frankly, we could see a niche in the market in this location. Five years ago, when we started planning this hospital, the only local facility was the Iranian hospital, so this location (Jumeirah, Dubai) was ideal for several reasons. Firstly, there is a huge population growth forming around here - look at the Burj Dubai development or the Palm - which means a large potential patient population. Secondly, we are targeting an affluent patient population, and this location will support that.

What services will you be offering?

Medcare is an acute care hospital where all the specialties will be covered, at least at a skeletal level. But we want state-of-the-art care in three or four fields, specifically nephrology, urology, gastroenterology and gastrointestinal surgery, and laparoscopic surgery. We're also placing an emphasis on paediatrics - the idea is that we provide family care to the patients in this area.

How are you planning to target high-income patients?

Through a combination of our staff, management, facilities, and ambience. Patients have told us that Medcare is one of the best places to experience a hospital stay - not just because of the medical facilities, but the suites and the rooms, which have their own gardens. It's a holistic approach. Our staff all understand that the patient should experience the least amount of bother possible. It is already distressing to be sick, so we specifically hire people to manage the paperwork, to liaise with patients during their stay, to organise follow-up care. We give patients the confidence that we will take care of everything.

Another important aspect is the technological edge that Medcare has, which impacts on the quality of patient care. Within the next six months, we will be a paperless hospital. Laboratory results are available immediately on workstations, for quicker evaluation and diagnosis of the patient. We have direct streaming of images from all the major operating areas and procedure rooms, into our conference hall. This helps, both in terms of CME events, and in allowing doctors to liaise with their colleagues in India or the UK, via videoconferencing, to discuss cases.

This hospital is financially viable with a particular patient load - about 60% of our top capacity. We feel that in this area, with our approach, we will be able to reach this 60%.

Is it challenging to balance profit and patient care?

No. In healthcare, profit should be a byproduct. It shouldn't be the aim. If you have that philosophy in mind, then you are going to be successful. A corporate hospital in India usually takes at least four or five years to break even; but we managed it in the second year of operations. Our investors understand our approach.

It's quite unusual that you opened your Emergency Department first.

It was an effective way to raise our profile in the community, and it's a major USP for us. Yes, the income received from ER care is far less than through outpatient facilities, but people need acute care. Remember, traffic is a huge issue in Dubai - before Medcare opened, Jumeirah was a long way from the nearest ER department. Even from the furthest reach of our community, Medcare is not more than ten minutes away. Our acute care specialists live on-site, in hospital accommodation, and that is a comfort for patients.

We've seen a flood of healthcare providers opening in Dubai Healthcare City. Did you consider opening Medcare Hospital there?

We have a presence in DHCC with EuroHealth, and we also have space for a Medcare-brand clinic there, but Jumeirah can support a hospital, which is why we chose it. While, yes, there are a lot of hospitals coming up in DHCC, we are nearer to our customers and, from a business angle, it is more prudent to have the hospital outside the free zone.

Ultimately, for the concept of DHCC to be successful, it will need a lot of medical tourism, but it will take at least three or five years for that to happen. As an investor, you have to ask yourself, are you ready to wait five years with a huge facility there? That is a little risky.

How are you marketing the hospital locally?

Our marketing strategies have targeted community doctors and patients. We have put a lot of emphasis on operating privileges for community doctors, which creates a patient base even before word-of-mouth referrals start. It takes at least six months for that information to be perculated into the grass roots level of a community. The shorter route is to go through the community doctors, who already have the confidence of the patient and the family circle. Our administrators have a great rapport with the local doctors.

Secondly, for patients, a well-publicised launch of the hospital is the best way of announcing that we are open. We have used direct mailings, door drops and various other techniques to raise our profile. We plan to hold open weeks, where we invite people to come and have check-ups; and awareness programmes for various illnesses, such as hypertension, cervical cancer. These activities will happen on a monthly basis and allow the community to come in, experience the hospital and get an understanding of our approach.

Have you faced any specific challenges in launching Medcare?

Recruitment is a major issue for any healthcare provider, because there are not that many good people. As a physician, I have an advantage, because I have a better rapport with clinicians. They feel more confident about joining us. We have about 2,200 staff across the group, but our staff turnover has been very, very low. The attrition rate of our doctors is less than 1%, so that tells people that we offer a true career.

How do you motivate your staff?

Through communication and financial rewards. The most important thing is to empathise with your staff - if you are a medical professional, this is far easier. If a finance or HR manager berates a doctor it can become very frustrating for them. If I tell a junior doctor not to do something, then it is taken on board, because I am a colleague. We take care of their ego. Secondly, when our doctors undertake a particular procedure, they receive a percentage of the fee. The physicians in our clinics especially get the benefit of this approach.

Could that not encourage unnecessary operations?

Healthcare is one area where if you incentivise, there is a chance of misuse. The incentive scheme is just for the procedure they do - not for any investigation, or medication. It is a personal skill the doctor is using.

Do your have a similar scheme for your nurses?

No. It's frankly very difficult to retain nurses, especially under the current situation where there is a lot of attrition. There is a vast difference between what we will pay here and what nurses can receive in Western healthcare systems, such as the US and UK. Again, we have found that if you have a proper working environment and nurses are happy, that is a great help. It is difficult, but tactics such as starting nursing schools can help give a ready source of staff.

We are looking at finding land for common accommodation for our medical staff, but unfortunately land prices are very high at the moment for our own building. Ideally, we would like to offer accommodation as part of our compensation package. The logistics of recruitment would become far easier.

You've been operating in the Middle East for 20 years. What major changes have you seen?

The gradual privatisation of healthcare has had a definite impact on healthcare delivery in this region. When I came, 20 years back, less than 5% of patients were covered by insurance. Now, in our clinics and our hospitals, we expect about 60 to 70% of people to be coming for private care.

The government has changed the focus from state-sponsored care to private care, which has helped our cause hugely, especially through the rise in expatriates. The government does not want to take up the responsibility of providing healthcare for a large expatriate population, so who is going to cover that? Private healthcare is going to do well in the next five years because, as has happened in Saudi Arabia, even the government hospitals will be turned over to private healthcare.

How do you plan to capitalise on these changes?

There are huge opportunities for those who manage hospitals rather than own them, which is why we are moving into healthcare consultancy solutions. In the future, it will be vital to both have your own facilities, but also have the capability to manage other healthcare facilities, especially those owned by government. This will benefit the business of medicine, but predominately it will benefit the end user - the patient.

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