Health Statistics 2011

Health Authority Abu Dhabi Reliable Excellence in Healthcare

www.haad.ae/statistics www.haad.ae/statistics-xl
Updated 4 October 2012

Contents
Overview Vision Achieving our vision the journey so far Statistical highlights Public Health highlights Investor highlights Benchmarks Population Population various breakdowns Births and Deaths Leading causes of death Injury deaths Communicable diseases Health status Diabetes Mellitus Diabetes Indicators Diabetes cost Cancer Episodes and activities Episodes various analyses Activities by type Procedures Drugs Providers Provider overview Clinical performance Labour productivity Hospital patient satisfaction Hospitals Hospital inpatient profile Centers and Clinics Beds including critical care Blood bank Market structure

New

2 3 4 5 6 7 9 12 13 15 16 17 19 21 22 23 26 29 30 31

33 34 35 36 38 39 40 41 43 44 47 48 49 51 52 54 55 56

Claims Claims Claims by provider Claim activities by provider Payers Payer members Payer claims Financing Enhanced plans premiums Enhanced plans limits Enhanced plans benefits

Note

The data presented have been prepared to the best of our knowledge at time of release. Although effort has been invested to creating consistency and coherence, this should be considered work in progress. Feedback on content and layout are welcome.

Stable Vision
In the Emirate of Abu Dhabi, everyone has access to healthcare and freedom to choose their provider. A system encompassing the full spectrum of health - protecting, promoting, sustaining and restoring services across the territory of the Emirate.

Person
Quality driven by ambitious improvement targets set by the regulatory authority of the Emirate and reflected in the regularly monitored and published key performance indicators of the system.

Payer

Provider

The health system finances itself through a mandatory health insurance for all AD residents. The financial system should be flexible in order to manage for change over time and the degree of subsidy should be managed as efficiently as possible.

Providers are independent and predominantly private. An open system for all certified providers of health services delivers World-class quality care and outcomes in compliance with the highest international standards.
2

Achieving our Vision the journey so far

In 2006 we first defined a vision for Abu Dhabis health system with the mission to Ensure Reliable Excellence in Healthcare. This vision has guided major reforms and continues to inform daily decisions in healthcare. The Health Authority Abu Dhabi (HAAD) was created to track and steer progress towards realizing the vision and, to measure returns on investments for a healthy society. HAAD regulates all healthcare actors public/private, provider/payer/professionals by licensing, setting clear and simple rules, e.g., minimum standards for facilities, and ensuring compliance. HAAD doesnt itself own, build or manage healthcare facilities, treat patients, pay for treatment (insurers and other payers do), or pay the private sector to partner. SEHA (Arabic for health) is the public provider; it owns and develops existing public healthcare facilities, including partnerships with several renowned overseas operators to manage its facilities. In 2012 HAAD plans to lead a major review of the health system, and the role of HAAD, providers and payers. patients manage their chronic conditions, like diabetes, on a daily basis. For instance, the Imperial College London Diabetes Centre offers integrated consultation, diagnostic and pharmacy services to diabetics. Another creative solution is to treat patients, particularly those who are frail, in their homes as the Sama Abu Dhabi Home Health Care group is now doing.

Everyone has access to healthcare via mandatory health insurance. In 2006 Abu Dhabi began giving all expatriates health insurance and, by linking it to resident permits, guaranteed access to healthcare a first in the region. In 2008 Nationals received Thiqa health insurance, providing free access to care in both private and public sector and the freedom to choose their provider.
World-class quality care and outcomes with Quality regularly monitored and published. We have invested heavily in a common, routine and confidential way to share information about the conditions patients have and the treatments they receive. In support of improving quality, HAAD has been standardising clinical care and service standards across the health sector through HAAD standards tailored to the health system of Abu Dhabi; and that in 2012, Abu Dhabi Health Regulations (Policy Manuals) will be published and implemented sector wide. We are also working with local doctors and international experts to develop measures that tell us if patients are getting the right treatments and outcomes, e.g., is a patients diabetes well-controlled after receiving treatment? Full spectrum of health services. Our model of care sets out services which are appropriate, convenient and well co-ordinated around patient needs. Prevention. We want to try to prevent diseases from occurring at the onset so we work with a range of stakeholders, e.g., Municipalities on tobacco control, schools on healthy eating and exercise, Police on road safety, and employers on workplace health promotion. Screening for health risks. When Nationals were screened for various health risk factors in a programme called Weqaya (Arabic for protection) it showed that 71% had at least one CVD risk factor; many were unaware thus unable to seek care, and risk factors are projected to increase. Community-based services help

Specialty care. Competition for patients is helping create new services, increased convenience and efficiency for existing services, and generally reduced waiting times. Examples include: international experts flying in to provide services otherwise not available; SKMCs pediatric kidney transplantation service; Tawam and Lifeline providing mobile breast cancer screening services; and the Corniche Hospital opening a conveniently located Womens Health Centre. Patients also have greater choice as private facilities offer services previously only available at SEHA, such as Al Noor Hospitals dialysis service and cancer treatments at the Gulf International Cancer Centre.
Hospital care. The desire is to treat patients outside hospitals wherever possible. however, to account for population increase, 7 new private facilities have opened in the last 5 years. In addition, 93 private clinics and 12 SEHA clinics have opened with more planned, in both private and public sectors. The challenge is to manage potential over-supply in some areas and to ensure the hospitals operate with both quality and cost comparable with international benchmarks. Ambulance services. Good hospitals are worthless if patients cant get there. The Police provide emergency ambulance services and are planning to privatize them. HAAD is working with them to develop a more integrated service that responds to a wider range of health emergencies by road or air. Predominantly private providers. Based on positive experience both locally and regionally, we would like private operators to provide most healthcare as well as add any required new capacity. Private facilities generally build and operate more efficiently than public, and are also generally more responsive to HAAD quality audits. Patients feel at least equally satisfied in private facilities and, we will be monitoring how they perform on robust clinical indicators. A Flexible and efficient financial system. We want to pay providers for the patients they actually treat and the quality of that treatment as well as limit direct subsidies to SEHA. The DRG system introduced in 2010 rewards quality: it pays hospitals on the basis of how sick patients are, not how long they stay or how many doctors they see. Insurers are also set to pay a bonus for high quality care. In 2012 we intend to improve the system by taking accurate account of providers costs in setting prices for healthcare delivery.

Statistical highlights
There are more insurance contracts (2.8m) than residents 2.4m residents, 18% Nationals Median age 19 for Nationals and 31 for Expatriates 32,084 births and 2902 deaths

Population

Financing

Episodes*

11.4 million Episodes* 1.1% inpatient (130,219) 39% by Nationals 51% by hospitals 4900 physicians, 10504 nurses and 5222 allied health professionals & pharmacists in 1353 licensed facilities including: 34 hospitals (3659 beds) 759 centers and clinics 427 pharmacies

Payers
Claims

Providers

38 licensed insurers compete for members

15 Million claims processed 99.1 % of claims for outpatients

Note * An Episode is an inpatient Encounter or a set of outpatient Encounters linked to the same clinical case based on the patient (identified by insurance member ID), Episode Clinician the clinician responsible for consultation, and principal diagnosis.

Public health highlights

Population One in five residents are Nationals, of whom two
thirds are under 30 and half are overwhelmingly male and of Asian origin and predominantly aged between 20 and 409. A significant share are employed in construction and accommodated in labour camps. The introduction of mandatory health insurance in 2007 provided all residents in Abu Dhabi access to high quality care. Residence status is generally contingent on being employed, so there are very few expatriated retirement age or unemployed. The population has been growing rapidly in previous years, with, a likely temporary decline in 2009. under 199. Expatriates
taken by government agencies. Occupational injuries are now covered by health insurance.

Non-Communicable diseases The Emirate has high rates of

chronic diseases related to life style such as obesity, diabetes, and cardiovascular diseases. Cardiovascular diseases accounted for over a quarter of deaths in 2011. Adult Nationals were screened for cardiovascular risk factors in 2008 as a condition for enrollment in Thiqa insurance. Early analysis of results of this screening showed obesity rates of 33% for males and 38% for females and high proportions of people at risk of diabetes and hypertension among UAE nationals over 1517. Without major changes, these rates are set to increase further as the young population ages. Individuals thought to be at high risk of cardiovascular disease are being followed up.

Birth Fertility rates the main driver of growth for Nationals

has declined for over 30 years11,12. The UAEs Total Fertility Rate has declined from 4.4 to 2.3 per woman between 1990 and 2007. Declining birth rates are attributed to urbanisation, delayed marriage, changing attitudes about family size, and increased education and work opportunities for women.

Cancer caused 14% of all deaths in the Emirate in 2011.

Lymphoid, Haematopoietic and related tissue cancers are the dominant cancers in Abu Dhabi. Late detection of breast cancer leads to significant increases in mortality. Female adult Nationals aged 40-69 are being screened for breast cancer as part of their Thiqa insurance renewal. Education and awareness campaigns have increased screening rates for all nationalities.

Death Mortality rates have also declined steadily12 over the past
years. Infant mortality is now comparable with other developed countries7 and the WHO has reported a decrease in the under 5 mortality rate from 15 to 7 per 1000 live births between 1990 and 2009 across the UAE. In 2011, the diseases of Circulatory System caused the highest number of deaths, accounting for 37.5% of all death cases registered in the Abu Dhabi Emirate. External Causes of morbidity and mortality and Neoplasms are the second and third highest causes of death13,14.

Communicable diseases Rates of childhood communicable

diseases are very low, due to immunization programs targeting children aged <5 years16. Expatriates are screened for communicable diseases before acquiring residence status16.

Injuries Abu Dhabi has one of the highest rates of injuries

resulting from Road traffic accidents. They account for 11% of all deaths and are the leading cause of death amongst young males13-15. Speeding fines, free provision of child seats, and traffic safety education programs are some of the actions being

Respiratory infections are the second most common non-life

threatening condition in the Emirate after signs, symptoms and ill-defined, accounting for 13.6% of Episodes across all healthcare facilities27. Respiratory infections mostly impact workforce productivity and quality of life. 5

Investor highlights

Population The population is concentrated on or nearby Abu Dhabi islandC23. Areas of growth in the short to medium term are expected to be just off the island (Mohammed Bin Zayed City, Capital district, Shamkha and the islands adjacent to Abu Dhabi island) and Al Ain city. At the end of 2011 there were 0.42m National Thiqa members, 1.3m Basic members and 1.0 m Enhanced members51. Demand Aggressive growth in demand is expected for services relating to lifestyle related diseases, e.g. diabetes and cardiovascular disease, and cancer with larger volume increases in outpatient settingsC26.

Supply There has been 3% growth in the number of physiciansC9 and 11.8% growth of facilities*C9. By 2021 it is estimated that up to 3,200 additional doctors and 5,900 nurses will be required. If churn remains at the 2011 level, this requires annual recruitment of some 1,500 doctors and 1,600 nursesC25. Physician productivity indicates however, there are reserves within existing facilities36. High demand projectionsC25 also indicate that in 2021 demand for inpatient services may require up to 1,600 additional beds beyond the current 3,659 beds38. However, investors hold 42 Preliminary hospital licenses which signals significant future capacity to meet this demandC22.
Capacity gaps Waiting times have been reduced across most specialties. There is a critical capacity gap in Intensive & Critical Care medicine and overall gaps remain in Emergency medicine, Neonatology, Cardiology, Psychiatry, Pediatrics, Oncology and Obstetrics & GynaecologyC9. Significant new capacity is however anticipated in pediatrics and obstetrics/gynaecologyC22. Overall bed occupancy rates vary by facility, but have significantly decreased in aggregate38 Indicating reduced efficiency. Bed occupancy in ICU, NICU, PICU, CICU, CCU and Isolation was consistently over the optimal 75% during 201142.
Note*

Reimbursement HAAD sets prices for the Basic product uniformly. Providers negotiate prices with Payers for Enhanced plans, generally as a multiple of Basic product rates. Thiqa rates are equivalent to Damans most generous Enhanced plan. Prices have been weighted towards outpatient care. DRGs were introduced for the Basic product in 2010, were voluntarily applied for Thiqa in 2011, and will be applied for Enhanced during 2012. 2012 will see more outpatient payments based on Evaluation and Management codes, thereby changed to reflect the severity of the patients condition not the grade of doctor seen. Provider market Government-subsidised SEHA hospitals provided care in 65% of all inpatient Episodes and 40% of all hospital outpatients (2% increase from 2010)26. The largest independent groups are Al Noor (who hold 21% of the hospital outpatient market) and NMC38. Off the island, health services are concentrated in larger facilities38,41. International providers have come to Abu Dhabi, generally on the basis of a management service agreement, such as the Cleveland Clinic for SKMC and Johns Hopkins for Tawam. Payer market Overall, the competitive Enhanced health insurance market has increased to almost 1.05m members. Over 50% of this market is held by three payers Daman (31.8%), ADNIC Insurance (14.4%) and Al Dhafra (7.0%)51. Daman also administers Thiqa and Basic product. Claims per member have risen from 4.58 in 2009 to 5.44 in 201147. On average payers take 47 days to remit AED1 claimed52. This has improved from 55 in 2010. Oman, Al Khazna and Alliance had the lowest time to remit, less than 40 days52. 6

Percentage growth needs to be interpreted with caution, due to the fact of having some services within SEHA facilities holding a separate license

Benchmarks
Population growth, 1999-2009 Life expectancy at birth (years), Males 74.9 73 78 3.5 1.9 8.7 2.4 1.9 4.1 0.5 1 72 78 78 Females 77 76 83 79 77 79 75 79 77 78 76 84 79 82 81

Abu Dhabi
Bahrain Germany Kuwait Oman Qatar Saudi Arabia Singapore UAE UK USA 0 2.2

5.5

69

Under - 5 mortality rate / 1'000 live birth

Abu Dhabi Bahrain Germany Kuwait Oman Qatar Saudi Arabia Singapore 3 7 5 8 9 21 4 8.7 12

Infant mortality rate / 1'000 live birth 6.4 9 3

Beds / 1'000 population 2.5 1.9

Physicians /10'000 population 20.4 14.4

Nurses / 10'000 population 43.6 37.3 35.3 108.2 45.5 41.1

8.2
11 9 7 18 1.8 1.9 1.4 2.2 3.1 7 5 7 1.9 3.4 3.1 9.4 18.3 19.3 27.4 26.7 17.9 19 27.6

13
12

73.7 21 59 40.9 103

UAE
UK USA

98.2

Notes

Sources

Bed ratio calculations were adjusted, as the population in Abu Dhabi is young and is not expected to need to go to hospital as frequently as other older population. To enable a fair comparison the bed ratio was adjusted by mapping the population age structure of Abu Dhabi to that of Germany, using German resource consumption profiles. Life expectancy 2010 for Abu Dhabi Emirate, 2009 for others. WHO Statistical Information System/World Health Statistics 2010, Public health department, HAAD population estimates, SCAD, and Health Statistics Analysis

Population

Financing

Episodes

Payers

Claims

Providers

Population by age, gender and nationality

Age band
85+

80-84 75-79 70-74 65-69 60-64 55-59

50-54 45-49

Female

Male

National Expatriate

40-44 35-39 30-34 25-29 20-24 15-19

10-14

05-09 0-4 110,000 10,000 90,000 190,000 290,000

0-4 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total

All 160'829 128'277 101'567 91'899 259'246 461'689 379'538 274'694 210'301 138'765 99'206 62'891 26'681 11'525 6'909 3'798 2'430 2'155 2'422'400

National Male 35'863 31'831 26'014 23'734 20'819 19'509 16'742 11'345 7'637 5'734 4'359 3'815 3'215 2'522 2'028 1'194 760 714 217'835

Female 32'288 28'633 23'050 21'547 20'061 20'890 18'798 13'696 9'493 7'198 5'859 4'810 3'246 2'182 1'761 978 704 756 215'950

Total 68'151 60'464 49'064 45'281 40'880 40'399 35'540 25'041 17'130 12'932 10'218 8'625 6'461 4'704 3'789 2'172 1'464 1'470 433'785

Expatriate Male 48'370 34'995 26'920 24'685 172'359 342'290 276'901 200'887 158'188 101'726 71'262 42'364 14'490 4'027 1512 707 376 252 1'522'311

Female 44'308 32'818 25'583 21'933 46'007 79'000 67'097 48'766 34'983 24'107 17'726 11'902 5'730 2'794 1608 919 590 433 466'304

Total 92'678 67'813 52'503 46'618 218'366 421'290 343'998 249'653 193'171 125'833 88'988 54'266 20'220 6'821 3'120 1626 966 685 1'988'615

Note Source

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here differ and are for internal HAAD use only SCAD population estimates for Nationals, additional HAAD assumptions and analysis based on raw insurance data

Population by region and nationality

Region Abu Dhabi Al Ain Western Total National 228'228 177'117 28'440 433'785
6.6%

Expatriate 1'560'966 307'590 120'059 1'988'615 6.0% 15.5%

Total 1'789'194 12.8% 484'707 36.5% 148'499 2'422'400 19.2%

National 87.2%

Expatriate

63.5% 80.8%

40.8%

78.5% 52.6%

National Abu Dhabi

Note Source

Expatriate Al Ain Western

10

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here differ and are for internal HAAD use only SCAD population estimates for Nationals, additional HAAD assumptions and analysis based on raw insurance data

Births and Deaths 2011

Total Number % By Region Number Rates By Nationality and gender National Expatriate NA

Western

Western

National

Eastern

Eastern

Female

Female

Female

Males

Abu Dhabi

Abu Dhabi

2010

2011

Male

Male

Male

Total

NA

NA

Live births Deaths Still births Neonatal mortality Infant mortality Child mortality (1-4) Death by age group 0-6 days 7-27 days 28-364 days 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ NA

29'528 2'879 182 133 235 60

32'084 2'902 68 127 205 75

46% 32% 44% 45% 42% 51%

51% 72% 35% 61% 56% 55%

19'312 11'397 1'642 57 102 157 47 952 8 21 40 22

1'089 227 3 4 5 3

13.2 1.2 2.1 4.0 6.4 2.3

10.8 0.9 3.0 5.3 8.1 2.4 % 5% 1% 3% 3% 1% 1% 2% 5% 7% 6% 6% 7% 7% 8% 8% 6% 6% 5% 5% 4% 5%

23.5 2.0 0.7 1.8 3.5 1.9 % 1% 1% 2% 2% 1% 1% 1% 4% 5% 6% 7% 6% 6% 8% 9% 8% 6% 7% 5% 6% 9%

7.3 1.5 2.8 3.7 4.6 2.8 % 2% 0% 0% 1% 1% 0% 0% 14% 13% 12% 10% 12% 7% 8% 7% 2% 2% 1% 3% 0% 4%

7'428 571 8 32 44 22

7'208 368 9 25 43 16 1 13

8'864 1502 15 45 70 19

8'534 454 12 24 47 18 2 8

26 2 1

24 2 2

95 38 102 60 42 17 46 129 186 184 180 206 187 229 215 193 142 158 153 136 179 2

99 28 78 75 24 25 45 152 193 176 182 200 188 229 245 184 166 170 142 125 176

46% 39% 38% 51% 54% 48% 67% 29% 11% 10% 15% 16% 16% 15% 22% 35% 45% 54% 61% 60% 63%

62% 61% 47% 55% 71% 40% 82% 88% 89% 85% 80% 85% 81% 84% 80% 68% 63% 59% 54% 39% 49%

82 20 55 47 11 15 26 81 115 95 95 112 111 126 136 100 97 88 85 64 81

13 8 19 22 9 6 14 34 45 53 62 58 57 80 86 73 57 69 49 57 81

4 1 3 2 1 1 31 29 27 22 27 16 18 17 4 4 3 6 1 10

3% 1% 3% 3% 1% 1% 2% 5% 7% 6% 6% 7% 6% 8% 8% 6% 6% 6% 5% 4% 6%

25 7 12 22 11 7 27 37 16 12 16 21 21 25 31 40 46 54 47 36 58

21 4 18 16 2 5 3 7 5 6 11 10 9 10 22 24 28 37 39 39 52

35 10 25 19 6 3 10 97 156 137 130 148 132 168 164 86 59 46 30 13 28

17 7 23 18 5 10 5 11 16 20 24 21 26 26 27 33 33 33 26 36 37

1 1

1 1

Note

Source

Rates = crude birth and death rates calculation are based on internal HAAD population estimates (per 1000) other rates based on crude births (per 1000); Total 2011 births include 9 Non-Hospital and 277 Outside UAE deliveries, 2010 still births as of 2009, HAAD and SCAD are collaborating to align with official SCAD data 11 Birth and Death notifications; Health Statistics Analysis

NA

Births and deaths time series

Births
Year Total 18'874 19'700 20'667 22'113 21'686 21'750 20'246 20'456 20'410 21'505 20'425 20'095 20'017 20'348 21'303 23'525 23'974 24'317 24'990 26'215 27'112 25'738 27'002 28'456 29'044 29'502 32'034 National 6'376 6'328 6'400 6'668 6'647 6'652 6'729 7'202 7'928 8'060 8'261 8'697 8'917 8'435 8'948 9'783 10'349 10'714 11'279 12'021 12'254 12'165 12'857 13'040 13,479 13,635 14,636 Rate Expatriate 46.9 45.2 43.8 43.3 41.0 39.1 37.8 38.3 40.4 39.1 37.1 38.1 37.2 33.5 33.9 35.2 34.9 34.5 34.6 35.2 35.3 33.8 34.7 32.4 31.1 31.4 33.7 12'498 13'372 14'267 15'445 15'039 15'098 13'517 13'254 12'482 13'445 12'164 11'398 11'100 11'913 12'355 13'742 13'625 13'603 13'711 14'194 14'858 13'573 14'145 15'416 15,565 15,867 17,398

50

National Expatriate Aggregate

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Rate % Nationals 34% 29.1 30.3 30.7 31.6 29.2 27.9 23.7 22.1 19.8 20.2 16.9 15.4 14.3 14.5 14.3 15.1 15.6 15.1 14.7 14.7 15.8 10.9 10.7 8.9 7.8 8.0 8.7 32% 31% 30% 31% 31% 33% 35% 39% 37% 40% 43% 45% 41% 42% 42% 43% 44% 45% 46% 45% 47% 48% 46% 46% 46% 46%

40

30

20

10

0
4.0

2011

Deaths
Year 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Total 1'275 1'356 1'444 1'480 1'561 1'628 1'774 1'829 1'946 1'963 2'166 2'050 2'105 2'098 2'206 2'250 2'574 2'612 2'493 2'489 2'443 2'380 2'750 2'949 2'973 2'855 2'898 National 520 492 528 551 571 572 652 690 689 614 722 723 708 758 792 822 928 849 913 887 820 821 990 981 983 967 940 Rate Expatriate 3.8 3.5 3.6 3.6 3.5 3.4 3.7 3.7 3.5 3.0 3.2 3.2 3.0 3.0 3.0 3.0 3.1 2.7 2.8 2.6 2.4 2.2 2.6 2.4 2.3 2.2 2.2 755 864 916 929 990 1'056 1'122 1'139 1'257 1'349 1'444 1'327 1'397 1'340 1'414 1'428 1'646 1'763 1'580 1'602 1'623 1'559 1'760 1'947 1'990 1'888 1,958 Rate % Nationals 41% 1.8 2.0 2.0 1.9 1.9 1.9 2.0 1.9 2.0 2.0 2.0 1.8 1.8 1.6 1.6 1.6 1.9 2.0 1.7 1.7 1.7 1.5 1.5 1.1 1.0 0.9 1.0 36% 37% 37% 37% 35% 37% 38% 35% 31% 33% 35% 34% 36% 36% 37% 36% 33% 37% 36% 34% 34% 36% 33% 33% 34% 32%

3.0

2.0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

1.0

0.0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

2009 2010 2011

Note Source

Rates based on internal HAAD population estimates; HAAD and SCAD are collaborating to align with official SCAD data Presented data include cases where nationality is not available. MOH statistics, Preventive Medicine Department annual reports, Public Health and Policy; Health Statistics analysis

12

Leading causes of death

Injury, poisoning and certain other consequences of external causes 3% Endocrine, nutritional and metabolic diseases 3% Congenital malformations, deformations and chromosomal abnormalities 2%

Causes Diseases of the circulatory system External causes of morbidity Injury, poisoning and certain other consequences of external causes

2011 1'089 481 100 461 98 72 601 2'902

2010 762 202 385 461 194 144 731

2009 707 632 57 397 210 199 715

2008 697 464

2007 506

2006 378

2005 424

2004 413

2003 624

2002 778

2001 622

621 85 360 79 120 1'144 370 201 177 867

503

565

563

574

614

600

Other causes 21%

Diseases of the circulatory system 38%

Neoplasms Endocrine, nutritional and metabolic diseases Congenital malformations, deformations and chromosomal abnormalities

315 130 131 993

294 133 156 874

298 126 146 943

276 103 152 763

289 73 199 664

252 65 190 845

Neoplasms 16% External causes of morbidity 17%

Other Total

2'879 2'917 2'949 2'742 2'450 2'446 2'489 2'492 2'617 2'574

Note Source

Causes of death classified according to WHO ICD-10 Death notifications; Health Statistics Analysis

13

Leading causes of death

Causes of death Total Death Diseases of the circulatory system External causes of morbidity Neoplasms Diseases of the respiratory system Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Injury, poisoning and certain other consequences of external causes Endocrine, nutritional and metabolic diseases Certain conditions originating in the perinatal period Certain infectious and parasitic diseases Congenital malformations, deformations and chromosomal abnormalities Diseases of the digestive system Diseases of the genitourinary system Diseases of the nervous system Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Diseases of the musculoskeletal system and connective tissue Diseases of the skin and subcutaneous tissue Pregnancy, childbirth and the puerperium Diseases of the ear and mastoid process Diseases of the eye and adnexa Mental, Behavioral and Neurodevelopmental disorders NA Cases 2'902 1'089 481 461 124 117 100 98 87 81 72 62 42 36 17 14 2 1 1 1 1 15 2 4 6 7 1 1 1 2 7 1 2 National By gender NA 571 368 1 193 140 82 22 93 63 40 22 1 20 15 27 23 18 14 13 12 10 6 3 18 7 16 14 12 18 9 11 5 3 4 1 6 1 1 2 1 37 2 24 2 6 2 1 1 5 1 1 1 1 1 7 5 2 3 22 1 8 17 4 5 4 0-1 87 4 3 1 4 4 1 Expatriate By age group By gender 1-15 15-30 30-45 45-60 60+ 63 95 76 118 501 1'502 454 9 21 21 37 241 648 105 23 50 13 6 9 338 39 6 2 20 36 91 175 130 2 3 6 48 36 25 3 2 1 5 10 4 5 2 4 4 7 33 18 47 65 37 28 38 21 22 13 13 5 6 1 30 13 18 22 13 19 17 6 8 3 1 1 1 1 1 1 4 2 5 2 1 1 NA By age group By gender By age group NA 0-1 1-15 15-30 30-45 45-60 60+ 0-1 30-45 60+ 2 117 61 295 480 544 461 2 2 1 2 1 1 8 6 88 185 298 169 1 1 1 1 2 17 148 147 48 15 9 11 46 101 138 3 2 3 10 14 29 3 1 1 50 2 30 4 2 7 3 3 1 2 6 2 4 2 6 2 2 1 4 8 4 5 19 13 1 1 1 1 16 22 2 2 3 6 28 2 27 32 7 14 14 16 25 1 26 1 1 1 1

Note Classification according to ICD 10 Source Death notifications; Health Statistics Analysis

14

Injury deaths
Occupational Injury 13%

Suicide 9%
Home 7% Road Traffic Injury 62%

Other 5%

% Change 2010-11 Total -3% Road Traffic Injury -6% Occupational Injury -5% Suicide 12% Home 90% Occupational RTI -54% Drowning -29% Other 17%

Cases % National 2011 2010 2009 2008 2007 2011 2010 2009 2008 537 551 680 623 621 330 350 430 422 427 25% 27% 27% 28% 71 75 82 68 66 1% 3% 4% 3% 47 42 51 66 39 2% 0% 0% 2% 40 21 57 34 10 25% 33% 23% 24% 12 26 26 8 34 0% 4% 0% 13% 10 14 13 13 22 30% 7% 31% 38% 27 23 21 12 23 22% 13% 24% 25%

2007 28% 5% 3% 20% 6% 36% 39%

Occupational RTI Drowning 2%

2%

200 180 160 140

Male Female Rate per 1000

0.40

17 0.28 13 0.25
0.20 6

0.37

0.35 0.28 0.22 0.20

0.15

0.30 0.25

120 100 80 60 40 20 0
0.13 6 27

0.26

0.13 5
31 159 124 90

4 1 11 60-69 2 4 80+

0.10

0.05 0.00

46

1 3

0-09

10-19

20-29

30-39

40-49

50-59

70-79

Source HAAD Death notification data complemented by investigation into the causes of injury using medical records and police reports - Public Health and Policy; Health Statistics Analysis

15

Communicable diseases
Total
Preventable Screened

National 2011 11'768 2'731 673 580 585 667 383 394 243 282 194 138 183 239 39 42 99 82 75 49 37 1 42 15 10 3 741 0-14 4282 4 1 23 197 1 11 1 59 61 30 1 139 31 1 8 15 12 7 3 5 1 79 15-34 441 108 20 33 64 15 10 62 56 8 11 8 35-54 54 2 68 24 11 8 7 9 36 10 2 6 55-64 8 15 21 2 2 3 3 2 4 1 2 65+ 1 7 13 3 4 2 1 6

Expatriate 0-14 3288 72 6 6 60 114 5 44 3 57 67 52 5 95 8 15-34 2922 1'734 222 160 306 181 210 199 66 41 35 38 119 4 16 29 38 19 19 11 1 30 1 3 156 35-54 744 823 205 242 128 94 111 112 63 41 20 5 34 1 7 46 15 15 1 6 3 1 4 124 55-64 23 98 30 75 16 7 22 3 9 7 1 1 4 65+ 3 2 8 18 3 5 1 1

NA 0-14 2

Disease

2010 7'429 1'415 711 668 654 471 450 335 318 248 221 193 175 105 73 62 62 55 52 50 36 26 22 11 10 1 315

Chickenpox Malaria n n Viral Hepatitis B Viral Hepatitis C Scabies Other Food Poisoning n Pulmonary Tuberculosis Typhoid Fever Other STD n Seasonal Influenza n Mumps n Viral Hepatitis A Extra Pulmonary Tuberculosis Scarlet Fever n Whooping Cough Gonorrhoea n Syphilis Giardia Lambia Brucellosis n Measles Viral Meningitis Other Viral Hepatitis n Rubella Acute Flaccid Paralysis Acute Encephalitis n Tetanus Other

17 8 2 8 1 1 1

1 7 1 10

2 2

1 2 3

12 3 16 11 5 9 2

1 5 2

1 124 54 5 7

1 15 6 1

170

Note Preventable: Diseases preventable by vaccination, Screened: Adult expatriates are screened on application or renewal of residence visa Source HAAD infectious diseases notification data 2011 BI report - Public Health and Policy; Health Statistics Analysis

16

Selected cardiovascular indicators overview

National1 Correlation2 Expatriate3

Preliminary

Hypertension

High lipids

Diabetes

Smoking

Obesity

Female

Obesity Hypertension Diabetes High lipids Smoking

36% 17% 21% 36% 11%

33% 24% 22% 50% 24%

38% 12% 20% 26% 0.8% Less likely

20% 35% 18% 18% 25% More likely

17% 33% 18% 19% 29%

32% 41% 18% 15% 6.6%

People who are obese are more likely to have high blood pressure, high lipids and diabetes, but are as likely to be smokers as those who aren't obese

Source

1Preliminary

analysis of Weqaya sample of 112301 UAE Nationals in the Emirate screened in 2008-9, Public Health and Policy; Definitions: Obesity: body-mass index 30; Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; High lipids: LDL >4.1 mmol/l or HDL <1 mmol/l; Diabetes: HbA1c 6.1%; Smoking: at least one cigarette per day, 1 cigar/pipe per week or one shisha per month 2Preliminary analysis of Weqaya sample1, Public Health and Policy; Indicators used in correlation analysis: Obesity: body-mass index; Hypertension: systolic blood pressure; High lipids: LDL; Diabetes: HbA1c; Smoking: self-reported consumption 3Extrapolation based on a survey of 76,070 residents in the Emirate in 2005; Definitions: High lipids: self-reported history of high cholesterol and/or total serum cholesterol >200 mg/dl; Hypertension: self-reported history of hypertension, and/or systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; Obesity: body-mass index > 30; Diabetes: self-reported diabetes or fasting glucose over 126 mg/dl; where only random glucose was available, diabetes status was imputed using a logistic model; Smoking: self-reported smoking; UAE University and Health Statistics analysis

Female

Total

Total

Male

Male

17

Selected cardiovascular indicators by age group and gender

Female Nationality Indicator National Obesity High lipids Hypertension Diabetes Smoking Heart disease Stroke Physical exercise Expatriate Obesity High lipids Hypertension Diabetes Smoking Physical exercise 20-29 30-39 40-49 50-59 60-69 70-79 80+ 25% 20% 5% 8% 1% 0% 0% 25% 21% 29% 3% 5% 6% 21% 41% 26% 8% 14% 1% 1% 1% 27% 32% 37% 9% 13% 7% 23% 57% 34% 18% 34% 1% 3% 2% 25% 42% 61% 28% 32% 9% 27% 65% 37% 34% 57% 1% 8% 4% 20% 51% 66% 45% 46% 6% 29% 55% 38% 44% 61% 1% 11% 5% 13% 49% 65% 61% 5% 23% 45% 36% 50% 59% 0% 14% 6% 5% 30% 61% 44% 10% 9% 37% 35% 47% 57% 0% 13% 6% 6% 67% N/A 58% 33% 0% 8% Male

Preliminary

20-29 30-39 40-49 50-59 60-69 70-79 80+ 29% 44% 18% 8% 27% 1% 1% 43% 12% 16% 9% 5% 33% 32% 37% 56% 20% 17% 27% 1% 1% 40% 18% 37% 16% 15% 29% 31% 37% 57% 28% 34% 22% 3% 1% 35% 21% 48% 30% 35% 25% 34% 36% 55% 42% 55% 17% 7% 3% 33% 23% 52% 46% 46% 21% 37% 30% 49% 47% 64% 10% 12% 5% 27% 30% 52% 58% 53% 21% 36% 25% 51% 49% 62% 7% 14% 6% 19% 21% 51% 53% 47% 14% 24% 23% 50% 46% 50% 7% 14% 6% 24% 18% 50% 33% 33% 21% 36%
2

60% N/A

Source

1 Preliminary analysis of Weqaya sample of 112301 UAE Nationals in the Emirate screened in 2008-9, Public Health and Policy; Definitions: Obesity: body-mass index 30; Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; High lipids: LDL >4.1 mmol/l or HDL <1 mmol/l; Diabetes: HbA1c 6.1%; Smoking: at least one cigarette per day, 1 cigar/pipe per week or one shisha per month 2 Extrapolation based on a survey of 76,070 residents in the Emirate in 2005; Definitions: High lipids: self-reported history of high cholesterol and/or total serum cholesterol >200 mg/dl; Hypertension: self-reported history of hypertension, and/or systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; Obesity: body-mass index > 30; Diabetes: self-reported diabetes or fasting glucose over 126 mg/dl; where only random glucose was available, diabetes status was imputed using a logistic model; Smoking: self-reported smoking; Physical exercise: self-reported physical exercise; UAE University and Health Statistics analysis

18

Prevalence of Diabetes Mellitus by age group

% At risk of diabetes Average Population
70% 90,000

80,000 60% 70,000 50% 60,000

40%

50,000

30%

40,000

23% 20%

30,000

20,000
10% 10,000

0% 20-29 30-39 40-49 50-59 60-69 70-79 80+

Note Risk of diabetes is defined as HbA1c 6.1% Source Preliminary analysis of Weqaya sample of 112301 UAE Nationals in the Emirate screened in 2008-9, Health Statistics`

19

Diabetes performance

Notes

Diabetics is number of members who had an Encounter with diagnosis of diabetes. Well controlled diabetes is a measure of diabetics whose latest HbA1c<7%. Moderate and well controlled diabetics are those whose latest HbA1c<7.5%.Poorly controlled diabetics are those whose latest HbA1c>9%. Related care indicators apply to diabetics only and indicate 1 test per member per annum. Rates shown are rates within breakdown category. Indicator definitions are available at https://www.shafafiya.org Source KEH Episodes with Encounter start date 1 January 31 December 2011 as at 5 April 2012

20

Diabetes indicators, top providers

Episodes with diabetics Target direction: SKMC 58'506 Tawam 52'647 Imperial College London Diabetes Centre 51'435 Al Ahalia 36'815 Al Noor 29'231 N M C Specialty 27'785 Al Noor - Al Ain 26'806 Al Mafraq 22'504 Al Ain 21'534 Life Line 16'666 Al Noor - Airport Road 16'318 N M C Specialty - Al Ain 14'636 Al Jahili 13'001 Al Rahba 11'370 Taha Medical Centre 11'123 Gulf Diagnostic Center 10'310 Al Salama 9'473 Oasis 9'361 Al Ameen Medical Centre 7'877 Madinat Zayed 7'815 Medical Services Administration Of Abu Dhabi Police Ghq 7'124 Al Musaffah Al Alhli Medical Centre 6'730 Life Line Hospital Al Musafah 6'714 Al Kamal Medicdal Poly Clinics- L L C 6'490 Modern Center 6'407 National 6'013 Al Khabisi Clinic 5'704 Neima 5'506 Specilaized Uneversity Medical Centre 4'616 Golden Sand Medical Centre 4'593 Diabetics w HbA1c observatio Well n & latest controlled HbA1c<7% diabetics QI 47.4% 41.7% 56.8% 31.4% 47.5% 40.4% 39.3% 43.4% 36.0% 37.3% 50.3% 36.5% 43.2% 46.7% 24.2% 48.9% 45.8% 39.1% 32.1% 42.7% 52.9% 28.2% 33.7% 28.4% 16.1% 31.7% 38.2% 41.6% 47.9% 36.2% 64.6% 58.7% 61.8% 61.7% 67.6% 64.7% 56.1% 61.1% 55.9% 66.9% 68.3% 58.4% 58.8% 65.6% 63.2% 73.0% 67.3% 59.4% 55.4% 58.9% 74.6% 53.4% 58.2% 65.7% 50.0% 63.6% 56.1% 59.5% 54.9% 58.5% Diabetics w HbA1c Moderate observatio & well n & latest Poorly controlled HbA1c<7.5 controlled diabetics % QI diabetics 54.8% 49.6% 68.3% 36.1% 54.2% 47.0% 47.5% 51.0% 44.1% 42.7% 57.2% 44.0% 51.4% 53.8% 31.0% 55.1% 51.6% 46.6% 38.2% 50.0% 58.1% 33.5% 39.1% 32.1% 21.7% 37.2% 46.1% 49.8% 73.9% 41.9% 74.7% 69.9% 74.4% 71.0% 77.2% 75.4% 67.8% 71.8% 68.4% 76.5% 77.6% 70.5% 69.9% 75.5% 80.8% 82.3% 75.9% 70.7% 65.9% 68.9% 82.1% 63.4% 67.5% 74.2% 67.3% 74.6% 67.7% 71.1% 84.6% 67.7% 20.5% 21.5% 33.0% 14.4% 18.3% 15.9% 23.4% 21.3% 19.9% 13.5% 20.1% 18.3% 22.3% 20.1% 5.7% 14.2% 17.6% 19.6% 17.7% 24.5% 19.1% 18.6% 18.0% 9.8% 8.7% 11.7% 20.5% 20.3% 17.7% 18.6% Diabetics w HbA1c observatio n & latest Annual HbA1c>9% Annual lipid profile Annual QI HbA1c test test renal test 27.9% 30.4% 35.9% 28.3% 26.1% 25.4% 33.4% 30.0% 30.9% 24.1% 27.3% 29.3% 30.3% 28.2% 14.9% 21.2% 26.0% 29.7% 30.5% 33.7% 26.9% 35.1% 31.1% 22.7% 27.0% 23.6% 30.1% 29.0% 20.3% 30.0% 79.0% 78.8% 96.2% 60.9% 78.0% 72.5% 75.3% 79.9% 73.7% 65.1% 80.9% 69.4% 81.5% 78.4% 44.0% 75.7% 76.0% 73.8% 63.1% 81.5% 78.7% 61.5% 67.3% 49.0% 34.4% 59.4% 78.0% 78.6% 89.0% 68.5% 63.2% 58.4% 87.3% 53.1% 62.1% 60.3% 58.1% 60.5% 57.8% 58.3% 64.4% 58.3% 58.6% 59.1% 59.2% 63.4% 59.9% 53.2% 36.9% 62.9% 59.6% 52.8% 56.3% 49.5% 43.9% 55.7% 60.1% 57.3% 76.2% 58.8% 79.0% 70.9% 95.4% 66.4% 85.6% 82.0% 80.5% 83.6% 73.6% 75.8% 88.0% 78.3% 71.4% 75.6% 68.7% 85.0% 82.2% 72.6% 56.8% 86.0% 83.6% 61.5% 74.1% 63.8% 56.3% 65.8% 75.8% 65.8% 58.7% 77.8% Annual eye exam 94.1% 93.0% 86.3% 95.6% 95.2% 85.4% 92.2% 95.9% 90.9% 92.9% 96.6% 89.3% 95.2% 94.0% 96.1% 95.7% 97.1% 91.0% 93.9% 96.4% 98.7% 96.9% 94.5% 92.7% 96.9% 92.9% 91.8% 97.3% 88.4% 97.6%

Notes

Green indicates better than average (previous page) indicator values, red indicates otherwise Indicator definitions are available at https://www.shafafiya.org. Source KEH Episodes with Encounter start date 1 January 31 December 2011 as at 5 April 2012

21

Diabetes cost
Total Thiqa Imperi a l Col l ege London Di a betes Centre SKMC Ta wa m Al Ma fra q Al Ai n Other Enhanced Imperi a l Col l ege London Di a betes Centre Al Noor N M C Speci a l ty SKMC Al Noor - Al Ai n Other Basic SKMC Al Ma fra q Al Ai n Al Noor - Al Ai n Al Noor Other Activi ty Net 100.0% 62.2% 22.7% 11.0% 9.8% 3.1% 2.1% 13.5% 24.9% 2.9% 2.5% 2.4% 1.2% 1.0% 14.9% 12.9% 2.0% 1.2% 1.1% 0.9% 0.6% 7.1% Epi s odes 749'322 261'917 42'081 42'349 45'355 12'814 7'579 111'739 219'800 8'854 16'588 19'409 5'401 6'436 163'112 268'095 10'794 6'781 9'422 17'612 10'389 213'097 Activi ties per Epi s ode 9.6 12.7 29.5 13.0 9.1 11.1 12.0 8.0 8.9 23.2 9.5 8.4 11.1 11.6 7.9 7.2 17.9 9.4 8.6 9.2 8.2 6.3 Activi ty Net per Epi s ode (AED) 1'307 2'326 5'285 2'545 2'119 2'363 2'657 1'187 1'107 3'198 1'468 1'208 2'226 1'497 892 472 1'770 1'674 1'095 481 591 334 Avera ge Activi ty Net (AED) 136 183 179 195 234 212 222 148 125 138 154 144 200 130 113 66 99 177 127 52 72 53 Cos t contri bution by Activi ty Type Drugs 38% 35% 39%* 33% 30% 36% 22% 36%* 53% 48% 51% 59% 35% 51% 55% 22% 9% 10% 12% 28% 27% 29% Procedures DRG 35% 16% 35% 51% 22% 19% 12% 14% 37% 37% 46% 37% 29% 45% 40% 36% 36% 14% 11% 20% 50% 46% 45% 19% 0% 31% 39% 44% 49% 15% 1% 0% 2% 3% 5% 1% 1% 35% 65% 72% 58% 14% 22% 21% Suppl i es 5% 7% 8% 9% 6% 5% 5% 5% 3% 3% 4% 3% 6% 4% 2% 1% 1% 0% 1% 0% 0% 1% Servi ces 6% 4% 2% 5% 6% 3% 10% 7% 6% 3% 6% 6% 9% 4% 6% 6% 11% 7% 9% 8% 5% 4%

Notes: Activity Net represents claimed amount * Excludes mandatory 50% co-pay for drugs for Thiqa patients in non-SEHA facilities Source KEH Episodes with Encounter start date 1 January 31 December 2011 as at 5 April 2012

22

Cancer death cases

By nationality
National 34% Expatriate 66%

Cancer death cases

Rate per 100'000 population

Total Male Female

Male

Female

403 229
National

174 58 116
Male

13.2 36.3 9.9

25.5 26.9 24.9

Female
14.8% Breast Colorectum Leukaemia
Liver and intrahepatic bile ducts Cervix uteri Pancreas Stomach Trachea, bronchus and lung Lymphoma Ovary 23.1% Other

By gender

137

79

Female 43%

Male 57%

Expatriate 266 150

By site
Breast Colorectum Trachea, bronchus and lung Liver and intrahepatic bile ducts
Leukaemia Pancreas Stomach Lymphoma Brain, nervous system Cervix uteri Other

All
11.7% 11.4% 10.4% 8.9% 8.9% 6.9% 5.5% 4.2% 4.2% 2.5% 25.1%
Trachea, bronchus and lung Colorectum Liver and intrahepatic bile ducts Leukaemia Pancreas Brain, nervous system Stomach Lymphoma Prostate Bladder Other

27.0% 11.5% 9.2% 6.3% 5.7% 5.7% 5.2% 4.6% 2.9% 2.9% 18.4%

11.4% 10.9% 8.7% 7.9%

6.1% 5.7% 5.2% 3.1% 3.1%

Note Source

Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator) Death Notifications, Health Statistics Analysis

23

Cancer death cases by age group

53 52 48
Cases Rate per 1000

35 35 31 26 22 22 15 5 6 3
0.0
0-4 5-9

21 17
10.7

2
0.0 0.1

4
0.0
20-24

5
0.0
25-29

0.0
30-34

0.0
35-39

0.1

0.1

0.3

0.4
55-59

0.8
60-64

1.9

4.2

4.5
75-79

5.5
80-84

7.9

10-14

15-19

40-44

45-49

65-69

Note Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator) Source Death Notifications, Health Statistics Analysis

70-74

50-54

Age 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

%National %Female 60% 20% 33% 0% 33% 67% 0% 0% 50% 25% 0% 0% 40% 40% 32% 77% 27% 64% 26% 57% 20% 37% 34% 36% 35% 33% 31% 42% 35% 42% 48% 19% 58% 69% 41% 35%

85+

24

Population

Financing

Episodes

Payers

Claims

Providers

25

Episodes by type, setting and nationality

Inpatient ER Clinic

N/A

Center

National

Outpatient

Hospital

Expatriate

Setting

Provider

Nationality

Total Hospital Inpatient ER National Expatriate N/A Non-ER National Expatriate N/A Outpatient ER National Expatriate N/A Non-ER National Expatriate N/A Center National Expatriate N/A Clinic National Expatriate N/A

2011 SEHA 11'361'157 37% 5'774'551 40% 130'219 65% 45'138 94% 21'216 97% 21'232 92% 2'690 76% 85'081 49% 28'894 67% 40'135 41% 16'052 39% 5'644'332 40% 655'394 97% 354'837 99% 297'177 96% 3'380 61% 4'988'938 32% 1'647'896 57% 2'907'096 22% 433'946 2% 5'049'446 38% 2'269'165 63% 2'497'339 19% 282'941 1% 537'160 2% 103'564 7% 394'009 0% 39'588 0%

2010* SEHA* 10'998'469 34% 5'954'723 38% 136'725 63% 36'576 95% 18'311 98% 17'469 95% 796 22% 100'149 51% 40'878 75% 43'793 45% 15'478 4% 5'817'998 38% 575'654 95% 321'781 96% 251'751 93% 2'123 61% 5'242'343 31% 1'875'221 53% 3'000'493 21% 366'629 2% 4'528'463 31% 1'974'079 54% 2'340'605 15% 213'779 1% 515'283 1% 107'613 2% 380'371 0% 27'298 0%

Notes

An Episode is an inpatient Encounter or a set of outpatient Encounters linked to the same clinical case based on the patient (identified by insurance member ID), Episode Clinician the clinician responsible for consultation, and principal diagnosis. Episodes are attributed to facility types according to Episode Clinician facility as per clinician licensing database. Non-SEHA ER Episodes are underrepresented because of miscoding of ER Encounter types as outpatient. * Estimate based on Encounters reported in 2010 eClaims end Encounter/Episode ratios Source Cube 2011; Health Statistics Analysis

26

Episodes by diagnosis group, % of volume

Total % of Total Episodes 100 Signs, symptoms and ill-defined 19.5 Respiratory infections Musculoskeletal diseases Digestive diseases Endocrine disorders Respiratory diseases Cardiovascular diseases Genitourinary diseases Skin diseases Diabetes mellitus Sense organ diseases Injuries Infectious and parasitic diseases Oral conditions Nutritional deficiencies Neuropsychiatric conditions Maternal and Perinatal conditions Cancer Congenital anomalies RTA 13.6 8.3 6.6 6.0 5.8 5.0 4.6 4.6 4.1 4.0 3.7 3.6 2.8 2.7 2.2 2.1 0.5 0.3 0.1 100.0 Outpatient Non-ER 93.1 19.3 13.5 8.6 6.5 6.1 5.8 5.1 4.6 4.7 4.2 4.2 3.2 3.7 3.0 2.8 2.1 1.9 0.5 0.2 0.0 100.0 ER 5.2 22.5 18.7 6.3 6.9 2.1 5.6 3.3 4.2 2.7 2.4 2.4 13.2 2.0 0.9 0.5 2.2 2.8 0.3 0.2 0.8 100.0 Inpatient Non-ER 1.0 24.1 4.2 3.1 7.9 7.9 5.4 6.1 5.1 1.6 3.2 1.1 3.2 3.0 0.4 2.9 2.7 15.0 1.9 1.2 0.2 100.0 ER 0.7 17.0 6.1 2.0 7.6 9.9 5.4 8.4 4.6 2.0 5.3 1.2 5.8 4.6 0.4 2.9 4.3 9.2 1.4 1.0 1.0 100.0
27

Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

Episodes by diagnosis group, % of value

Total 100.0% Outpatient 70.3% Break down Services Procedures Drugs 8.3 59.0 30.6 1.9 0.4 1.4 0.4 0.6 0.2 0.4 0.5 0.0 0.4 0.3 0.3 0.2 0.3 0.5 0.5 0.0 0.1 0.0 0.0 12.1 4.6 3.8 2.7 5.1 2.1 2.3 3.8 6.7 1.7 2.7 2.1 1.6 1.6 1.9 2.0 0.9 0.9 0.3 0.0 3.0 6.0 3.7 3.1 2.4 0.3 1.6 1.2 0.2 1.8 1.9 0.5 1.0 1.1 1.3 0.6 0.4 0.3 0.0 0.0 Supplies 2.3 0.5 0.6 0.0 0.2 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.0 0.3 0.0 0.0 0.2 0.0 0.0 0.1 0.0 Inpatient 29.7% Break down DRG Services 47.2 15.2 8.6 0.7 2.5 5.7 1.4 7.8 3.8 1.6 0.1 2.6 1.5 4.2 1.0 2.0 0.6 0.4 1.7 0.1 1.0 1.7 0.1 0.8 1.2 0.4 1.9 0.8 0.5 0.1 2.2 0.5 0.9 2.5 0.6 0.2 0.3 0.3 0.0 0.3 0.0 Procedures Drugs 29.1 6.1 3.7 0.2 1.2 2.1 2.7 4.3 3.3 2.8 0.3 1.7 0.6 2.5 0.6 0.4 0.3 1.3 0.7 0.1 0.3 0.0 1.3 0.2 0.5 0.3 0.4 0.2 0.4 0.2 0.0 0.3 0.4 0.2 0.2 0.1 0.4 0.4 0.6 0.0 0.0 0.0 Supplies 2.6 0.2 0.0 0.0 0.7 0.3 0.1 0.2 0.1 0.0 0.1 0.2 0.2 0.1 0.0 0.0 0.2 0.0 0.0 0.0 % of Total value 100 Signs, symptoms and ill-defined Diabetes mellitus Respiratory infections Cardiovascular diseases Musculoskeletal diseases Maternal and Perinatal conditions Digestive diseases Genitourinary diseases Oral conditions Respiratory diseases Endocrine disorders Injuries Neuropsychiatric conditions Infectious and parasitic diseases Skin diseases Sense organ diseases Cancer Nutritional deficiencies Congenital anomalies RTA 17.0 8.6 7.8 7.4 7.3 6.1 5.5 5.5 5.0 4.9 4.4 4.3 3.4 3.1 3.1 3.0 2.0 1.0 0.8 0.0 100 17.5 11.6 9.0 6.4 8.2 2.7 4.3 5.6 6.9 4.1 4.9 2.8 3.0 3.1 3.7 3.2 1.5 1.4 0.4 0.0 100 15.5 1.2 5.0 10.0 5.3 14.3 8.4 5.2 0.5 6.9 3.2 7.9 4.4 3.1 1.5 2.5 3.3 0.2 1.8 0.0

Source

Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

28

Activities by type, % of value

CPT Pathology & Laboratory Evaluation & Management Diagnostic Ultrasound Radiology Musculoskeletal Digestive System Maternity Care & Delivery Integumentary Respiratory System Eye & Ocular Adnexa Urinary System Nuclear Medicine Cardiovascular System Female Genital System Radiation Oncology Auditory System Male Genital System Nervous System Other CPT Breast Mammography 100% 47.3% 16.1% 7.6% 7.4% 3.4% 3.4% 2.7% 2.4% 1.7% 1.7% 1.6% 1.1% .8% .6% .6% .5% .4% .4% .3% .2% 0.0% 100% 25.2% 15.6% 14.1% 12.8% 7.5% 5.1% 3.3% 2.6% 2.5% 2.4% 2.0% 1.9% 1.7% 1.1% .5% .4% .3% .2% .2% .2% .2% .1% .1% .1% .0% .1% OP* Drug Alimentary tract and metabolism Cardiovascular system Antiinfectives for systemic use Antineoplastic and immunomodulating agents Respiratory system Blood and blood forming organs Musculo-skeletal system Nervous system Dermatologicals Genito-urinary system and sex hormones Sensory organs Systemic hormonal preparations, excluding sex hormones and insulins Various Antiparasitic products, insecticides and repellents

HCPCS 2% Dental 5% Service 10%

CPT 46% DRG 14%

Drug 23%

Service Consultation Specialist Perdiem - Long Term Stay Consultation Consultant Consultation GP Room and Board: First Class Room Observation or Treatment room Perdiem - Haemodialysis (HD) Generic code for yet undefined services Outlier Payment Room and Board: Shared Room Per diem Intensive - Care Unit (ICU) Perdiem - Day Stay (Day care) Per diem N-ICU Per diem Inpatient Operating Room and Services Per diem - Special-Care Baby Unit (SCBU) Room and Board: Private Room Deluxe or better Comprehensive screening evaluation and management Perdiem - PICU - Daily Rate (Day 1 to 7) Room and Board: Ward Perdiem - Non-Medical Escort Perdiem - New-born Nursery - Daily Rate (Day 1 to 3) Perdiem - SCU - Daily Rate (Day 1 to 3) Perdiem - Room Rate difference Delivery Room Other services

OP*

100% OP* 22.9% 16.1% 15.3% 10.8% 8.8% 5.9% 5.9% 5.6% 2.5% 2.1% 1.8% 1.3% .7% .2% 0.0% DRG 100% OP* Newborns & Other Neonates 16.7% Diseases & Disorders Of The Respiratory System 16.3% Childbirth 11.5% Diseases & Disorders Of The Circulatory System 10.5% Diseases & Disorders Of The Digestive System 8.9% Diseases & Disorders Of The Musculoskeletal System & Connective Tissue6.7% Diseases & Disorders Of The Female Reproductive System 4.2% Diseases & Disorders Of The Nervous System 4.1% Diseases & Disorders Of The Ear, Nose, Mouth & Throat 3.5% Diseases & Disorders Of The Urinary Tract 2.9% Diseases & Disorders Of The Skin, Subcutaneous Tissue & Breast 2.6% Diseases & Disorders Of The Hepatobiliary System & Pancreas 2.3% Diseases & Disorders Of The Endocrine, Nutritional & Metabolic Systems 2.0% Infectious & Parasitic Diseases Of Systemic Or Unspecified Sites 1.9% Diseases & Disorders Of The Myeloproliferative System & Poorly Differentiated Neoplasms 1.4% Diseases & Disorders Of Blood, Blood Forming Organs, Immunological System 1.4% Mental Diseases & Disorders .8% Diseases & Disorders Of The Male Reproductive System .7% Injuries, Poisonings & Toxic Effects Of Drugs .6% Diseases & Disorders Of The Eye .6% Other DRG .4% 0.0% Dental 100% OP* Restoration 35.3% Diagnostic 11.7% Oralmaxillo 10.3% Adjunctivegeneral 9.8% Endodontics 9.3% Orthodontics 9.0% Prevention 7.1% Fixedprostho 3.5% Periodontics 2.9% Removableprostho 1.1%

* Dark area indicates proportion of outpatient Note Not all drugs have been mapped to the appropriate ATC code http://en.wikipedia.org/wiki/ATC_code_A02 ; HCPCS CMS Hospital Outpatient Payment system includes 90% unclassified drugs. Source Cube 2011; Health statistics analysis

29

Procedures by diagnosis group, % of value

Diagnosis group Signs, symptoms and ill-defined Oral conditions Musculoskeletal diseases Genitourinary diseases Diabetes mellitus Maternal and Perinatal conditions Digestive diseases Cardiovascular diseases Injuries Endocrine disorders Respiratory infections Sense organ diseases Respiratory diseases Neuropsychiatric conditions Skin diseases Infectious and parasitic diseases Cancer Nutritional deficiencies Congenital anomalies RTA 100 20 10 9 7 7 6 5 5 4 4 4 3 3 3 2 2 2 1 1 Top 5* 1st Complete Cbc W/Auto Diff Wbc (3.8%) Two Surfaces (5.6%) Knee Arthroscopy/Surgery (10.3%) Us Exam, Pelvic, Complete (6.6%) Lipid Panel (8.7%) Cesarean Delivery Only (16.4%) Upper Gi Endoscopy, Biopsy (6.8%) Echo Exam Of Heart (9.0%) Repair Superficial Wound(S) (9.2%) Lipid Panel (6.8%) Nasal Endoscopy, Dx (9.2%) Cataract Surg W/Iol, 1 Stage (13.7%) Nasal Endoscopy, Dx (14.6%) Psytx, Off, 20-30 Min W/E&M (7.2%) Drainage Of Skin Abscess (16.0%) Destruct B9 Lesion, 1-14 (6.5%) Pet Image W/Ct, Full Body (18.0%) Assay Of Vitamin D (14.3%) Echo Transthoracic (16.7%) Speech/Hearing Evaluation (31.2%) 2nd Ob Us >/= 14 Wks, Sngl Fetus (2.8%) One Surface (5.5%) Mri Lumbar Spine W/O Dye (8.4%) Fragmenting Of Kidney Stone (6.2%) Assay Of Parathormone (7.9%) Obstetrical Care (16.4%) Laparoscopic Cholecystectomy (5.6%) Cath Placement, Angiography (4.8%) Knee Arthroscopy/Surgery (8.3%) Assay Thyroid Stim Hormone (6.1%) Ther/Proph/Diag Inj, Sc/Im (7.5%) Treatment Of Retinal Lesion (6.4%) Airway Inhalation Treatment (7.2%) Speech/Hearing Therapy (5.6%) Photochemotherapy With Uv-B (4.1%) Transvaginal Us, Non-Ob (5.5%) Pet Image W/Ct, Skull-Thigh (10.6%) Assay Of Parathormone (5.6%) Suspension Of Testis (5.7%) Ct Head/Brain W/O Dye (9.7%) 3rd Echo Exam Of Heart (2.7%) Crown, Porcelain/Ceramic/Polymer Glass + L (5.4%) Therapeutic Exercises (5.0%) Transvaginal Us, Non-Ob (5.6%) Glycosylated Hemoglobin Test (7.8%) Ob Us >/= 14 Wks, Sngl Fetus (9.4%) Us Exam, Abdom, Complete (4.8%) Lipid Panel (4.6%) Mri Jnt Of Lwr Extre W/O Dye (5.3%) Assay Of Vitamin D (5.7%) Airway Inhalation Treatment (7.0%) Remove Impacted Ear Wax (5.6%) Remove Tonsils And Adenoids (6.3%) Psy Dx Interview (5.4%) Complete Cbc W/Auto Diff Wbc (3.1%) Us Exam, Pelvic, Complete (4.5%) Radiation Tx Delivery, Imrt (3.7%) Assay Of Ferritin (5.3%) Reconstruction Of Urethra (2.4%) Ct Neck Spine W/O Dye (9.3%) 4th Ob Us, Detailed, Sngl Fetus (2.3%) Three Surfaces (4.6%) Mri Neck Spine W/O Dye (3.7%) Hemodialysis, One Evaluation (4.1%) Assay Of Vitamin D (7.6%) Ob Us, Detailed, Sngl Fetus (6.3%) Laparoscopy, Appendectomy (4.6%) Extremity Study (3.1%) Remove Foreign Body From Eye (3.2%) Free Assay (Ft-3) (3.9%) Complete Cbc W/Auto Diff Wbc (6.0%) Ophth Dx Imaging Post Seg (5.6%) Ct Maxillofacial W/O Dye (5.1%) Motor Nerve Conduction Test (4.8%) Destruct B9 Lesion, 1-14 (3.0%) Complete Cbc W/Auto Diff Wbc (3.5%) Tissue Exam By Pathologist (2.6%) Assay Thyroid Stim Hormone (4.6%) Echo Exam Of Heart (2.3%) Ct Lumbar Spine W/O Dye (8.7%) 5th Us Exam, Abdom, Complete (2.3%) Class I Malocclusion + L (4.2%) Mri Jnt Of Lwr Extre W/O Dye (3.7%) Us Exam Abdo Back Wall, Comp (3.9%) Eye Exam With Photos (3.0%) Ob Us < 14 Wks, Single Fetus (6.0%) Colonoscopy And Biopsy (3.7%) Cardiovascular Stress Test (3.0%) Layer Closure Of Wound(S) (2.3%) Assay Of Free Thyroxine (3.6%) Chest X-Ray (4.0%) Eye Service Or Procedure (4.6%) Repair Of Nasal Septum (4.7%) Medication Management (4.0%) Ther/Proph/Diag Inj, Sc/Im (2.7%) Culture, Bacteria, Other (2.3%) Ct Abdomen W/Dye (2.2%) Complete Cbc W/Auto Diff Wbc (4.6%) Therapeutic Exercises (2.3%) Therapeutic Exercises (5.6%)

* Dark area in pie charts represents share of top 5 procedures within total value of diagnosis group Note Procedures: CPT excluding E&M codes Data should be interpreted with caution, particularly for categories with low counts Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

30

Drugs by diagnosis group, % of value

Diagnosis group Diabetes mellitus Respiratory infections Signs, symptoms and ill-defined Cardiovascular diseases Musculoskeletal diseases Endocrine disorders Respiratory diseases Digestive diseases Skin diseases Genitourinary diseases Infectious and parasitic diseases Neuropsychiatric conditions Sense organ diseases Cancer Injuries Maternal and Perinatal conditions Nutritional deficiencies Oral conditions Congenital anomalies RTA 100 18 12 11 10 8 6 6 5 5 4 4 3 2 2 2 1 1 1 Top 5* 1st Lipitor (10.2%) Augmentin (10.5%) Herceptin (6.8%) Lipitor (11.9%) Humira (12.2%) Lipitor (10.9%) Singulair (10.3%) Nexium (11.9%) Humira (15.2%) Gonal - F (9.2%) Lamisil (4.8%) Keppra (9.4%) Lucentis (18.9%) Glivec (12.5%) Augmentin (6.4%) Duphaston (7.4%) D-Forte (8.1%) Augmentin (37.9%) Tracleer (13.2%) Celebrex (24.3%) 2nd Janumet (7.9%) Rocephin (4.8%) Norditropin (2.5%) Plavix (7.2%) Celebrex (9.0%) Kogenate Fs (9.7%) Seretide Diskus (7.1%) Pantozol (7.1%) Remicade (10.0%) Ciprobay (6.2%) Baraclude (4.7%) Avonex (6.6%) Cosopt (4.6%) Herceptin (10.2%) Celebrex (5.8%) Clexane (7.0%) Lipitor (4.0%) Brufen (4.6%) Ventolin (12.8%) Lyrica (14.8%) 3rd Januvia (5.1%) Zinnat (4.4%) Lipitor (2.2%) Crestor (5.1%) Arcoxia (6.7%) Ceprotin (8.4%) 4th Lantus Solostar (4.7%) Omnicef (3.4%) Nexium (1.8%) Norvasc (4.1%) Lyrica (4.4%) Crestor (6.7%) 5th Crestor (4.5%) Klacid (2.8%) Glivec (1.8%) Exforge (2.7%) Voltaren (4.0%) Exjade (4.4%)

Symbicort Turbuhler (5.6%) Singulair Paediatric (4.0%) Pulmicort (4.0%) Humira (5.6%) Roaccutane (5.3%) Arnasep (4.3%) Pegasys (3.9%) Rebif (5.7%) Zaditen (2.7%) Revlimid (8.2%) Voltaren (5.1%) Promise Nunal (4.0%) Humira (3.5%) Cataflam (3.2%) Norditropin (8.6%) Augmentin (6.6%) Pariet (4.1%) Enbrel (5.2%) Tavanic (3.8%) Zovirax (3.7%) Zyprexa Velotab (4.3%) Travatan (2.7%) Sprycel (4.7%) Arcoxia (4.1%) Synagis (3.9%) One-Alpha (2.7%) Amoxil (2.6%) Synagis (7.6%) Brufen (5.5%) Remicade (3.3%) Augmentin (3.3%) Xatral Xl (3.5%) Peg-Intron (2.9%) Seroquel (4.2%) Augmentin (2.6%) Neulastim (3.7%) Zinnat (2.4%) Augmentin (2.8%) Nexium (2.4%) Metrolag (2.0%) Human Albumin (2.6%) Zinnat (5.3%)

* Dark area in pie charts represents share of top 5 drugs within total value of diagnosis group Note Data should be interpreted with caution, particularly for categories with low counts Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

31

Population

Financing

Episodes

Payers

Claims

Providers

32

Providers
Other 5% Store 5% Hospital 3%

Facilities Total Total Hospital Centers (various) Center Polyclinic Diagnostic Rehabilitation Clinic Pharmacy Store Other 1'354 35 494 151 216 21 106 265 427 67 66 SEHA 12% 34% 13% 39% 0% 29% 1% 1% 16% 4% 14% Abu Dhabi Eastern 934 19 348 98 159 12 79 180 277 60 50 362 10 124 40 52 6 26 81 127 7 13 Western 58 6 22 13 5 3 1 4 23 3

Clinicians Total Physicians SEHA Dentists SEHA 864 25% 167 32% 608 26% 296 54% 312 Nurses& AHP& SEHA SEHA Midwifes Pharmacists 10'504 60% 5'222 52% 7477 73% 2067 77% 1'504 39% 1'102 39% 1207 48% 722 54% 282 97 9 78% 99 40% 6 184 3% 207 7% 13 1'628 105 3% 1316 24% 307 2% 11 9% 112 63% 2'047 45% 8'331 64% 1 100% 2 50% 6'975 3'028 501 54% 73% 78% 37 261 2'338 2'583 70% 75% 45% 55%

Clinic 20%

Centers (various) 36%

Pharmacy 31%

Growth rate (CAGR 2007 - 11) 2011 2010 Hospital 35 33 Centers (various) 494 429 Clinic 265 239 Pharmacy 427 408 Store 67 60

2009 39 365 207 405 61

2008 37 386 196 369 62

2007 33 389 188 358 63

CAGR 1.5 6.2 9.0 4.5 1.6

21'490 4'900 47% 13'016 3305 60% 4'479 1'265 26% 3'176 951 34% 968 277 143 35 26% 192 2 417 118 3% 1'628 105 1'845 212 3% Breakdown by Nationality & Gender National Male 241 39% Female 380 77% Expatriate Male 2'958 44% Female 1'319 47% NA Male Female 2 100% Breakdown by Region Abu Dhabi 3'176 37% Al Ain 1'457 64% Western 267 78%

79

10 34 71 480 279

30% 44% 59% 20% 23%

3 100% 3'451 1'490 281 42% 69% 83%

586 246 32

20% 31% 72%

Notes

Source

Definitions of categories as per Health Facilities Licensing criteria, see www.haad.ae Seven Day Surgery Hospitals considered as Centers as per Health Facilities Licensing Criteria changes, One hospital was licensed by December 30, 2010. Behavioral Science Pavillion and Rehabilitation Center considered as part of SKMC as they are under SKMC management Liwa licensed as a hospital but doesn't have inpatients, therefore classified as a Center Al Ain Military Hospital added to the Eastern region Non-SEHA hospitals, not licensed by HAAD, but they do operate in Eastern region with about 130 bed capacity Clinicians licensing database; facility licensing database

33

Clinical performance

Target direction Indicator Episodes Hypertensive w treatment Thiqa episodes Obese w Lifestyle or drug treatment Episodes w Diabetics HbA1c>7% w/o Medication Episodes w Diabetics HbA1c>9% w/o Medication Episodes w Diabetics HbA1c>9% w/o Treatment Episodes w Diabetics w Microalbuminuria w/o ACE/ARB Episodes w Common Cold w Antibiotics Routine dental extraction w complication

Change Specialist GP 2011 2010-11 Public Private Hospital Center Polyclinic Clinic Consultant Specialist GP Dentist Dentist 51 % -4 % 49% 52% 48% 58% 49% 50% 55% 48% 52% 22% 36% 2% -4 % 3% 0% 1% 6% 6% 0% 3% 1% 4% 0% 0% 11 % +4 % 18% 8% 17% 5% 8% 7% 5% 13% 12% 33% 13% 11 % +4 % 16% 9% 16% 6% 7% 9% 5% 12% 13% 50% 20% 10 % +3 % 15% 8% 15% 6% 7% 9% 5% 12% 13% 50% 20% 95 % -3 % 91% 96% 93% 97% 98% 95% 97% 94% 96% 100% 38 % +1 % 18% 43% 38% 31% 50% 41% 47% 39% 37% 64% 45% 1% -0 % 1% 1% 1% 1% 1% 0% 0% 0% 0% 1% 1%

Notes

Performance is reported for Episodes with HAAD licensed clinicians. Performance is not shown for all categories of healthcare professionals or healthcare facilities. Rates shown are rates within breakdown category. Indicator definitions are available at https://www.shafafiya.org Source KEH Episodes with Encounter start date 1 January 31 December 2011 as at 5 April 2012

34

Labour productivity
Productivity

Indicative
Episodes (000)

Outpatient
468.3 339.0 174.7 125.3 52.8 111.8 476.6 356.4 59.1 192.9 186.5 343.3 220.5 95.3 516.5 92.7 541.8 63.4 85.2 125.9 10.3 325.7 322.6 34.3 47.3 28.7 33.2 124.7 45.0 21.6 15.4

Hospital*

Episodes per doctor per day

Al Ahalia

16.1 11.1 10.6 10.4 10.2 9.9 9.8 9.5 8.4 8.3 8.0 7.6 7.5 7.4 7.2 7.1 6.9 6.8 6.3 5.9 5.8 5.5 5.3 5.2 4.7 4.6 4.5 4.4 3.9 2.1 6.8

18.1 5.8 6.4 9.1 6.2 3.9 7.5 5.7 5.1 4.2 5.6 4.0 14.5 10.0 2.4 1.9 1.7 9.5 5.0 2.1 1.8 2.1 1.9 3.2 3.4 2.1 2.8 2.6 8.5 3.5 1.0 3.1

4.4 4.2 3.3 .8 .7 4.1 6.5 6.2 .2 3.1 2.6 5.1 1.0 1.6 16.8 14.9 11.9 .6 .7 7.4 .0 14.5 11.7 .5 .9 .4 .6 3.8 .1 .4 .3 129.4

Al Ahalia Al Noor - Al Ain Al Salama Oasis Al Wagan Al Noor Dar Al Shifaa

Al Noor - Al Ain Al Salama Dar Al Shifaa Al Wagan Oasis Al Noor Al Noor - Airport Road National N M C Specialty - Al Ain Life Line N M C Specialty

Al Noor - Airport Road

NMC Specialty - Al Ain

National Life Line

Gulf Diagnostic Center

Al Corniche
6.8

Tawam

NMC Specialty 2011 Average Life Line Hospital Al Musafah

Emirates International

Gulf Diagnostic Center Emirates International Tawam Al Corniche SKMC Specialized Medical Care Al Rahba Al Reef Internaional Al Ain Al Mafraq

SKMC Al Rahba Al Reef Internaional Al Ain Al Mafraq Emirates French Ghayathi

Specialized Medical Care

Life Line Hospital Al Musafah 6.7

Al Mirfa
Madinat Zayed

Al Silla
Delma

Al Raha

Seha

Emirates French Ghayathi Al Mirfa Al Silla

Other
Al Rewaise
3.1

Episodes per nurse per day

Madinat Zayed Al Raha Delma Al Rewaise Total/Average

5,636.5 8,113.1

Notes

Source

* Episode Clinician facility Productivity is defined as adjusted Episodes per clinician per day. To account for the higher resource need of inpatients, inpatient Episodes are multiplied by ratio of the average value (ClaimNet) of an Inpatient Episode versus an Outpatient Episode. To reflect clinical complexity inpatient Episodes are then adjusted by the difference of case mix index of each individual hospital from Abu Dhabi average. SEHA hospitals Episodes are underestimated due to certain SEHA clinical obligations such as public events medical preparation. Tawam hospital provides rotating staff to Al Wagan which effects both hospitals productivity. Cube 2011; HAAD licensing database; Health Statistics analysis

Total, Weighted
541.8 399.6 221.0 136.4 63.6 173.3 578.6 484.3 61.6 246.0 223.5 448.9 233.7 113.2 936.9 328.7 894.9 69.5 85.2 253.0 10.8 582.6 571.6 40.5 61.2 34.6 40.5 184.7 46.6 27.1 19.4

Inpatient

Doctor

Nurse

35

Hospital patient satisfaction, inpatient indicators

Note

Overall facility rating is based on a single question in the patient satisfaction questionnaire; Source: GRMC Advisory Services, 2010 Seven Day Surgery Hospitals considered as Centers as per Health Facilities Licensing Criteria changes.

36

Hospital patient satisfaction, outpatient indicators

Note

Overall facility rating is based on a single question in the patient satisfaction questionnaire; Source: GRMC Advisory Services, 2010 Seven Day Surgery Hospitals considered as Centers as per Health Facilities Licensing Criteria changes.

37

Hospitals
Episodes*, 000's Staff Beds Indicators Ambulances

Nurses & Midwifes

AHP &Pharmacists

Physicians

Dentists

Region

Hospital

Inpatient ER Non-ER
45.1 42.2 6.2 6.0 7.5 8.4 2.3 4.8 5.8 .2 .7 .1 .2 .2 .0 .0 85.1 41.8 10.6 5.7 4.4 6.1 1.6 10.1 1.6 .7 .0 .5 .2 .2 .0 .0

Outpatient

Bed Occupancy

Administration

Bed Capacity

Critical Beds

Royal

ER
655.4 637.2 181.0 59.8 120.3 127.9 34.4 13.6 58.5 12.6 7.3 5.8 9.6 6.4 .1 .1

Non-ER
4'988.9 1'596.2 335.5 262.8 421.5 197.8 90.3 79.1 67.4 34.7 45.6 27.4 19.1 15.2 .4 .4

Total SEHA Ea s tern Abu Dha bi Abu Dha bi Ea s tern Wes tern Abu Dha bi Abu Dha bi Wes tern Ea s tern Wes tern Wes tern Wes tern Military Abu Dha bi Ea s tern Other Abu Dha bi Abu Dha bi Abu Dha bi Abu Dha bi Ea s tern Abu Dha bi Ea s tern Abu Dha bi Abu Dha bi Ea s tern Abu Dha bi Ea s tern Abu Dha bi Abu Dha bi Abu Dha bi Abu Dha bi Ea s tern Abu Dha bi Wes tern Ea s tern Abu Dha bi Al Noor Al Aha l i a Al Noor - Ai rport Roa d N M C Speci a l ty Al Noor - Al Ai n Gul f Di a gnos ti c Center N M C Speci a l ty - Al Ai n Li fe Li ne Al Sa l a ma Oa s i s Da r Al Shi fa a Emi ra tes Interna ti ona l Li fe Li ne Hos pi ta l Al Mus a fa h L.L.C. Emi ra tes French Al Reef Interna i ona l Al Ra ha Speci a l i zed Medi ca l Ca re Na ti ona l Al Rewa i s e Al Ai n Cromwel l Women & Chi l drens Hos pi ta l Provi ta Interna ti ona l Medi ca l Center Ll c Za yed Mi l i ta ry Al Ai n Mi l i ta ry Ta wa m Al Ma fra q SKMC Al Ai n Ma di na t Za yed Al Corni che Al Ra hba Gha ya thi Al Wa ga n Al Si l l a Al Mi rfa Del ma

17.8 12.8 2'861 1'643 3'645 1'859 457 1'109 731 132 91 94 114 70 254 254
NA

3'305 1'966 443 314 470 305 99 127 106 30 15 22 18 17 149 149
NA

167 54 5 3 17 2 13 4 2 2 2 2 2 31 31
NA

7'477 5'328 1'096 821 1'434 791 197 478 329 49 28 39 45 21 37 37

NA

2'067 1'569 358 256 461 223 70 60 78 18 5 10 18 12 37 37

NA

4'904 3'889 959 249 1263 538 78 444 214 33 41 21 31 18 NA

NA NA

3'659 2'415 435 360 552 387 148 285 119 28 15 36 28 22 314 314
NA

598 442 82 59 138 56 21 50 36

107 54 20 8 10 6 8 2

21 13 2 2 4 2 3

ALOS

Total

VIP

73% 60% 70% 71% 30% 55% 82% 61% 40% 11% 21% 5%

6.9 6.7 11.9 6.9 4.2 3.8 4.9 6.8 3.1 2.6 5.1 0.9
NA NA NA

106 56 8 6 13 5 6 2 4 4 3 3 2

35 35
NA

18 18
NA

1 1
NA

41%
NA

NA NA

2.9 .1 .0 .2 1.1 .0 .1 .6 .0 .2 .0 .0 .1 .2 .0 .0 .0 .0 .0 .0 .0 .3

43.0 6.5 4.4 6.0 4.0 4.2 .9 2.5 2.5 3.1 4.1 .8 1.5 .5 .5 .0 .1 .6 .2 .3 .2 .0

18.1 .0 1.3 .7 .6 .0 .4 .6 1.2 8.7 1.9 .7 1.2 .2 .0 .0 .2 .0 .0 .0 .3 .0

3,390.1 476.6 467.0 355.7 342.7 339.0 220.1 192.3 185.3 165.9 109.9 124.5 94.1 85.0 34.3 10.2 44.7 63.3 59.1 15.4 4.7 .1

4742 454 225 429 870 345 358 266 237 168 420 100 93 96 163 33 54 73 66 87 121 84

1184 153 88 132 141 96 80 75 75 54 48 33 42 33 19 5 24 24 18 23 17 4

82 9 4 8 21 3 5 6 2 3 3 2 2 5 4 2 2 1

2018 212 82 231 305 190 44 160 110 94 123 41 31 47 35 16 15 20 33 54 96 79

443 80 21 58 55 45 23 23 25 17 24 11 10 14 4 1 2 6 8 8 7 1

1015 30 348 11 206 2 25 225 12 10 103 11 8 19 5

735 95 40 106 92 50 8 30 25 19 52 17 25 36 11 21 11 23 20 25 29

121 22 8 30 11 10 4 7 2 14 2 7 2

35 3 6 5 1 3 2

7 42% 78% 43% 62% 36% 0% 37% 60% 21% 75% 12% 16% 9% 0% 9% 4% 0% 2.2 2.5 2.7 4.1 1.6 1.3 2.1 0.4 3.5 0.9 0.9 0.8 2.8 0.6

50 1 2 2 9 4 2 8 7 1 4 1 1 6 1 1

2 6 2 2 2 1

Notes * Totals include data for SKMC Rehabilitation Center and Behavioral Science Pavilion as of 31st December 11; Episodes are attributed to facilities according to Episode Clinician facility as per clinician licensing database Source Hospital submissions, Operation Center, Clinician Licensing Database

38

Hospital inpatient profile by value

Diagnosis group Tawam SKMC Al Mafraq Al Ain Al Corniche Al Noor - Airport Road Al Rahba N M C Specialty Al Noor Provita International Medical Center Llc Al Ahalia Al Noor - Al Ain Oasis Life Line Madinat Zayed N M C Specialty - Al Ain Al Salama Abu Dhabi Rehabilitation Center Emirates International Behavioral Sciences Pavilion Gulf Diagnostic Center Ghayathi Dar Al Shifaa Emirates French Al Wagan Life Line Hospital Al Musafah Specialized Medical Care Al Silla Al Mirfa Al Rewaise Delma Al Raha National Al Reef Internaional Al Ain Cromwell Women & Children Hospital 100 18 14 10 9 7 6 4 4 4 4 3 2 2 2 2 2 2 1 1 1 Top 5* 1st Signs, Symptoms And Ill-Defined (20.9%) Cardiovascular Diseases (21.1%) Signs, Symptoms And Ill-Defined (18.0%) 2nd 3rd 4th Injuries (7.6%) Congenital Anomalies (8.2%) 5th Cancer (7.1%) Respiratory Diseases (6.4%) Maternal And Perinatal Conditions (14.5%) Cardiovascular Diseases (8.9%) Injuries (8.8%) Injuries (17.4%) Infectious And Parasitic Diseases (8.4%) Cardiovascular Diseases (16.1%) Digestive Diseases (10.7%) Genitourinary Diseases (1.2%) Digestive Diseases (11.4%) Maternal And Perinatal Conditions (11.1%) Digestive Diseases (6.9%) Cardiovascular Diseases (10.1%) Cancer (0.4%) Respiratory Diseases (8.3%) Digestive Diseases (7.1%) Signs, Symptoms And Ill-Defined (9.7%) Congenital Anomalies (0.1%) Musculoskeletal Diseases (6.2%) Respiratory Infections (6.8%) Signs, Symptoms And Ill-Defined (8.7%) Cardiovascular Diseases (7.3%) Endocrine Disorders (4.9%) Maternal And Perinatal Conditions (17.7%) Injuries (12.6%) Maternal And Perinatal Conditions (54.7%) Signs, Symptoms And Ill-Defined (43.4%) Maternal And Perinatal Conditions (26.0%) Cardiovascular Diseases (20.9%) Signs, Symptoms And Ill-Defined (27.4%) Cardiovascular Diseases (22.4%)

Maternal And Perinatal Conditions (25.2%) Injuries (8.6%) Digestive Diseases (15.7%)

Maternal And Perinatal Conditions (11.0%) Musculoskeletal Diseases (8.9%) Endocrine Disorders (8.7%) Signs, Symptoms And Ill-Defined (6.7%) Genitourinary Diseases (16.5%) Musculoskeletal Diseases (12.6%) Respiratory Infections (5.3%) Signs, Symptoms And Ill-Defined (8.0%) Cardiovascular Diseases (5.9%)

Maternal And Perinatal Conditions (32.4%) Digestive Diseases (14.2%) Respiratory Diseases (52.8%) Digestive Diseases (25.8%) Neuropsychiatric Conditions (19.1%) Cardiovascular Diseases (21.8%)

Maternal And Perinatal Conditions (10.4%) Injuries (5.1%) Cardiovascular Diseases (11.8%) Digestive Diseases (5.3%) Signs, Symptoms And Ill-Defined (9.4%) Injuries (12.5%) Respiratory Diseases (8.4%) Genitourinary Diseases (2.9%) Genitourinary Diseases (9.3%) Cardiovascular Diseases (9.7%)

Maternal And Perinatal Conditions (15.9%) Digestive Diseases (15.5%) Maternal And Perinatal Conditions (63.3%) Signs, Symptoms And Ill-Defined (16.3%) Digestive Diseases (23.2%)

Maternal And Perinatal Conditions (22.2%) Cardiovascular Diseases (13.8%) Digestive Diseases (13.1%) Musculoskeletal Diseases (15.6%) Injuries (12.3%) Genitourinary Diseases (2.6%)

Maternal And Perinatal Conditions (15.6%) Signs, Symptoms And Ill-Defined (13.4%) Digestive Diseases (18.7%) Respiratory Infections (16.7%) Neuropsychiatric Conditions (87.2%) Endocrine Disorders (31.7%) Neuropsychiatric Conditions (98.5%) Genitourinary Diseases (21.7%) Cardiovascular Diseases (17.2%) Cardiovascular Diseases (16.4%) Digestive Diseases (14.5%) Congenital Anomalies (5.4%) Digestive Diseases (17.3%) Signs, Symptoms And Ill-Defined (0.7%) Respiratory Diseases (21.4%) Respiratory Infections (16.4%)

Maternal And Perinatal Conditions (10.7%) Genitourinary Diseases (10.0%) Musculoskeletal Diseases (11.7%) Injuries (2.3%) Respiratory Diseases (8.8%) Cardiovascular Diseases (1.5%) Cardiovascular Diseases (6.0%) Cancer (0.1%) Respiratory Infections (8.3%)

Maternal And Perinatal Conditions (12.4%) Respiratory Diseases (10.7%) Maternal And Perinatal Conditions (0.3%) Digestive Diseases (13.6%) Digestive Diseases (16.3%) Respiratory Diseases (9.8%) Digestive Diseases (0.3%) Cardiovascular Diseases (8.3%)

Maternal And Perinatal Conditions (11.4%) Neuropsychiatric Conditions (9.4%) Genitourinary Diseases (5.2%) Cancer (3.3%) Signs, Symptoms And Ill-Defined (5.7%) Cardiovascular Diseases (7.6%) Cardiovascular Diseases (5.1%) Injuries (1.5%) Infectious And Parasitic Diseases (5.0%) Signs, Symptoms And Ill-Defined (6.5%) Digestive Diseases (9.2%) Neuropsychiatric Conditions (6.4%) Respiratory Diseases (6.3%) Respiratory Infections (8.3%) Respiratory Infections (7.9%) Digestive Diseases (9.2%) Respiratory Diseases (5.1%) Skin Diseases (7.5%) Signs, Symptoms And Ill-Defined (1.2%)

Maternal And Perinatal Conditions (38.2%) Digestive Diseases (22.1%) Respiratory Diseases (63.4%) Respiratory Infections (55.6%) Digestive Diseases (28.9%) Genitourinary Diseases (30.9%)

Maternal And Perinatal Conditions (24.1%) Genitourinary Diseases (3.9%) Digestive Diseases (13.8%) Respiratory Diseases (18.5%) Respiratory Diseases (15.7%) Respiratory Diseases (8.7%) Respiratory Infections (9.2%)

Maternal And Perinatal Conditions (12.6%) Respiratory Infections (11.9%) Respiratory Infections (15.7%) Digestive Diseases (14.2%) Cardiovascular Diseases (15.3%) Cardiovascular Diseases (12.7%) Cardiovascular Diseases (14.8%) Signs, Symptoms And Ill-Defined (8.4%) Signs, Symptoms And Ill-Defined (8.8%) Injuries (8.1%) Genitourinary Diseases (13.3%) Injuries (5.2%) Signs, Symptoms And Ill-Defined (8.8%) Respiratory Infections (1.8%)

Maternal And Perinatal Conditions (21.5%) Digestive Diseases (16.2%) Maternal And Perinatal Conditions (30.7%) Respiratory Infections (15.4%) Maternal And Perinatal Conditions (35.7%) Digestive Diseases (19.6%) Maternal And Perinatal Conditions (15.6%) Digestive Diseases (15.6%) Sense Organ Diseases (19.0%) Digestive Diseases (42.7%) Digestive Diseases (49.0%)

Maternal And Perinatal Conditions (14.9%) Respiratory Diseases (13.9%) Musculoskeletal Diseases (12.9%) Cardiovascular Diseases (9.8%) Cardiovascular Diseases (11.8%) Genitourinary Diseases (9.5%) Digestive Diseases (2.4%)

Maternal And Perinatal Conditions (89.9%) Congenital Anomalies (4.0%)

* Dark area in pie chart represents share of top 5 Diagnosis groups within the total value of providers services Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

39

Centres & Clinics

Region Facility Total Abu Dhabi Baniyas Khalifa A Shahama Al Bateen Abu Dhabi City Dental Center Bain Al Gesreen Al Zafarana Samha Disease Prevention And Screening Center Al Khaleej Al Khalidiya Urgent Care Al Mafraq Dental Center Al Zafra Dental Center Disease Prevention And Screening Center - Mussafah Al Khatim Airport Seha Dialysis Services Sheikh Khalifa Medical City Seha Dialysis Services Al Rahba Hospital Other Al Ain Neima Al Jahili Al Yahar Al Masoudi Primary Health Care Center Mezyed Muweiji Al Maqam Al Khabisi Clinic Tawam Dental Center Hili Niyadat Al Qua'A Oud Al Toba Primary Health Care Center Blood Bank Center Zakher Al Hayer Swaihan Remah Al Khazna Tawam Ivf Center Disease Prevention And Screening Center-Alain Other Western Liwa Hospital Al Dhafra Family Medicine Center Other Episodes (best estimate) 1'922'236 167'299 101'775 81'212 80'385 62'834 * 55'853 * 43'761 38'554 37'235 * 34'445 34'407 17'937 15'592 13'963 * 12'235 9'309 * 5'740 2'355 150'100 * 122'294 105'447 72'314 71'375 65'150 61'157 55'693 53'989 33'261 33'099 32'746 29'632 28'805 27'094 * 22'311 20'464 15'655 13'963 8'585 4'654 * 3'857 18'900 * 25'599 * 23'664 7'536 *

Dentists

335 9 25 19 6 0 19 3 10 16 3 6 0 0 6 6 4 0 0 8 18 21 9 10 13 13 10 13 0 6 7 6 6 1 7 6 5 5 3 2 8 5 9 8 4

160 2 7 5 0 27 5 0 5 0 0 0 29 5 0 2 0 0 0 3 4 0 3 1 3 8 3 0 39 1 1 2 0 0 0 1 1 0 1 0 0 0 2 0 0

600 3 37 27 9 8 37 8 17 15 8 20 0 5 7 11 14 13 15 18 22 29 22 14 18 21 18 16 0 10 14 12 13 0 11 11 11 9 9 6 13 11 17 17 4

426 8 25 17 1 10 18 0 9 50 0 0 27 10 21 4 0 0 0 13 8 10 3 1 6 19 6 2 65 2 6 3 3 13 0 0 1 2 0 13 26 5 4 5 10

Episodes (best Region Facility estimate) Total 3'664'370 1'058 533 1'122 5 Abu Dhabi Medical Services Administration Of Abu Dhabi Police Ghq 108'323 92 21 167 Al Noor Hospital Clinics - Al Mussaffah 94'620 7 0 10 0 Al Musaffah Al Alhli Medical Centre 89'325 14 1 10 Imperial College London Diabetes Centre 73'898 38 0 30 Adnoc Medical Center 72'143 * 21 10 25 New National Medical Centre 66'275 16 1 20 Prince Specialized Medical Centre 58'180 * 21 4 28 Dr. Ahmed Hassan Fikri Medical Centre 48'726 10 1 3 Al Amal Medical Centre 43'204 7 1 8 Ibn Al Nafis Medical Centre 39'482 15 2 6 Al Noor Hospital Speciality Clinics- Al Musafah 37'235 * 14 2 7 Amrita Midical Centre 33'648 14 5 9 Taha Medical Centre 33'222 9 6 6 Al Mafraq Medical Centre 32'233 7 2 3 Al Kamal Medicdal Poly Clinics- L L C 31'418 7 3 4 Advance Cure Diagnostic Centre L.L.C 29'720 19 1 8 Exeter Medical Center 27'926 * 12 0 2 Home Health Medical Centre L.L.C 25'927 8 1 5 Cosmesurge Emarites Hospital For One Day Surgery 25'895 25 3 27 Nadia Medical Center L.L.C 24'506 9 1 4 Al Musaffah Al Alhli Medical Centre - Branch 23'412 5 0 7 Adco Medical Centre 23'272 * 10 0 9 Al Hendawy Medical Centre 23'204 10 0 4 Golden Sand Medical Centre 21'113 5 1 5 Capital Medical Centre For Health Screening - L.L.C 20'945 * 9 0 9 Magrabi Specialized Hospital 20'287 10 0 6 Consultant Medical Centre 19'525 7 0 6 American European Medical Center 17'589 9 1 13 Etihad Airways Polyclinic 16'290 * 7 0 9 Al Hikma Medical Centre 16'290 * 0 7 4 Seha Emirates One Day Surgery Centerllc 16'290 * 7 0 5 Almazroui Hospital One Day Surgery 15'614 14 1 4 Ruwais Housing Medical Center 14'224 5 2 17 Al Rafa Medical Center L.L.C 13'380 7 1 8 Prime Medical Center 11'255 12 1 9 Oxford Medical Center 6'899 5 3 3 Al Rawdah German Medical Center - L L C 5'083 10 0 7 Al Bustan Medical Center 4'977 4 4 6 American Crescent Health Care Centre 4'023 5 1 5 Abu Dhabi Knee And Sports Medicine Center 3'327 5 0 15 National Petroleum Construction Company Medical Center 1'738 2 0 13 Canadian Medical Center Llc 1'513 0 1 13 Other 1'476'145 * 356 283 359 5 Al Ain Al Sultan Advanced Medical Clinics 51'065 10 3 1 Mubarak Medical Center 26'611 7 1 4 Dr. Khalid Aljamal Medical Center 12'179 4 3 4 Al Madar Medical Center - Branch 9'762 5 6 12 The Specialist Diabetes Treatment & Research Centre (Imperial College Diabetes Centre) Llc - Branch 3'975 2 0 14 Cosmesurge & Emirates Hospital For One Day Surgery Polyclinic L L 1'843 Ain Branch 1 C. Al 3 7 Uae University Clinics - Tawam Clinic 954 2 0 19 Other 584'634 * 119 141 116 Western Al- Noor Hospital Clinics - Madinat Zayed 61'380 7 0 4 Alnoor Hospital Speciality Clinics Llc Madinet Zayed Branch 34'908 * 14 1 5 Other 104'758 * 16 6 18
Dentists Nurses AHP

Nurses

Notes Source

List of Non-SEHA facilities with more than 10 clinicians, some centers Episodes were reported under the managing hospital * Includes estimates based on the number of clinicians and average productivity Cube 2011; Professionals licensing database; Extrapolation and Facility submissions

AHP

Physicians

SEHA

Physicians

Other

40

Critical care bed capacity

Source

Operation Center as of 31st December 2011

41

Bed occupancy
100% 75% 50% 25% 0% 100%
75%

Seha 2011 Average 2011

Private 2011 Average 2010

Occupancy above optimal level

Normal Ward

CICU

NICU

ICU

CCU

PICU

50% 25% 0% 100% 75% 50% 25% 0%

Notes

Isolation & Burns*

CCU/Medical Stepdown

SCBU

Jan

Apr

Jul

Oct

Jan

Apr

Jul

Oct

Jan

Apr

Jul

Oct

*All Burns beds are shown in green and are provided by SEHA. For the duration of 2010 and 2011 the occupancy in PICU Private was 0%. Optimal occupancy is 85% for normal beds and 75% for critical care beds. Source HAAD Operation Center

42

Blood Bank Donors

Year

2011 27'094 3'794 23'300 27'094 10'141 6'704 5'740 1'767 1'310 706 575 151

2010 25'850 4'240 21'610 25'850 9'441 6'620 5'423 1'727 1'274 711 521 133

2009 24'758 4'116 20'642 24'758 8'960 1'430 6'421 705 5'130 483 1'493 136

2008 21'834 3'832 18'002 22'379 8'314 5'840 4'294 1'302 1'346 667 501 115

2007 3'311

2006 2'664

National

Expatriate

Donors National Expatriate Units donated O + A + B + AB + O A B AB -

19'461 16'737 16'150 14'073 19'849 17'129 7'242 5'263 4'040 1'074 1'101 587 426 116 6'396 4'548 3'396 857 953 501 381 97

20'642

21'610

23'300

16'150
14'073

18'002

2'664 2006

3'311

3'832

4'116

4'240

3'794 2011

2007

2008

2009

2010

Source

Abu Dhabi Blood Bank, Health Statistics Analysis

43

Inpatient market by value

Diagnosis group Maternal and Perinatal conditions Signs, symptoms and ill-defined Cardiovascular diseases Digestive diseases Injuries Respiratory diseases Musculoskeletal diseases Neuropsychiatric conditions Respiratory infections Genitourinary diseases Infectious and parasitic diseases Endocrine disorders Cancer Congenital anomalies Diabetes mellitus Skin diseases Sense organ diseases Oral conditions Nutritional deficiencies RTA 100 17 14 12 9 8 7 5 5 4 4 4 3 3 2 1 1 1 Top 5* 1st Al Corniche (22.4%) Tawam (26.2%) SKMC (23.7%) Al Ain (11.1%) Al Mafraq (21.0%) Provita International Medical Center Llc (26.0%) Abu Dhabi Knee And Sports Medicine Center (34.4%) Abu Dhabi Rehabilitation Center (22.5%) Tawam (19.4%) Tawam (16.1%) SKMC (29.7%) Tawam (26.9%) Tawam (38.5%) SKMC (51.8%) Tawam (21.0%) SKMC (17.6%) SKMC (26.6%) SKMC (39.0%) SKMC (24.7%) Al Rewaise (100.0%) 2nd Tawam (14.4%) Al Corniche (22.3%) Tawam (13.2%) Tawam (9.7%) Tawam (16.8%) Tawam (14.4%) SKMC (12.1%) Tawam (17.3%) SKMC (13.9%) Al Ahalia (11.0%) Tawam (18.7%) SKMC (20.7%) SKMC (25.4%) Tawam (12.9%) SKMC (19.3%) Al Ain (12.4%) Al Mafraq (24.8%) Tawam (19.2%) Tawam (24.2%) 3rd Al Ain (9.1%) Al Mafraq (12.3%) Al Mafraq (13.0%) SKMC (9.6%) SKMC (14.8%) SKMC (11.3%) Tawam (7.2%) SKMC (15.7%) Al Ain (11.0%) SKMC (9.1%) Al Mafraq (11.3%) Al Noor (10.8%) Al Mafraq (10.2%) Provita International Medical Center Llc (8.1%) Al Mafraq (15.4%) Al Mafraq (11.8%) Al Ain (14.3%) Al Mafraq (16.2%) Al Mafraq (9.9%) 4th Al Noor - Airport Road (8.6%) Al Rahba (8.7%) Al Noor - Airport Road (10.2%) Al Ahalia (8.2%) Al Ain (14.4%) Al Ain (9.7%) N M C Specialty (6.9%) Provita International Medical Center Llc (14.2%) N M C Specialty (7.4%) Al Mafraq (7.0%) Al Ain (10.7%) Al Noor - Airport Road (8.3%) Al Ain (7.6%) Al Noor - Airport Road (6.9%) Al Ain (13.2%) Tawam (11.7%) Tawam (6.8%) Al Rahba (4.2%) Al Ain (7.9%) 5th Al Noor (7.9%) Al Ain (6.3%) N M C Specialty (8.1%) N M C Specialty (7.6%) Abu Dhabi Knee And Sports Medicine Center (4.9%) Al Noor - Airport Road (6.3%) Al Noor - Airport Road (6.5%) Behavioral Sciences Pavilion (10.9%) Al Mafraq (7.3%) Al Noor (6.9%) Al Rahba (5.0%) Emirates International (5.4%) N M C Specialty (2.8%) Al Ain (6.3%) Al Rahba (9.9%) Al Ahalia (5.6%) Al Raha (3.2%) Al Ain (2.8%) Al Noor - Airport Road (5.1%)

* Dark area in pie chart represents share of top 5 providers within the total value of diagnosis group Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

44

Outpatient market by value

Diagnosis group Signs, symptoms and ill-defined Diabetes mellitus Respiratory infections Musculoskeletal diseases Oral conditions Cardiovascular diseases Genitourinary diseases Endocrine disorders Digestive diseases Respiratory diseases Sense organ diseases Skin diseases Injuries Neuropsychiatric conditions Infectious and parasitic diseases Maternal and Perinatal conditions Cancer Nutritional deficiencies Congenital anomalies RTA 100 18 11 9 8 6 6 6 5 5 4 4 4 3 3 3 3 2 1 Top 5* 1st Tawam (16.6%) Imperial College London Diabetes Centre (41.0%) Al Noor (7.6%) SKMC (9.3%) Tawam Dental Center (14.0%) SKMC (12.2%) Tawam (13.1%) SKMC (17.0%) Tawam (7.4%) Al Noor (8.7%) Al Noor (10.9%) Al Noor - Airport Road (9.0%) Tawam (7.3%) SKMC (19.1%) Al Noor (10.5%) Al Noor (12.8%) SKMC (19.2%) Imperial College London Diabetes Centre (19.9%) SKMC (41.3%) 2nd Al Noor (6.2%) SKMC (5.9%) Al Noor - Airport Road (5.0%) Al Noor (7.3%) Al Mafraq Dental Center (7.0%) Al Noor (6.9%) SKMC (9.3%) Imperial College London Diabetes Centre (13.3%) Al Noor - Airport Road (6.6%) SKMC (6.3%) Samaya Specialized Center -SscLaser & Day Care Surgery Llc (9.9%) SKMC (8.2%) SKMC (7.2%) Tawam (14.1%) Tawam (8.2%) Tawam (11.0%) Al Mafraq (18.9%) SKMC (9.7%) Tawam (20.6%) 3rd SKMC (6.1%) Tawam (5.3%) N M C Specialty (4.5%) Tawam (6.4%) Abu Dhabi Dental Clinic (5.6%) Tawam (6.1%) Al Noor (6.6%) Tawam (10.1%) Al Noor (6.0%) Al Noor - Airport Road (6.1%) SKMC (7.6%) Al Noor (6.4%) Al Noor - Airport Road (6.4%) 4th Al Noor - Airport Road (5.2%) N M C Specialty (2.9%) Tawam (2.9%) Al Noor - Airport Road (5.4%) Bain Al Gesreen (3.4%) Al Noor - Airport Road (5.2%) Al Noor - Airport Road (5.2%) Al Noor (4.8%) SKMC (5.8%) Tawam (5.3%) 5th Al Noor - Al Ain (3.8%) Al Noor (2.7%) Al Noor - Al Ain (2.9%) N M C Specialty (5.3%) Madinat Zayed (2.8%) N M C Specialty (4.8%) N M C Specialty (3.9%) Gulf Diagnostic Center (4.2%) Gulf Diagnostic Center (5.7%) Gulf Diagnostic Center (3.2%)

Magrabi Specialized Hospital (6.9%) N M C Specialty (6.4%) Tawam (5.4%) N M C Specialty (6.2%) Al Mafraq (5.2%) Al Ain (6.1%) Al Mafraq (6.2%) Gulf Diagnostic Center (4.3%) Al Noor - Al Ain (3.6%) Tawam Molecular Imaging Centre (8.5%) Al Noor (3.8%) Al Noor (3.9%) N M C Specialty (1.7%)

Behavioral Sciences Pavilion (12.4%) Al Ain (7.2%) Al Noor - Airport Road (5.4%) Al Corniche (9.4%) Gulf International Cancer Center (17.7%) Gulf Diagnostic Center (6.1%) Al Noor - Airport Road (6.6%) N M C Specialty - Al Ain (4.4%) SKMC (4.6%) Al Noor - Airport Road (8.7%) Tawam (17.7%) Al Bateen (3.8%) Al Mafraq (5.4%) Al Ahalia (2.0%)

Step Home Health Care Centre (56.5%) Mafraq (29.6%) Al

* Dark area in pie chart represents share of top 5 providers within the total value of diagnosis group Source Cube 2011; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

45

Population

Financing

Episodes

Payers

Claims

Providers

46

Claims

Outpatient Inpatient

Claims per member per year, standardised(1) 260% Thiqa 285% Inpatient Inpatient Basic Inpatient Enhanced Inpatient Thiqa 70% Outpatient Outpatient Basic 58% Basic 62% Utilisation for Population (100%) Outpatient Enhanced Outpatient Thiqa Total Average ClaimNet (AED) 2011 10'861 9'006 9'380 12'939 300 154 342 364 390

86% Enhanced

Claims (000)(2) 2011 2010 131 166 38 35 35 55 59 15'197 4'138 4'860 6'199 15'328 76 12'918 2'928 4'146 5'844 13'084

2009 146 25 50 71 10'443 2'107 3'932 4'404 10'589

Claims per member 2011 2010 2009 0.05 0.06 0.06 0.03 0.03 0.03 0.03 0.05 0.05 0.13 5.39 3.1 4.6 14.0 5.44 0.18 4.84 2.4 4.0 13.8 4.90 0.18 4.52 2.3 4.0 11.2 4.58

Notes
Source

(1) (2)

Average for population is set to 100% to allow comparison across inpatient and outpatient utilisation Average Claim Net per Claim, represents claimed amount Cube 2011; Health Statistics analysis

47

Claims by provider
Facility Market Share Claim Net (AED) (1) Average Claim Net (AED) Inpatient Basic Enhanced Thiqa 9'006 15'552 16'271 7'614 9'208 11'374 8'359 9'626 6'535 6'301 10'412 7'649 6'488 5'525 6'383 7'481 5'185 6'949 9'380 16'522 15'617 10'113 12'545 9'575 7'145 9'466 9'735 8'856 7'945 5'123 8'913 6'664 6'688 9'979 7'385 4'737 12'939 14'962 22'531 11'712 10'887 12'349 12'182 8'014 10'776 7'925 6'778 9'621 11'712 5'962 1'592 5'624 6'153 9'380 201'160* 5'887 6'983 Outpatient Basic Enhanced 154 261 202 317 386 192 2'439* 166 287 334 110 230 90 259 194 148 251 262 97 87 214 344 313 655 394 70 125 293 208 225 100 342 662 509 612 601 457 1'884* 294 365 524 186 404 197 445 453 192 337 402 178 160 344 350 367 446 469 143 246 348 294 228 255 Thiqa 364 555 674 586 664 411 3'434* 312 354 524 203 466 233 676 378 272 324 406 214 184 304 303 354 667 434 200 282 353 286 274 241 Claims processing (days) Activity to Submission (2) Basic Enhanced Thiqa 40 56 41 32 35 54 47 49 35 30 45 26 53 28 31 51 37 26 26 58 38 38 52 59 22 21 28 45 37 36 45 53 36 40 41 56 54 52 54 33 56 36 55 46 43 62 47 36 26 57 53 43 78 61 22 23 40 67 48 43 41 52 36 32 31 53 53 49 35 30 47 24 53 26 29 48 35 25 27 57 42 33 38 59 39 57 21 25 28 43 43 33 Submission to Remittance (3) Basic Enhanced Thiqa 38 38 41 37 69 38 39 35 39 36 36 36 36 39 39 36 37 38 38 37 55 35 35 35 40 31 39 46 37 40 50 63 40 42 40 45 70 39 46 43 46 48 40 53 47 40 37 44 51 49 41 36 37 23 42 36 45 50 50 49 47 48 53 50 46 48 47 49 48 47 50 49 51 48 47 46 49 59 46 48 48 48 54 49 49 Total 5,982 Million Tawam 10.9% SKMC 8.2% Al Noor 5.2% Al Noor - Airport Road 4.8% Al Mafraq 4.8% Imperial College London Diabetes Centre 4.7% Al Ain 4.5% N M C Specialty 3.1% Al Noor - Al Ain 3.0% Al Corniche 2.3% Gulf Diagnostic Center 1.9% Al Rahba 1.9% Life Line 1.8% Al Salama 1.6% Al Ahalia 1.6% N M C Specialty - Al Ain 1.3% Oasis 1.2% Madinat Zayed 1.1% Baniyas 0.9% Provita International Medical Center 0.8% Dar Al Shifaa 0.7% Emirates International 0.7% Medical Services Administration Of Abu Dhabi Police Ghq 0.6% Tawam Dental Center 0.6% Specialized Medical Care 0.6% Khalifa A 0.6% Al Bateen 0.6% Al Noor Hospital Clinics - Al Mussaffah 0.5% Life Line Hospital Al Musafah 0.5% Abu Dhabi Knee And Sports Medicine Center 0.4% Other 28.6%

6'708 5'224

6'973 5'272

4'529

5'368

5'155

5'822 29'253* 5'490

4'143 32'958* 6'401

6'453 48'657* 9'795

Notes

(1) (2)

Source

Claim Net represents claimed amount. Data relates to providers licensed by HAAD. Market Share break down represents proportion of the total Activity to Submission represents average number of days to submit AED 1 from Activity Start Date to first Claim Submission Date, weighted by Activity Net (3) Submission to Remittance represents average number of days to remit AED 1 from first Claim submission date to first Remittance Advice submission date, weighted by Activity Net * Imperial College London Diabetes Centre, Provita International Medical Centre and Abu Dhabi Knee And Sports Medicine Center are specialised facilities that provide non-standard mix of services, which explains high average Claim Net SEHA facilities receive Government subsidy in addition to insurance Claims payments Cube 2011; Health Statistics analysis

48

Claim activities by provider

Inpa tient Activi ties per Cl a i m 38 100 22 37 28 28 41 20 24 10 24 18 28 20 25 21 17 1 12 15 Avera ge Activi ty Net (AED) 366 170 443 301 364 310 218 410 301 765 335 437 222 314 324 272 421 197'804* 549 407 11% 1% 56% 60% 2% 5% Outpa tient Activi ties per Cl a i m 2.2 2.0 4.9 6.1 2.0 18.3 84% 24% 44% 81% 13% 87% 20% 17% 36% 41% 32% 83% 6% 49% 35% 11% 69% 4% 50% 52% 46% 39% 40% 7% 2% 4% 2% 1% 3% 2% 5% 6% 4% 3% 2% 1% 8% 14% 11% 8% 12% 8% 22% 22% 10% 9% 25% 9% 100% 26% 24% 0% 9% 8% 0% 3% 0% 3% 4% 4% 9% 1% 0% 0% 5% 10% 3.5 4.5 4.8 2.3 16 317 24% 48% 5% 19% 4% 4.8 1.9 2.4 5.7 17 1 31 301 24'635* 323 59% 46% 30% 99% 20% 2% 16% 5% 18% 0% 1% 2% 4.7 1.5 2.7 86 70 70 259 88 85 103 56 51 149 73 67% 64% 44% 99% 72% 72% 48% 81% 71% 66% 59% 30% 20% 22% 46% 1% 18% 19% 42% 10% 20% 10% 9% 11% 9% 9% 34% 9% 13% 14% 10% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 2% 2.0 3.5 5.5 2.1 3.3 1.8 4.7 4.4 2.4 3.5 4.3 1.8 2.1 Avera ge Activi ty Net (AED) 228 251 107 95 161 160 119 96 77 86 117 99 79 76 65 87 77 83 71 Fa ci l i ty Ta wa m SKMC Al Noor Al Noor - Ai rport Roa d Al Ma fra q Imperi a l Col l ege London Di a betes Centre Al Ai n N M C Speci a l ty Al Noor - Al Ai n Al Corni che Gul f Di a gnos tic Center Al Ra hba Li fe Li ne Al Sa l a ma Al Aha l i a N M C Speci a l ty - Al Ai n Oa s i s Ma di na t Za yed Ba ni ya s Provi ta Interna tiona l Medi ca l Center Da r Al Shi fa a Emi ra tes Interna tiona l Medi ca l Servi ces Admi ni s tra tion Of Abu Dha bi Pol i ce Ghq Ta wa m Dental Center Speci a l i zed Medi ca l Ca re Kha l i fa A Al Ba teen Al Noor Hos pi tal Cl i ni cs - Al Mus s a ffa h Li fe Li ne Hos pi tal Al Mus a fa h Abu Dha bi Knee And Sports Medi ci ne Center Other DRG 80% 76% 24% 27% 90% Procedures 7% 9% 46% 40% 4%
(1)

Drugs 2% 3% 4% 4% 1%

(1)

Servi ces 10% 11% 18% 19% 5%

Suppl i es 0% 1% 8% 9% 0%

Procedures 52% 46% 69% 78% 40% 57% 54% 65% 79% 79% 73% 59% 69% 58% 81% 73% 67% 67% 53%

(1)

Drugs 34% 38% 22% 11% 49% 35% 26% 24% 8% 10% 17% 28% 22% 33% 1% 13% 21% 22% 36%

(1)

Servi ces 8% 7% 10% 11% 6% 3% 16% 11% 13% 10% 10% 11% 9% 9% 18% 13% 12% 9% 10%

Suppl i es 7% 10% 0% 0% 5% 6% 3% 1% 0% 1% 0% 2% 0% 0% 0% 1% 1% 2% 2%

Notes:

(1)

Source

Excludes mandatory 50% co-pay for drugs and dental procedure for Thiqa patients in non-SEHA facilities * Provita International Medical Centre provides specialised long-term care service, and Abu Dhabi Knee And Sports Medicine Center claims all services related to an orthopedic surgical procedure as a lump sum, which explains low number of activities and high average Activity Net SEHA facilities receive Government subsidy in addition to health insurance Claims funding Cube 2011; Health Statistics analysis

49

Population

Financing

Episodes

Payers

Claims

Providers

50

Payer members
Volume
Thiqa 16%
Total Thiqa Basic Total Enhanced Daman ADNIC Al Dhafra Oman Al Buhaira Al Wathba Green Crescent EIC ArabOrient Abu Dhabi Takaful AXA Al Hilal Takaful Methaq Takaful Al Sagr Qatar Al Khazna RAK ALICO Lebanese Al Fujairah Aman Al Ain Ahlia Al-Ittihad United Sharjah Saudi Arabian NoorTakaful Arabia Arabian Scandinavian Union Insurance House - PSC Royal and Sun Alliance NGI Salama Alliance Dubai Insurance Co. Takaful Emarat Dubai National

Members Market Share

Enhanced 37%

Basic 47%

Value

Enhanced 30%

Basic 8%

Thiqa 62%

100.0% 31.8% 14.4% 7.0% 6.7% 6.0% 5.3% 4.6% 3.0% 2.8% 2.2% 2.1% 2.1% 1.9% 1.7% 1.2% 1.1% 0.9% 0.9% 0.6% 0.5% 0.5% 0.4% 0.4% 0.3% 0.3% 0.3% 0.2% 0.2% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.0% 0.0% 0.0%

2011 2'818'958 442'261 1'322'804 1'053'893 335'593 151'247 73'549 70'101 63'263 56'059 48'591 32'083 29'997 22'988 22'449 21'723 20'523 17'710 12'304 11'167 9'508 9'239 6'457 5'269 4'764 4'269 3'781 3'403 3'299 3'057 1'801 1'662 1'332 1'269 1'216 1'216 937 745 588 383 328 23

2010 2'671'391 422'239 1'204'418 1'044'734 299'089 151'654 12'590 171'478 49'838 48'038 70'881 17'721 26'742 1'131 886 11'075 17'002 6'305 78'147 10'508 10'384 7'044 4'099 286 24'419 825

2009 2'312'569 394'618 936'207 981'744 301'447 90'190 957 205'690 51'215 41'583 21'341 15'167 1'524 3'537 5'003 27'661 9'332 137'648 11'368 1'030 3'596 36 258 23'857 3'645 2'445 47 443 1

2008 2'260'749 383'795 944'344 932'610 304'649 97'058 14'087 155'735 25'083

26'517 24'337 3'044

94'758 10'381 90'229 8'827 6'431 1'437 2'112 916 4'707 1'887 469 49 4'489

2'094 1'076 29

1'381 2'798 622 14'822 1'600

781 627 1'726 881 16'222

9 792 926 40'960 12'721

Change 2010-11 147'567 20'022 118'386 9'159 36'504 -407 60'959 -101'377 13'425 8'021 -22'290 14'362 3'255 21'857 21'563 10'648 3'521 17'710 5'999 -66'980 -1'000 -1'145 -587 1'170 4'478 -20'150 3'781 2'578 3'299 3'057 -293 586 1'303 1'269 1'216 -165 -1'861 123 -14'234 383 -1'272 23

Contracts 2011 2'843'849 454'118 1'326'663 1'063'068 341'729 151'247 73'561 70'130 63'265 56'059 48'591 32'083 30'051 22'988 22'461 21'727 20'523 17'710 12'304 11'283 9'508 12'036 6'457 5'269 4'764 4'269 3'781 3'403 3'299 3'062 1'801 1'663 1'332 1'273 1'216 1'216 940 745 588 383 328 23

PPMPA* 2011 2'371 602 3'019 4'746 3'761 775 2'195 839 1'714 2'571 2'246 1'814 2'609 3'672 1'249 928 1'275 2'283 1'046 2'667 3'782 789 1'061 1'977 2'831 2'478 2'372 744 3'993 3'135 2'693 1'265 2'151 2'297 5'347 3'216 3'371 3'648 1'168 1'823 2'246

Note Source

Market share applies to Enhanced products * Premium per Member Per Annum, Thiqa value is based on ClaimNet x 1.1 as a proxy for Premium Cube 2011; Health Statistics analysis

51

Payer claims
ClaimNet (1) 2011 15'432'738 6'080'751 4'015'083 100.0% 37.7% 21.7% 7.3% 5.5% 3.5% 4.6% 2.2% 1.6% 1.3% 1.6% 1.7% 1.4% 1.1% 0.6% 1.4% 0.8% 1.2% 0.8% 0.7% 0.9% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.2% 0.1% 0.1% 0.1% 0.1% 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% 5'336'904 2'010'955 1'160'175 391'019 292'777 188'644 243'697 117'510 83'302 69'589 85'622 91'765 72'257 60'996 34'163 74'364 45'121 63'518 43'065 38'935 45'464 16'223 17'098 11'204 11'584 11'196 8'458 10'413 9'374 6'406 4'479 4'377 3'353 1'888 2'764 1'674 1'912 1'543 20 5 2'597 172 18'245 3'055 487 1'017 4'702 4'950 158 1'680 3'656 6'404 1'841 7'145 1'297 3'635 4'483 8'936 1'474 60 7'750 2010 13'084'009 5'920'296 2'932'545 4'200'514 1'993'114 733'321 432'316 146'809 173'397 127'519 66'261 47'022 38'332 98'489 111'181 51'659 34'359 17'463 42'363 2 12'224 40'256 2'014 14'450 196 40'102 323'149 31'453 1'369 2'590 16'439 1'366 29'291 267'491 32'106 1'015 2'215 2'867 2009 10'589'348 4'475'578 2'132'354 3'996'092 1'656'879 42'914 806'221 67'127 89'700 84'053 69'999 366'736 124'824 72'831 79'801 49'146 14'480 677 55'499 72'802 134'390 47'742 6'326 101'078 47'599 36'874 3'557 1'319'825 2'668'098 1'287'361 32'814 523'760 2008 3'987'923

Change 10-11 2'348'729 160'455 1'082'538 1'136'390 17'841 426'854 -41'297 145'968 15'247 116'178 51'249 36'280 31'257 -12'867 -19'416 20'598 26'637 16'700 32'001 45'119 51'294 2'809 36'921 45'464 7'287 15'624 11'144 3'834 11'196 8'458 5'463 9'216 4'726 823 4'377 298 1'401 2'764 1'502 1'912 1'538 20

Days to Remit ClaimNet per Claims per 2011 (2) Claim 2011 Member 2011 47 50 38 46 40 62 26 76 49 58 75 35 390 482 234 403 444 452 363 383 276 198 344 484 425 326 300 354 361 121 47 126 327 134 380 145 77 64 58 103 640 260 422 267 372 352 245 438 407 459 386 330 418 274 304 346 485 346 230 40 37 326 512 341 542 227 179 544 5.4 13.7 3.0 5.1 6.0 7.7 5.6 6.0 3.4 3.9 3.7 2.8 7.5 20 8.2 3.1 5.0 11.2 3.4 2.0 3.1 4.5 2.2 0.6 9.8 18.2 3.3 6.4 3.4 22 1.6 2.0 1.2 3.7 1.2 4.5 5.8 2.2 2.8 1.6 1.2 0.9

Volume

Total Thiqa Basic Total Enhanced Daman ADNIC

Enhanced 35%

Thiqa 39%

Oman Green Crescent Al Wathba Al Buhaira EIC ArabOrient ALICO Al Ain Ahlia

Basic 26% Value

Al Khazna Abu Dhabi Takaful Qatar Saudi Arabian Al Hilal Takaful AXA Methaq Takaful RAK Al Sagr Al Dhafra Arabia NGI United NoorTakaful Sharjah Dubai Insurance Co.

Enhanced 36%
Thiqa 49%

Basic 15%

Lebanese Aman Al Fujairah Royal and Sun Alliance Al-Ittihad Salama Takaful Emarat Union Alliance Insurance House - PSC Arabian Scandinavian Dubai National

Notes

(1)

Source

Market share calculation applies to Enhanced products; Claim Net represents claimed amount (2) Days to Remit is measured as average number of days to submit AED 1 from first Claim Submission Date to first Remittance Date, using the following mathematical formulae: t xt / xt; {x} being the series denoted as Claim Net at duration t (3) Claim Net per Claim Cube 2011; Health Statistics analysis

52

Population

Financing

Episodes

Payers

Claims

Providers

53

Enhanced plans premiums

7,993

Average Gross Premium

4,383

3,413
2,504

5000+ AED, 168,000

1,469 685 601-999 AED, 260,000 1000 - 1999 AED, 155,000 2000 - 2999 AED, 202,000 3000 - 3999 AED, 131,000

40004999 AED, 104,000

Number of Contracts
Note Source 39,105 contracts have gross premium < 601 AED, inconsistent with the definition of GrossPremium on https://www.shafafiya.org KEH and Products Search Engine Database; Strategy Analysis

54

Enhanced plans limits

Benefit Level Basic Product Better than Basic Product

Geographic Coverage
+ Home Country, 14%

Annual Limit AED millions Other, 10% 5.00, 1% 2.50, 2% 1.50, 2% 1.00, 12% .40, 1%

% Cover Outside Network

100 (16%)

.50, 18%

80 (36%)

Member %

+ Internatio nal, 58%

.30, 24%

70 (2%) 20 (2%)

+ Other Emirates In/Outpatie nt, 27%

.25,

0 (44%) 30%

Other Emirates Emergency, 1%

Note Source

About 26% of the enhanced plans contracts are excluded due to non compliance with reporting of benefits information KEH and Products Search Engine Database; Strategy Analysis

55

Enhanced plans benefits

Member Count
Any Clinical Service > Basic Level
Miscellaneous Enhanced Clinical & Non Clinical

77%
76%

Dental Alternative Medicine Psychiatry Ophthalmology Home Nursing Congenital Disorders Chiropractic Rehabilitation Preventive care
Infertility

26% 16%
15%

11% 10% 8% 6% 4% 3% 2% 1% 0%
0%

Dietician Cosmetic treatment

Genetic Disorders

Note Source

Benefits are not mutually exclusive, a plan may have more than one of the listed benefits. About 26% of the enhanced plans contracts are excluded due to non compliance with reporting of benefits information KEH and Products Search Engine Database; Strategy Analysis

56

Capacity Masterplan
August 2012

Contents
Model Abu Dhabis model of care Model of care How health services are currently used, whats wrong? Model of care whats new Abu Dhabi working definition of World Class healthcare HAAD will regulate to drive Quality, Access and Cost-Efficiency Plan* Current service balance Service capacity balance by specialty Capacity gaps by sub-specialty Service capacity balance by location Planning for healthcare services Improving capacity management through regulating clinical service lines List of Abu Dhabi clinical service lines Centralised, Regional and Standard services, by % total Abu Dhabi DRG volumes Current and projected demand, by Episodes and beds Projected demand by Abu Dhabi planning region Projected demand by Abu Dhabi planning region, by number of beds Assumptions Health facility Locations Supply projections Population density Population growth, scenarios Demand projections Demand projections based on WHO disease classification Demand projections for doctors by specialty Recommendations Planning Recommendations Summary Facility recommendations for developers, investors, and healthcare Providers Service recommendations for investors and developers Recommendation for allocation of land and service provision Access requirements Case example C3 C4 C5 C6 C7 C9 C10 C11 C12 C13 C14 C15 C16 C17 C18 C19 C21 C22 C23 C24 C25 C26 C27

C29 C30 C31 C32 C33 C34

*Detailed plans for specific locations and services are available on https://www.shafafiya.org Note The data presented have been prepared to the best of our knowledge at time of release. Although effort has been invested to creating consistency and coherence, this should be considered work in progress. Feedback on content and layout are welcome.

C1

Model
Model of care How health services should be used
Patient self-care
DRAFT

Planning
Capacity Masterplan
Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way

Nationals

Facilities /10000

Hospitals

Hospitals

Clinics

Clinics

Remote support

Outpatient Clinic

Elective Admission

Screening

Ambulance

Check-up

Urgent Care Centre

Disease management

Triage

ER

Emergency Admission .

Preventative
Source

Emergency
Including diagnostics
11

Region District Abu Dhabi Desert Villages Al Falah Ghantoot District Abu Dhabi Island CBD/Financial Centre Musaffah Bani Yas Al Shahama Shamkhah Al Rahba New Port City Capital District South Bain Al Jesrain Khalifa City A Grand Mosque District Inner Islands Capital District North Al Mina Al Raha Yas Island Mohamed Bin Zayed City Saadiyat Airport District Lulu Island Capital District Mohamed Bin Zayed Centre South Hudayriat Island Marina Village Al Suwwah Al Reem Al Ain Umm Ghaffa Nahel Industrial City Al Salamat/Al Yaher Al Dhahra Abu Krayyah Al Saad Al Araad Abu Samra Al Ain City Al Quaa Al Wagan Al Hayer Al Dhaher Remah Sweihan Al Khazna Mezyad Al Shwaib Al Fagah Western Liwa Madinat Zayed Ruwais Mirfa Ghayathi Sila'a Delma Island

Gap now

Type Rural Rural Rural Urban Urban Urban Rural Rural Rural Rural Rural Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Rural Urban Urban Urban Rural Rural Rural Urban Rural Rural Rural Rural Rural Urban Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural

28,480 4,028 2,478 313,809 174,625 141,268 47,245 37,831 15,839 15,315 11,740 9,247 7,694 5,317 5,257 2,804 2,371 1,070 827 776 328 122 98 75

8,851 5,196 48,803 37,544 4,958 4,108 3,829 3,791 1,942 343,002 12,512 11,865 11,484 10,641 8,187 7,880 7,350 6,407 3,260 2,089 20,000 29,000 16,000 15,000 8,000 5,000 5,000

#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?

10,963 1,996 44,004 14,141 2,256 27,267 16,361 10,674 13,038 4,565 33 4,927 2,703 1,837 480 2,121 53 397 1 95 32

None None None 229 124 36 43 10 None 1 None None 3 11 None 2 7 2 None 2 None 6 None None None None 3 None None None None 8 1 None None None None None 186 1 1 3 1 1 1 2 None 1 1 5 16 4 4 6 1 1

13 5

182 86 31 37 10 1

2,529 1,131 161 162 45 132 1 1

3,878 1,663 194 106 47 325

430 241 21 57 14 5

1,284 539 68 73 24 89

6.2 5.2 2.2 7.8 2.6 0.7

8.1 6.5 1.1 3.4 1.2 8.6

12.4 9.5 1.4 2.2 1.2 21.2

3 10 1 1 1 4 1 2 4

33 78 2 426 87 41 1 8

42 74 4 792 103 42 2 11

10 17

17 75

3.9 20.7 3.6 8.4 37.4

4.3 14.7 0.7 179.7 81.3 49.6 3.0 81.6

5.5 13.9 1.4 334.0 96.3 50.8 6.1 112.2

1 1

36 25 9 4 5

302 62 12 2 11

5,873 2,377 18 23,400 715 655 702 139 286 100,298 4,912 3,330 2,570 7,325 683 713 1,071 3,809 1,546 378 661 6,785 1,270 3,676 3,898 2,139

5 1

14 3

5 1

1 6

1.0 0.3

0.3 0.1

0.1 0.0

7 1

148 1 3 1 1 1 2 1 1 1 1 11 3 3 5

1,733 8 17 25 13 6 8 4 3 3 8 175 50 32 38 22 23

2,864 13 29 34 20 9 11 13 4 3 17 256 100 61 63 39 25

318 1 1 4 3 1 1

968 3 4 3 4 2 1

4.5 0.8 0.8 2.6 0.9 1.2 1.3 2.7 3.1 4.8 1.0 4.5 2.5 2.7 7.5 2.0 2.0

5.1 0.6 1.4 2.2 1.2 0.7 1.0 0.5 0.9 1.4 0.4 6.0 3.1 2.1 4.8 4.4 4.6

8.3 1.0 2.4 3.0 1.9 1.1 1.4 1.8 1.2 1.4 0.9 8.8 6.3 4.1 7.9 7.8 5.0

1 2 1 1 1 1 1

5 23 7 3 5 2 2

32 107 14 17 18 10 10

81,520 95,972 97,522 111,191 15,375 (41,268) 22,755 72,169 114,161 94,685 138,260 45,753 17,306 64,683 114,743 17,196 67,629 98,930 119,173 99,224 49,672 119,878 49,902 19,925 240,000 80,000 100,000 5,000 30,000 200,000 3,049 4,804 30,937 36,456 1,042 892 1,171 209 558 364,298 10,488 18,135 20,516 3,709 1,313 32,120 1,650 1,993 2,240 1,411 45,000 11,000 114,000 60,000 7,000 65,000 5,000

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1

Clinics

Other

Total

Total

Population Growth

Hospitals

Dentists

Doctors /1000

Nearby hospital

Doctors

Nurses /1000

Nurses

Non-emergency/elective

1 1

3 4 1

1 1 6 1 3

1 1 1 1 2 1 1 1 1 1 8 1 1 2 1 1 2 1 1 1 1 1

3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Capacity Gap Severe Moderate None

Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

Assumptions
Population growth, scenarios
As at 31 December 2010 Draft

Recommendations
Land requirements Guidelines for urban planners
Population (000s people) Land provision options Land area Co-location GFA4 OR (m2 000s) (m2 000s) OR 6 ?3 2.5 7 Parking (spaces) Minimum service requirement

DRAFT

For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines:
Estimated Resources Residential Transient1
OR

4.0 High 3.5

Population (millions)

Population growth, Scenarios

Clinics2 4-5 8-12

12-15 24-36

25 30

Low
Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

National 411'200 416'150 422'200 429'400 437'800 445'800 453'600 460'500 467'600 473'600

3.0 2.5 2.0 1.5

1.0
0.5

Expatriate Low 1'945'000 1'970'000 2'060'000 2'130'000 2'175'000 2'250'000 2'310'000 2'360'000 2'400'000 2'475'000

High 2'045'000 2'190'000 2'350'000 2'505'000 2'675'000 2'850'000 3'045'000 3'240'000 3'400'000 3'575'000

?3 ?3
?3
n/a n/a

Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service

2 Physicians 4-6 Physicians

12-30
30-40 Hospitals5 60-80 90-110 Ambulance 10-16 Stations 16-40
Notes
1Transient

36-90
90-120 180-240 270-330 30-48 48-120

8.5
12 80 100 3 4

3.5
4.5 n/a n/a n/a n/a

35
45 3/bed 3/bed 10 15 Emergency services Laboratory services Radiology services Stand-alone building Ambulance service (land /air) Ambulance service (land /air)

7-14 Physicians
15-20 Physicians 180-240 Beds6 270-330 beds6 1 Ambulance 2 Ambulances

?7 ?7

0.0

Note

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data`

73

population includes staff and other non-residential visitors Clinics, Centers and Polyclinics Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4Clinic GFA may be provided within larger commercial centre with adequate transport options and shared parking 5 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accesibility of existing hospital facilities 6Optimal hospital size is 200-600 beds 7Appropriate facilities for co-location with Ambulance Stations include Clinics, Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Source HAAD Health Facility Community Guidelines 2009, Strategy analysis
2Clinics collectively refers to 3Appropriate facilities for co-location with Clinics include Hospitals,

2030 Population
110,000 100,000 100,000 425,000 190,000 100,000 70,000 110,000 130,000 110,000 150,000 55,000 25,000 70,000 120,000 20,000 70,000 100,000 120,000 100,000 50,000 120,000 50,000 20,000 240,000 80,000 100,000 5,000 30,000 200,000 11,900 10,000 79,740 74,000 6,000 5,000 5,000 4,000 2,500 707,300 23,000 30,000 32,000 14,350 9,500 40,000 9,000 8,400 5,500 3,500 65,000 40,000 130,000 75,000 15,000 70,000 10,000

% National

Hospitals required

Clinic required

C2

Abu Dhabis model of care

Healthcare in Abu Dhabi faces growing demand for services arising from an expanding populationC12,C24 that has a deteriorating health statusC26. The current population is young and has a high rate of chronic diseases that is set to increase as it ages. The current model of care in Abu Dhabi does not adequately support self care or prevention screening programmes and diagnostic services are not integrated into care plans. Also, patients have undirected access to services and specialty care which leads to inappropriate use and, in turn, over-supply of servicesC4. In response HAAD is developing integrated care pathways and further developing its Weqaya screening programme. It has issued a new RFP for the provision of Weqaya data services. Historically, Abu Dhabi has had a relatively limited supply of healthcare services, particularly hospital beds, which led to investment in infrastructure3. Achieving world-class quality care, however, is about much more than new buildingsC6. Before embarking on large-scale projects which affect community healthcare services long-term, it is important to be clear on what type of healthcare is appropriate for the evolving communities and population of Abu Dhabi in the 21st century.

Abu Dhabis model of care (see page C5) describes how healthcare should look in future and is based on robust international experience**. The focus is on empowering patients. As a first step, pro-active check-ups and convenient routine follow-up should help prevent disease. When there is a condition, patients should be supported to care for themselves, where appropriate given the growing burden of chronic disease the reality is that most such care is already managed by patients (and their families) themselves. This should be supported by targeted home care and the integrated use of telemedicine*. This has been shown to improve quality, and improve access in rural areas. Patients will clearly still have reactive access to appropriate elective and emergency care, but this should be streamlined and optimised from the patients perspective through an emphasis on early clinical triage. Diagnostics, for instance, should be available everywhere to enable one-stoptreatment. In order to promote the use of home care and telemedicine HAAD has developed new At Home and telemedicine standards. Making such ambitious changes to our healthcare system will requires countless small decisions on what to do and what not to do. HAADs quantitative definition of world-class quality careC6 helps clarify how trade-offs should be made in delivering health services and transitioning to the new model of care. HAAD is facilitating these changes through the adoption of payment incentives, introduction of care pathways and streamlining of licensing processes in accordance with the intended service structureC9.
C3

*A randomised controlled trial of child psychiatric assessment conducted by videoconferencing. Alford, R et al (2000) . ** Impact of home care on hospital days: a meta analysis. Hughes, SL et al (1997)

Model of care How health services are currently used, whats wrong?
There are no systems in place to support patient self-care and management of chronic disease

Open access1

Outpatient
Primary care centre/ clinic Hospital ER

Inpatient

Ambulance

Specialist

Hospital admission
Screening programmes are not (yet) fully aligned to prevent and treat chronic conditions

Hospital specialist
Screening
Patient access to services is not streamed: leading to over-servicing, oversupply and inappropriate service use
Notes Source
1Access

Laboratory and radiology

Diagnostics

Diagnostic services are not optimally integrated into treatment paths

to Seha hospital specialists is only via referral from Seha Centres/Clinics and ER departments. Some Seha Hospital ER departments also direct non-emergency patients to adjacent Urgent care centres Strategy analysis

C4

Desired model of care whats new?

Patient self-care Non-emergency/elective

Remote support

Outpatient Clinic

Elective Admission

Screening

Ambulance

Check-up

Urgent Care Centre

Disease management

Triage Including diagnostics

ER

Emergency Admission .

Preventive
Source

Emergency
C5

Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

Abu Dhabi working definition of World Class healthcare

Quality
Health system Health performance indicators reviewed by Clinical Quality Panel, e.g., % of well-controlled diabetics Citizen satisfaction with health system Pathway Pathway performance indicators reviewed by Clinical Quality Panel, e.g., Diabetics with regular HbA1c tests Provider Provider performance indicators reviewed by Clinical Quality Panel Patient satisfaction from standardised survey conducted by HAAD Service level, such as Hotel services, e.g., 10 beds per ward for Basic, 2 per room most Enhanced, single room for Thiqa Intervention/Investigation level beyond a guideline-determined floor, e.g., it may be indicated to do 2 standard ultrasound scans per pregnancy, but an Enhanced/Thiqa plan may cover more scans or higher specification scans Clinician experience, such as qualification level/years of experience of a clinician, e.g., Thiqa has preferential access to Consultants; Basic may have more junior Doctors, as long as Clinicians act within their respective privileges
1 2 3 4

Absolute targets must be met by all plans (including Basic), while improvements are paid for by differential budget

Absolute target Target varies by plan

Access
Network size Inpatients: >1 inpatient Provider per 250,000 population for Regional secondary and simple tertiary care services and 1-2 Provider(s) for complex tertiary care4 Critical care bed occupancy [<90%] Outpatients: primary care within [30 minutes]; specialist outpatient care at least in Abu Dhabi or Al Ain, unless tertiary specialty Waiting time Emergency: [Ambulance arrival <20 mins; Waiting time in ER <4 hours] Elective: [<3 months in all cases] Ambulatory: [<1 month in all cases] Schedule of Benefits Authorization requirement Exclusions (Dental, Mental health) Member incentives Assume no material changes in the short run for Basic/Enhanced which are equilibrating, while there is still quite some movement on the structure of Thiqa benefits, including member incentives

Cost

Reimbursement Market prices as a principle within a price corridor 1-3x HAADs Basic product2 Pay for Quality premium based on Provider quality (expected to be up to 10%) Reimbursement structure is fixed Reflects severity: DRGs for inpatients and E and M logic for outpatients Capital 6 Million AED/bed [US average] 23,000 AED/m2 [US average] Premium+Subsidy per member1 in AED as Health systems are designed to revenue Basic 1950 ~Thailand Enhanced 3400 ~Turkey Thiqa 16000 ~England Assumptions for evolving reimbursement Pay for Health pilots for Thiqa (shortterm) Tendering process a la Medicare to set Lab rates for Basic product (short-term) Introduce capitation elements for outpatients, e.g., primary care in the medium term

Includes Insurance premiums, Thiqa payments, as well as funded mandates and capital, but not loss transfers . Government determines budgets for Basic and Thiqa, while Employers determine effective budgets for Enhanced, while Individuals can choose to add discretionary spending on health This refers to Cost limits/Prices; Funded mandates to follow the same logic and price levels as insurance-based system Exceptions to market pricing are Specialised services provided by certified Providers for which HAAD sets a uniform base rate; non-market DRGs only provided by SEHA at that time, where HAAD sets Gap=0 and Marginal=100% Providers may be outside Abu Dhabi, but within the UAE if travel/accommodation are covered and Provider complies with HAAD standards Health Authority Abu Dhabi 2011

C6

HAAD will regulate to drive Quality, Access and Cost-Efficiency

In addition to developing the model of care and planning for healthcare need, HAAD will: 1. Promote the use of homecare, telemedicine and screening programmes by creating necessary prerequisites in terms of financing (schedule of benefits), reimbursement (payment codes) and licensing/accreditation, and then aligning HAADs licensing, care standards and quality audit practices accordingly. For instance, homecare reimbursement has been enabled recently, screening in the Weqaya and Visa programmes are being aligned, while telemedicine financing and reimbursement will be clarified. 2. Create/continue taskforces for key planning areas with the mandate to align financing, reimbursement, licensing and quality audit to address capacity gaps and ensure care is integrated across the Emirate: 2 key specialties: Emergency services and Mental Health Rural Transformation to address the specific healthcare challenges faced by rural communities of Abu Dhabi, including guidelines for serving communities of <4,000 residents, e.g., using clinician rotations, mobile clinics, homecare and telemedicine to improve access Designation of Centralised and Regional services. Allocation of Centralised and Regional services to specific facilities will ensure that concentration of clinical experience can lead to improved clinical outcomes for patients, and the more efficient use of resources. Quality, Access and Cost outcomes will be reviewed regularly and Provider designation updated in light of these reviews. Prioritise licensing of healthcare professionals where there are acute shortages. Intensive and Critical Care, Emergency Medicine, Neonatology, Cardiology and Psychiatry, as well as rural areas in general

3.

4.

5.

Maturing and strengthening licensing standards and procedures, e.g., by streamlining processes and supporting clinical training and privileging within the Professional Qualification Requirements (PQR). C7

Model
Model of care How health services should be used
Patient self-care
DRAFT

Planning
Capacity Masterplan
Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way

Nationals

Facilities /10000

Hospitals

Hospitals

Clinics

Clinics

Remote support

Outpatient Clinic

Elective Admission

Screening

Ambulance

Check-up

Urgent Care Centre

Disease management

Triage

ER

Emergency Admission .

Preventative
Source

Emergency
Including diagnostics
11

Region District Abu Dhabi Desert Villages Al Falah Ghantoot District Abu Dhabi Island CBD/Financial Centre Musaffah Bani Yas Al Shahama Shamkhah Al Rahba New Port City Capital District South Bain Al Jesrain Khalifa City A Grand Mosque District Inner Islands Capital District North Al Mina Al Raha Yas Island Mohamed Bin Zayed City Saadiyat Airport District Lulu Island Capital District Mohamed Bin Zayed Centre South Hudayriat Island Marina Village Al Suwwah Al Reem Al Ain Umm Ghaffa Nahel Industrial City Al Salamat/Al Yaher Al Dhahra Abu Krayyah Al Saad Al Araad Abu Samra Al Ain City Al Quaa Al Wagan Al Hayer Al Dhaher Remah Sweihan Al Khazna Mezyad Al Shwaib Al Fagah Western Liwa Madinat Zayed Ruwais Mirfa Ghayathi Sila'a Delma Island

Gap now

Type Rural Rural Rural Urban Urban Urban Rural Rural Rural Rural Rural Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Rural Urban Urban Urban Rural Rural Rural Urban Rural Rural Rural Rural Rural Urban Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural

28,480 4,028 2,478 313,809 174,625 141,268 47,245 37,831 15,839 15,315 11,740 9,247 7,694 5,317 5,257 2,804 2,371 1,070 827 776 328 122 98 75

8,851 5,196 48,803 37,544 4,958 4,108 3,829 3,791 1,942 343,002 12,512 11,865 11,484 10,641 8,187 7,880 7,350 6,407 3,260 2,089 20,000 29,000 16,000 15,000 8,000 5,000 5,000

#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?

10,963 1,996 44,004 14,141 2,256 27,267 16,361 10,674 13,038 4,565 33 4,927 2,703 1,837 480 2,121 53 397 1 95 32

None None None 229 124 36 43 10 None 1 None None 3 11 None 2 7 2 None 2 None 6 None None None None 3 None None None None 8 1 None None None None None 186 1 1 3 1 1 1 2 None 1 1 5 16 4 4 6 1 1

13 5

182 86 31 37 10 1

2,529 1,131 161 162 45 132 1 1

3,878 1,663 194 106 47 325

430 241 21 57 14 5

1,284 539 68 73 24 89

6.2 5.2 2.2 7.8 2.6 0.7

8.1 6.5 1.1 3.4 1.2 8.6

12.4 9.5 1.4 2.2 1.2 21.2

3 10 1 1 1 4 1 2 4

33 78 2 426 87 41 1 8

42 74 4 792 103 42 2 11

10 17

17 75

3.9 20.7 3.6 8.4 37.4

4.3 14.7 0.7 179.7 81.3 49.6 3.0 81.6

5.5 13.9 1.4 334.0 96.3 50.8 6.1 112.2

1 1

36 25 9 4 5

302 62 12 2 11

5,873 2,377 18 23,400 715 655 702 139 286 100,298 4,912 3,330 2,570 7,325 683 713 1,071 3,809 1,546 378 661 6,785 1,270 3,676 3,898 2,139

5 1

14 3

5 1

1 6

1.0 0.3

0.3 0.1

0.1 0.0

7 1

148 1 3 1 1 1 2 1 1 1 1 11 3 3 5

1,733 8 17 25 13 6 8 4 3 3 8 175 50 32 38 22 23

2,864 13 29 34 20 9 11 13 4 3 17 256 100 61 63 39 25

318 1 1 4 3 1 1

968 3 4 3 4 2 1

4.5 0.8 0.8 2.6 0.9 1.2 1.3 2.7 3.1 4.8 1.0 4.5 2.5 2.7 7.5 2.0 2.0

5.1 0.6 1.4 2.2 1.2 0.7 1.0 0.5 0.9 1.4 0.4 6.0 3.1 2.1 4.8 4.4 4.6

8.3 1.0 2.4 3.0 1.9 1.1 1.4 1.8 1.2 1.4 0.9 8.8 6.3 4.1 7.9 7.8 5.0

1 2 1 1 1 1 1

5 23 7 3 5 2 2

32 107 14 17 18 10 10

81,520 95,972 97,522 111,191 15,375 (41,268) 22,755 72,169 114,161 94,685 138,260 45,753 17,306 64,683 114,743 17,196 67,629 98,930 119,173 99,224 49,672 119,878 49,902 19,925 240,000 80,000 100,000 5,000 30,000 200,000 3,049 4,804 30,937 36,456 1,042 892 1,171 209 558 364,298 10,488 18,135 20,516 3,709 1,313 32,120 1,650 1,993 2,240 1,411 45,000 11,000 114,000 60,000 7,000 65,000 5,000

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1

Clinics

Other

Total

Total

Population Growth

Hospitals

Dentists

Doctors /1000

Nearby hospital

Doctors

Nurses /1000

Nurses

Non-emergency/elective

1 1

3 4 1

1 1 6 1 3

1 1 1 1 2 1 1 1 1 1 8 1 1 2 1 1 2 1 1 1 1 1

3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Capacity Gap Severe Moderate None

Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

Assumptions
Population growth, scenarios
As at 31 December 2010 Draft

Recommendations
Land requirements Guidelines for urban planners
Population (000s people) Land provision options Land area Co-location GFA4 OR (m2 000s) (m2 000s) OR 6 ?3 2.5 7 Parking (spaces) Minimum service requirement

DRAFT

For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines:
Estimated Resources Residential Transient1
OR

4.0 High 3.5

Population (millions)

Population growth, Scenarios

Clinics2 4-5 8-12

12-15 24-36

25 30

Low
Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

National 411'200 416'150 422'200 429'400 437'800 445'800 453'600 460'500 467'600 473'600

3.0 2.5 2.0 1.5

1.0
0.5

Expatriate Low 1'945'000 1'970'000 2'060'000 2'130'000 2'175'000 2'250'000 2'310'000 2'360'000 2'400'000 2'475'000

High 2'045'000 2'190'000 2'350'000 2'505'000 2'675'000 2'850'000 3'045'000 3'240'000 3'400'000 3'575'000

?3 ?3
?3
n/a n/a

Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service

2 Physicians 4-6 Physicians

12-30
30-40 Hospitals5 60-80 90-110 Ambulance 10-16 Stations 16-40
Notes
1Transient

36-90
90-120 180-240 270-330 30-48 48-120

8.5
12 80 100 3 4

3.5
4.5 n/a n/a n/a n/a

35
45 3/bed 3/bed 10 15 Emergency services Laboratory services Radiology services Stand-alone building Ambulance service (land /air) Ambulance service (land /air)

7-14 Physicians
15-20 Physicians 180-240 Beds6 270-330 beds6 1 Ambulance 2 Ambulances

?7 ?7

0.0

Note

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data`

73

population includes staff and other non-residential visitors Clinics, Centers and Polyclinics Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4Clinic GFA may be provided within larger commercial centre with adequate transport options and shared parking 5 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accesibility of existing hospital facilities 6Optimal hospital size is 200-600 beds 7Appropriate facilities for co-location with Ambulance Stations include Clinics, Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Source HAAD Health Facility Community Guidelines 2009, Strategy analysis
2Clinics collectively refers to 3Appropriate facilities for co-location with Clinics include Hospitals,

2030 Population
110,000 100,000 100,000 425,000 190,000 100,000 70,000 110,000 130,000 110,000 150,000 55,000 25,000 70,000 120,000 20,000 70,000 100,000 120,000 100,000 50,000 120,000 50,000 20,000 240,000 80,000 100,000 5,000 30,000 200,000 11,900 10,000 79,740 74,000 6,000 5,000 5,000 4,000 2,500 707,300 23,000 30,000 32,000 14,350 9,500 40,000 9,000 8,400 5,500 3,500 65,000 40,000 130,000 75,000 15,000 70,000 10,000

% National

Hospitals required

Clinic required

C8

Current service balance

To obtain an accurate picture of capacity balance in Waiting times have been reduced across all specialties
the Emirate, results from a detailed 2011 survey of 574 Clinicians were synthesised through interviews with Hospital Medical Directors and a number of quantitative sources including IPC data. Capacity Gaps Intensive and Critical Care medicine is the most severe capacity gap impacting healthcare services within Abu Dhabi. Severe capacity gaps also exist in Emergency care, NICU, Cardiology and PsychiatryC9. Small reductions in the number of clinicians licensed have occurred in Intensive and Critical Care medicine and Emergency care. Modest increases have occurred in the other specialties facing shortages Neonatology, Cardiology and PsychiatryC10. Health challenges. Growth in demand for healthcare services associated with the prevention and treatment of cancer, cardiovascular disease, diabetes, neuropsychiatric conditions is expected to be particularly high. Growth in demand for outpatient services is generally anticipated to be greater than for inpatient servicesC26. Growth. The number of clinicians licensed within the emirate has grown by 159 (3%) since the end of 2010 continuing to ensure wider coverage across the range of specialties, 798 new clinician licenses were issued during the same period. The number of facilities offering healthcare has also grown by 96 (6% ) to 1,729C10. with the exception of slight increases in waiting times for family medicine and radiology as more facilities offer a broader range of specialtiesC10. The private sector has been responsible for the largest proportion (75%) of growth in healthcare capacity, however this growth has been predominantly in areas such as general and internal medicine, alternative medicine and dentistryC10. There has been little or no growth in the specialties where capacity gaps exist with the exception of Obstetrics and Gynecology and Paediatric where further capacity is also expected to be added by new and existing Providers in the futureC22. Improving capacity management through regulating clinical service lines. From 2013 HAAD will license clinical services within facilities (by DRG). Centralised and Regional services. In order to improve coverage and concentrate clinical expertise (and thus improve quality and cost efficiency) HAAD will designate a limited number of Regional services each serving a population of ~250,000 residents. For complex and highly specialised Centralised services HAAD will designate 1-2 Abu Dhabi Providers to serve the whole Emirate.

C9

Service capacity balance by specialty

As at 31 December 2011

Capacity Balance Critical capacity gap Severe capacity gap No capacity gap % private/public capacity Growth - public private Growth - public Waiting times High Intermediate Low Shorter than 2010 Longer than 2010

Note

Gaps Sub specialty gaps have been identified such as pediatric Cardio physiology, Pediatric Rheumatology and Hand Surgery by IPC data Medical Board, these gaps mainly reflect in small volume in Abu Dhabi and which are addressed via the IPC Program. Source Gaps: 2011 survey of 575 clinicians; 2012 Interviews with Medical Directors; Planning analysis; Episodes: KEH; Physicians and Facilities: Licensing database; Waiting times: 2011 TPA analysis. Note Growth compares 2011 to 2010. C10

Capacity gaps by sub-specialty

Subject to regular update

Specialty
Paediatric Ophthalmologist Paediatric Neuro-ophthalmic Specialist Paediatric Cardiac Electrophysiology Paediatric Epilepsy Surgical Specialist Paediatric Upper Arm & Hand Specialist Paediatric Spinal Surgery Specialist Paediatric Immunologist Paediatric Neuro-Muscular Specialist Paediatric Onco-Ophthalmic Paediatric Ortho-Oncology Specialist - Sarcoma Paediatric Retina , Cornea & Glaucoma Specialist Paediatric Rheumatologist Ortho-Oncologist specialist (Sarcoma) Foot & Ankle specialist Hand, Micro-Constructive hand surgeon Dystonia Specialist Glaucoma Specialist Congenital heart disease in adult Fetal Medicine Gynaecology Pelvic Floor Specialist Movement Disorder Specialist Ear Reconstruction Specialist Micro vascular Plastic Reconstruction Facial Palsy Plastic Surgery

Notes Sub-specialty gaps are subject to dynamic change; Sub-specialty gaps identified based on Medical Board referrals abroad for treatment (under International Patient Care, IPC) Source IPC 2011 Annual Statistics Report

C11

Service capacity balance by location

Population
% National Nationals

Facilities
Hospitals Clinics & Centres Nearby hospital

Clinicians
Dentists Doctors Nurses

Ratios
Facilities /10000 Doctors /1000 Nurses /1000

2030 Plan growth Population Growth 74,511 55,408 4,802 (120,775) 107,788 (136,927) 25,578 14,868 192,544 (1,909) 8,220 43,477 33,710 73,374 35,643 7,656 75,045 65,209 103,669 67,768 287,591 82,133 64,363 23,135 270,106 80,000 100,000 14,132 28,907 169,888 3,755 4,570 (15,477) (21,963) 354 1,864 (309) (270) (960) 348,828 7,411 13,368 18,654 6,877 3,788 15,088 2,155 4,651 1,248 32 23,744 2,079 72,995 44,058 28,398 7,186 (2,014)

Hospitals Clinics
Ambulance station 2030 Population under way under way

Other

need

need

Total

Total

Region District Abu Dhabi Desert Villages Al Falah Ghantoot District Abu Dhabi Island CBD/Financial Centre Musaffah Bani Yas Al Shahama Shamkhah Al Rahba New Port City Capital District South Bain Al Jesrain Khalifa City A Grand Mosque District Inner Islands Capital District North Al Mina Al Raha Yas Island Mohamed Bin Zayed City Saadiyat Airport District Lulu Island Capital District Mohamed Bin Zayed Centre South Hudayriat Island Marina Village Al Suwwah Al Reem Al Ain Umm Ghaffa Nahel Industrial City Al Salamat/Al Yaher Al Dhahra Abu Krayyah Al Saad Al Araad Abu Samra Al Ain City Al Quaa Al Wagan Al Hayer Al Dhaher Remah Sweihan Al Khazna Mezyad Al Shwaib Al Fagah Western Liwa Madinat Zayed Ruwais Mirfa Ghayathi Sila'a Delma Island

Gap now

Type Rural Rural Rural Urban Urban Urban Rural Rural Rural Rural Rural Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Rural Urban Urban Urban Rural Rural Rural Urban Rural Rural Rural Rural Rural Urban Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural

Capacity Gap Severe Moderate None Underserved Potential over supply Clinic size, Large Medium, Small

35,489 5,019 3,088 391,040 217,602 176,035 58,872 47,142 19,737 19,084 14,629 11,523 9,588 6,626 6,551 3,494 2,955 1,333 1,031 967 409 152 122 93 9,250 5,430 51,004 39,237 5,182 4,293 4,002 3,962 2,030 358,472 13,076 12,400 12,002 11,121 8,556 8,235 7,682 6,696 3,407 2,183 41,256 59,821 33,005 30,942 16,502 10,314 10,314

#NAME? 13,661 #NAME? 2,487 #NAME? #NAME? 54,834 #NAME? 17,621 #NAME? 2,811 #NAME? 27,747 #NAME? 20,388 #NAME? 13,301 #NAME? 16,247 #NAME? 5,688 #NAME? 41 #NAME? 6,140 #NAME? 3,368 #NAME? 2,289 #NAME? 598 #NAME? 2,643 #NAME? 66 #NAME? 495 #NAME? 1 #NAME? 118 #NAME? #NAME? 40 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 6,138 #NAME? 2,484 #NAME? 19 #NAME? 24,455 #NAME? 747 #NAME? 685 #NAME? 734 #NAME? 145 #NAME? 299 #NAME? 104,822 #NAME? 5,134 #NAME? 3,480 #NAME? 2,686 #NAME? 7,655 #NAME? 714 #NAME? 745 #NAME? 1,119 #NAME? 3,981 #NAME? 1,616 #NAME? 395 #NAME? 1,364 #NAME? 13,996 #NAME? 2,620 #NAME? 7,583 #NAME? 8,041 #NAME? 0 #NAME? 4,536

2 None None 229 124 36 43 10 None 1 None None 3 11 None 2 7 2 None 2 None 6 None None None None 3 None None None None 8 1 None None None None None 186 1 1 3 1 1 1 2 None 1 1 5 16 4 4 6 1 1

12

0.6

0.2

0.3

1 1 1 3 3 1 2

1L 2L 1S 1L 1L 1M 2L 1S 1L 1L 1M 1L 1S 1M 1L 3L 2L 2L 2L 1L 1M 1L 1L 1M 1M 2L 1S 1S 1 1S 1S 1S 1S 1 1

1 1 1

13 5

182 86 31 37 10 1

2,529 1,131 161 162 45 132 1 1

3,878 1,663 194 106 47 325

430 241 21 57 14 5

1,284 539 68 73 24 89

5.0 4.2 1.8 6.3 2.1 0.5

6.5 5.2 0.9 2.8 1.0 6.9

9.9 7.6 1.1 1.8 1.0 17.0

1 1

1 1 1 1 1 1 1 1

3 10 1 1 1 4 1 2 4

33 78 2 426 87 41 1 8

42 74 4 792 103 42 2 11

10 17

17 75

3.1 16.6 2.9 6.8 30.0 19.4

3.4 11.8 0.6 144.2 65.2 39.8 2.4 65.5

4.4 11.2 1.1 268.1 77.2 40.8 4.9 90.1

1 2 3 1 1

1 1

36 25 9 4 5

302 62 12 2 11

2 1 1 1

1 1 1 1 1 1 1

5 1

14 3

5 1

1 6

1.0 0.3

0.3 0.1

0.1 0.0

1 1 1 1 1 1 1

7 1

148 1 3 1 1 1 2 1 1 1 1 11 3 3 5

1,733 8 17 25 13 6 8 4 3 3 8 175 50 32 38 22 23

2,864 13 29 34 20 9 11 13 4 3 17 256 100 61 63 39 25

318 1 1 4 3 1 1

968 3 4 3 4 2 1

4.3 0.8 0.8 2.5 0.9 1.2 1.2 2.6 2.9 4.6 0.2 2.2 1.2 1.3 3.6 1.0 1.0

4.8 0.6 1.4 2.1 1.2 0.7 1.0 0.5 0.9 1.4 0.2 2.9 1.5 1.0 2.3 2.1 2.2

8.0 1.0 2.3 2.8 1.8 1.1 1.3 1.7 1.2 1.4 0.4 4.3 3.0 2.0 3.8 3.8 2.4

3L 1M 1M 1M 1S 1S 1M 1S

2 1 1 1 1 1

2 1 1 1 1 1

5 23 7 3 5 2 2

32 107 14 17 18 10 10

1L 1S 1L 1L 1M 1S

1 1 1

110,000 60,427 7,890 Supply 270,265 325,390 39,108 84,451 L, M, S 62,010 212,281 17,175 22,849 55,000 43,298 80,000 42,194 11,151 78,000 66,543 104,699 68,735 288,000 82,285 64,485 23,228 270,106 80,000 100,000 14,132 28,907 169,888 13,005 10,000 35,527 17,274 5,536 6,157 3,692 3,692 1,069 707,300 20,487 25,768 30,656 17,998 12,344 23,323 9,837 11,347 4,655 2,215 65,000 61,900 106,000 75,000 44,900 17,500 8,300

Source Population: SCAD, 2010 Estimate, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

C12

Planning for healthcare services

Current capacity gaps. Geographic coverage in the Emirate is generally good. There are, however, severe capacity shortfalls in the Desert Villages, Al Falah and Ghantoot districts. In Al Ain region, Umm Ghaffa, Nahel and Al Dhahra are underserved as is Liwa in the western region.C12. During Q4 2012 HAAD seeks to centrally procure for primary care facilities in these locations. Based on HAAD planning RecommendationsC32 moderate gaps exist in other rural locations. In rural areas, the key to patient access to high quality healthcare requires innovation in delivering services, not primarily building new facilities. This might include the use of mobile and visiting clinics, and clinical staff on a visiting or rotational basis. In larger settlements of the Western region, the pre-existing hospitals will need to adapt and respond to changing and growing needs, rather than the development of new access points. Significant population growth. The Abu Dhabi Urban Planning Council (UPC) 2030 Plan envisages the population of Abu Dhabi Emirate doublingC12. In Abu Dhabi region the old core (Abu Dhabi Island and Musaffah) is expected to reduce over time, with aggressive growth off island and in rural areas, e.g., Mohammed Bin Zayed, Capital District, Shamkha, and Al Reem Island populations are projected to grow by over 820,000 respectively. Growth in 17 of the 28 districts is projected to exceed 60,000 in each case. Population in the villages along the road stretching east from Bani Yas and west of Al Ain city is anticipated to grow to over 74,000 transforming it from a predominately rural area to an urban corridorC12. The Al Ain city population is projected to double by 2030 with more modest growth expected in the surrounding rural areasC12. Western region population is projected to almost double to over 378,000 with the biggest growth in Ruwais, Ghayathi, Mirfa, and LiwaC12. Significant additional capacity is required to meet growth in demand for healthcare services as the population growsC25 and
Source Abu Dhabi Urban Planning Council. http://www.upc.gov.ae/

ages. In existing developed areas the emphasis is on growing existing facilities to facilitate specialization and scale. Existing development plans are focused on or close to existing population centres: Hospitals, clinics and emergency network. According to HAAD recommendations for allocation of land and service provisionC32 the 2030 projected populations would require a maximum of 17 new small-to-medium general hospitals and 56 (31 Large,11 Medium and 14 Small) new clinicsC12 to provide local access to the expanding communities. The actual number required will depend on many factors including the extent to which existing facilities expand or improve efficiency of services. The current ambulance service network will also need to expand to support populations in newly developed and remote areasC12. Clinical staff. During 2011 the number of licensed Doctors within grew by 3%C10. Attracting and retaining qualified staff remains a challenge for healthcare services across the emirate, particularly in rural areas. It is estimated that by 2021 up to 3,200 additional doctors and 5,900 nurses will be required, if turnover remains high, this translates into 1,500 doctors and almost 1,600 nurses to be recruited annuallyC25. Clinical training and education of a world class standard must be established locally to build a sustainable healthcare workforce and service supply. The risk of potential oversupply of healthcare requires careful management. For example, Khalifa City A currently has 3 provisional hospital projectsC12, despite a projected 2030 population of only 80,000C12. Similarly, Al Ain city has 5 provisional hospital projectsC12 with potential demand for 3C12. In contrast to these examples, there are few health facility projects in rural areas of the emirateC22. HAAD guidelines for urban planners and developers aim to ensure building of healthcare facilities occurs when demand exists, not years in anticipationC31.

C13

Improving capacity management through regulating clinical service lines

Description Highly specialised Strong volume based competency Low volume High cost Examples* Burn Care Open Heart Surgery Oncology surgery

Government subsidised
Non-Government subsidised

Provider(s) Initially public (subject to review)

Centralised1

Regional2
(Island/Middle, Eastern and Western)

Moderate complexity Time dependency Some volumebased competency Middle volume Middle cost Non-complex High volume Low cost

Cardiac catheterisation Specialist diabetes care

Public and private

Standard

Basic diabetes care Family medicine Preventive services

Open market

1 HAAD 2 HAAD

will restrict provision of these services to 1-2 facilities will issue licenses for these services on the basis of 1-5 per 250,000 population Source Categories maintained by HAAD with input from Providers, Payers, and other stakeholders

C14

List of Abu Dhabi clinical service lines

For Planning and Licensing purposes HAAD will designate Centralised, Regional and Standard services (at DRG level) within the following 32 clinical service lines:

Burns Cardiology - Invasive Cardiology - Medical Cardiothoracic surgery Dentistry Dermatology Endocrinology ENT Gastroenterology General medicine General surgery

Gynaecology Haematology Immunology and infectious disease Neonatology Nephrology Neurological surgery Neurology Obstetrics Obstetric - Delivery Oncology Ophthalmology

Orthopaedic Plastic surgery Psychiatry Rehabilitation Respiratory medicine Rheumatology Transplant surgery Trauma Urology Vascular surgery

Source

Categories maintained by HAAD with input from Providers, Payers, and other stakeholders

C15

Centralised, Regional and Standard services, by % total Abu Dhabi DRG volumes
# 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 HAAD Service Line Burns Cardiology - Invasive Cardiology - Medical Cardiothoracic surgery Dentistry Dermatology Endocrinology ENT surgery Gastroenterology General medicine General surgery Gynaecology Haematology Immunology and infectious disease Neonatology Nephrology Neurological surgery Neurology Obstetrics Obstetric - Delivery Medical oncology Ophthalmology Orthopaedic Plastic surgery Psychiatric Rehabilitation Respiratory medicine Rheumatology Transplant surgery 1 Trauma Urology Vascular surgery Centralised 99.5% 5.3% 3.5% 100.0% 0.0% 0.0% 0.5% 0.5% 0.0% 5.6% 1.2% 0.2% 3.5% 0.4% 4.0% 0.0% 40.1% 0.0% 0.0% 0.0% 30.7% 0.0% 0.6% 0.0% 0.0% 0.0% 0.7% 0.0% 100.0% 100.0% 0.4% 32.5% Regional 0.5% 82.7% 44.9% 0.0% 0.0% 8.0% 13.3% 8.3% 1.0% 26.6% 4.7% 0.0% 44.9% 0.6% 13.1% 2.8% 4.5% 34.4% 13.3% 0.0% 69.3% 81.1% 13.3% 26.8% 20.8% 100.0% 7.9% 39.6% 0.0% 0.0% 30.5% 67.5% Standard 0.0% 12.0% 51.6% 0.0% 100.0% 92.0% 86.2% 91.3% 99.0% 67.7% 94.0% 99.8% 51.6% 99.0% 82.9% 97.2% 55.5% 65.6% 86.7% 100.0% 0.0% 18.9% 86.2% 73.1% 79.2% 0.0% 91.4% 60.4% 0.0% 0.0% 69.1% 0.0%

Centralised services may only be provided by Providers designated by HAAD to do so (1-2 in Abu Dhabi) Regional services may only be offered by Providers designated by HAAD to do so (1-5 per Region, depending on demand and supply factors) Standard services may be offered by all HAAD Licensed Providers Note: Emergency cases presenting to any HAAD Licensed Facilities should be treated (in accordance with HAAD Regulations. In case the DRG falls under Centralised or Regional service line, the case should be transferred to Providers Licensed for those service lines when clinically appropriate.

Source Categories maintained by HAAD with input from Providers, Payers, and other stakeholders Note Percentage figures are % by volume of all DRGs within each clinical service line; Details to be published on HAAD website (www.haad.ae) 1Trauma Service Line contains only 3 DRGs related to Head Trauma.

C16

Current and projected demand, by Episodes and beds

Bed Occupancy Acute Overnight Episodes Acute Overnight Beds Current (58%) Intermediate (70%) Target (85%) Sub Acute Overnight Episodes Sub Acute Overnight Beds ICU beds Emergency Bays

2011 Actual 122,345 3,289

2016 184,102 3,992 3,308 2,724

2021 223,539 5,223 4,328 3,564 4,233 292 209 420

2026 276,589 6,769 5,609 4,619 5,461 299 245 494

2031 332,040 7,061 5,850 4,818 6,738 350 281 602

N/A 224 146 N/A

3,216 228 175 353

Assumptions

Notes

Projected bed numbers from 2016 onwards are based on International Average ALOS and 75% occupancy for ICU beds. Population growth based on: Abu Dhabi Urban Planning Council 2030 Plan projections, Advantaged socio-economic class and with life expectancy >77years. Expatriate utilisation increases from 45% of UAE National utilisation to 55% of UAE National utilisation. Sub Acute beds include: Rehabilitation, Palliative care, Maintenance, Older Persons and Psychogeriatric care; ICU beds exclude Paediatrics, NICU, CCU, etc. Acute Overnight beds exclude day case beds.

C17

Projected demand by Abu Dhabi planning region

Number of Regional and Centralised Providers
From 2013 Centralised and Regional services may only be provided by Providers designated by HAAD to do so. HAAD has determined the current and future number of Centralised and Regional facilities:

Abu Dhabi and Middle Region population Regional Providers (Abu Dhabi and Middle Region) Al Ain (Eastern) Region population Regional Providers (Al Ain Region) Al Gharbiya (Western) Region population Regional Providers (Al Gharbiya Region) Total Regional Facilities in Abu Dhabi Emirate wide 'Centralised' Centers

2010* 1,198,000 4 568,000 2 198,000 1 7 1

2012** 1,348,000 5 610,000 2 217,010 1 8 (1-2)

2017** 1,723,000 7 715,000 3 264,526 1 11 (2-3)

2030** 2,622,379 10 1,002,466 4 378,600 2 16 4

Note HAAD may limit the number of Regional facilities, for example, where there are low volumes Sources * 2010 population estimates from Statistics Centre Abu Dhabi (SCAD); ** 20122030 projections based on Urban Planning Council (UPC) Plan 2030 Methodology Based on 2010 SCAD current population and UPC Plan 2030 projected population and derived compound annual growth rate 20102030 C18

Projected demand by Abu Dhabi planning region, by number of beds (Acute, Sub Acute and Intensive Care) plus Emergency bays
Actual Region Beds Bed Occupancy Abu Dhabi & Middle Acute Overnight Current (58%) Intermediate (70%) Target (85%) Sub acute Intensive care Emergency bays Al Ain Acute Overnight Current (67%) Intermediate (70%) Target (85%) Sub acute Intensive care Emergency bays Western Acute Overnight Current (30%) Intermediate (70%) Target (85%) Sub acute Intensive care Emergency bays 2011 1,946 Demand 2016 2,146 1,778 1,464 124 90 187 1,153 1,104 909 76 57 126 592 254 209 12 12 26 2021 2,666 2,209 1,819 130 108 226 1,407 1,347 1,109 94 70 151 717 307 253 15 14 32 2026 3,277 2,715 2,236 161 126 264 1,801 1,724 1,420 98 79 181 864 370 305 18 16 35 2031 3,967 3,287 2,707 188 143 303 2,213 2,118 1,744 109 91 210 1,031 442 364 22 18 40

224 101 N/A 1,012

N/A 41 N/A 240

N/A 4 N/A

Assumptions

Notes

Projected bed numbers from 2016 onwards are based on International Average ALOS and 75% occupancy for ICU beds. Population growth based on: Abu Dhabi Urban Planning Council 2030 Plan projections, Advantaged socio- economic class and with life expectancy >77years. Expatriate utilisation increases from 45% of UAE National utilisation to 55% of UAE National utilisation. Sub Acute beds include: Rehabilitation, Palliative care, Maintenance, Older Persons and Psychogeriatric care; ICU beds exclude Paediatrics, NICU, CCU, etc. Acute Overnight beds exclude day case beds.

C19

Model
Model of care How health services should be used
Patient self-care
DRAFT

Planning
Capacity Masterplan
Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way

Nationals

Facilities /10000

Hospitals

Hospitals

Clinics

Clinics

Remote support

Outpatient Clinic

Elective Admission

Screening

Ambulance

Check-up

Urgent Care Centre

Disease management

Triage

ER

Emergency Admission .

Preventative
Source

Emergency
Including diagnostics
11

Region District Abu Dhabi Desert Villages Al Falah Ghantoot District Abu Dhabi Island CBD/Financial Centre Musaffah Bani Yas Al Shahama Shamkhah Al Rahba New Port City Capital District South Bain Al Jesrain Khalifa City A Grand Mosque District Inner Islands Capital District North Al Mina Al Raha Yas Island Mohamed Bin Zayed City Saadiyat Airport District Lulu Island Capital District Mohamed Bin Zayed Centre South Hudayriat Island Marina Village Al Suwwah Al Reem Al Ain Umm Ghaffa Nahel Industrial City Al Salamat/Al Yaher Al Dhahra Abu Krayyah Al Saad Al Araad Abu Samra Al Ain City Al Quaa Al Wagan Al Hayer Al Dhaher Remah Sweihan Al Khazna Mezyad Al Shwaib Al Fagah Western Liwa Madinat Zayed Ruwais Mirfa Ghayathi Sila'a Delma Island

Gap now

Type Rural Rural Rural Urban Urban Urban Rural Rural Rural Rural Rural Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Rural Urban Urban Urban Rural Rural Rural Urban Rural Rural Rural Rural Rural Urban Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural

28,480 4,028 2,478 313,809 174,625 141,268 47,245 37,831 15,839 15,315 11,740 9,247 7,694 5,317 5,257 2,804 2,371 1,070 827 776 328 122 98 75

8,851 5,196 48,803 37,544 4,958 4,108 3,829 3,791 1,942 343,002 12,512 11,865 11,484 10,641 8,187 7,880 7,350 6,407 3,260 2,089 20,000 29,000 16,000 15,000 8,000 5,000 5,000

#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?

10,963 1,996 44,004 14,141 2,256 27,267 16,361 10,674 13,038 4,565 33 4,927 2,703 1,837 480 2,121 53 397 1 95 32

None None None 229 124 36 43 10 None 1 None None 3 11 None 2 7 2 None 2 None 6 None None None None 3 None None None None 8 1 None None None None None 186 1 1 3 1 1 1 2 None 1 1 5 16 4 4 6 1 1

13 5

182 86 31 37 10 1

2,529 1,131 161 162 45 132 1 1

3,878 1,663 194 106 47 325

430 241 21 57 14 5

1,284 539 68 73 24 89

6.2 5.2 2.2 7.8 2.6 0.7

8.1 6.5 1.1 3.4 1.2 8.6

12.4 9.5 1.4 2.2 1.2 21.2

3 10 1 1 1 4 1 2 4

33 78 2 426 87 41 1 8

42 74 4 792 103 42 2 11

10 17

17 75

3.9 20.7 3.6 8.4 37.4

4.3 14.7 0.7 179.7 81.3 49.6 3.0 81.6

5.5 13.9 1.4 334.0 96.3 50.8 6.1 112.2

1 1

36 25 9 4 5

302 62 12 2 11

5,873 2,377 18 23,400 715 655 702 139 286 100,298 4,912 3,330 2,570 7,325 683 713 1,071 3,809 1,546 378 661 6,785 1,270 3,676 3,898 2,139

5 1

14 3

5 1

1 6

1.0 0.3

0.3 0.1

0.1 0.0

7 1

148 1 3 1 1 1 2 1 1 1 1 11 3 3 5

1,733 8 17 25 13 6 8 4 3 3 8 175 50 32 38 22 23

2,864 13 29 34 20 9 11 13 4 3 17 256 100 61 63 39 25

318 1 1 4 3 1 1

968 3 4 3 4 2 1

4.5 0.8 0.8 2.6 0.9 1.2 1.3 2.7 3.1 4.8 1.0 4.5 2.5 2.7 7.5 2.0 2.0

5.1 0.6 1.4 2.2 1.2 0.7 1.0 0.5 0.9 1.4 0.4 6.0 3.1 2.1 4.8 4.4 4.6

8.3 1.0 2.4 3.0 1.9 1.1 1.4 1.8 1.2 1.4 0.9 8.8 6.3 4.1 7.9 7.8 5.0

1 2 1 1 1 1 1

5 23 7 3 5 2 2

32 107 14 17 18 10 10

81,520 95,972 97,522 111,191 15,375 (41,268) 22,755 72,169 114,161 94,685 138,260 45,753 17,306 64,683 114,743 17,196 67,629 98,930 119,173 99,224 49,672 119,878 49,902 19,925 240,000 80,000 100,000 5,000 30,000 200,000 3,049 4,804 30,937 36,456 1,042 892 1,171 209 558 364,298 10,488 18,135 20,516 3,709 1,313 32,120 1,650 1,993 2,240 1,411 45,000 11,000 114,000 60,000 7,000 65,000 5,000

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1

Clinics

Other

Total

Total

Population Growth

Hospitals

Dentists

Doctors /1000

Nearby hospital

Doctors

Nurses /1000

Nurses

Non-emergency/elective

1 1

3 4 1

1 1 6 1 3

1 1 1 1 2 1 1 1 1 1 8 1 1 2 1 1 2 1 1 1 1 1

3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Capacity Gap Severe Moderate None

Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

Assumptions
Population growth, scenarios
As at 31 December 2010 Draft

Recommendations
Land requirements Guidelines for urban planners
Population (000s people) Land provision options Land area Co-location GFA4 OR (m2 000s) (m2 000s) OR 6 ?3 2.5 7 Parking (spaces) Minimum service requirement

DRAFT

For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines:
Estimated Resources Residential Transient1
OR

4.0 High 3.5

Population (millions)

Population growth, Scenarios

Clinics2 4-5 8-12

12-15 24-36

25 30

Low
Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

National 411'200 416'150 422'200 429'400 437'800 445'800 453'600 460'500 467'600 473'600

3.0 2.5 2.0 1.5

1.0
0.5

Expatriate Low 1'945'000 1'970'000 2'060'000 2'130'000 2'175'000 2'250'000 2'310'000 2'360'000 2'400'000 2'475'000

High 2'045'000 2'190'000 2'350'000 2'505'000 2'675'000 2'850'000 3'045'000 3'240'000 3'400'000 3'575'000

?3 ?3
?3
n/a n/a

Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service

2 Physicians 4-6 Physicians

12-30
30-40 Hospitals5 60-80 90-110 Ambulance 10-16 Stations 16-40
Notes
1Transient

36-90
90-120 180-240 270-330 30-48 48-120

8.5
12 80 100 3 4

3.5
4.5 n/a n/a n/a n/a

35
45 3/bed 3/bed 10 15 Emergency services Laboratory services Radiology services Stand-alone building Ambulance service (land /air) Ambulance service (land /air)

7-14 Physicians
15-20 Physicians 180-240 Beds6 270-330 beds6 1 Ambulance 2 Ambulances

?7 ?7

0.0

Note

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data`

73

population includes staff and other non-residential visitors Clinics, Centers and Polyclinics Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4Clinic GFA may be provided within larger commercial centre with adequate transport options and shared parking 5 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accesibility of existing hospital facilities 6Optimal hospital size is 200-600 beds 7Appropriate facilities for co-location with Ambulance Stations include Clinics, Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Source HAAD Health Facility Community Guidelines 2009, Strategy analysis
2Clinics collectively refers to 3Appropriate facilities for co-location with Clinics include Hospitals,

2030 Population
110,000 100,000 100,000 425,000 190,000 100,000 70,000 110,000 130,000 110,000 150,000 55,000 25,000 70,000 120,000 20,000 70,000 100,000 120,000 100,000 50,000 120,000 50,000 20,000 240,000 80,000 100,000 5,000 30,000 200,000 11,900 10,000 79,740 74,000 6,000 5,000 5,000 4,000 2,500 707,300 23,000 30,000 32,000 14,350 9,500 40,000 9,000 8,400 5,500 3,500 65,000 40,000 130,000 75,000 15,000 70,000 10,000

% National

Hospitals required

Clinic required

C20

Health Facility locations

#

AL Corniche HospitalAl Salama Hospital ##

# ! " Franco Emirates Hospital!""#! "#!# # #"! ## # # # ! # !# v!!" ! # #!"!#"Al ! ## ! " !! " # "# ! " # " " "# # !# ! "! "# v " v " Hospital " "# " ! Lifeline "#!!##!#" # "#"!"##"### Reef!#!"Hospital v " !# # " !##!"# " " "# # ! National Hospital v # # " " !# "# " v""!# v# v " ! ! # ! " " ! " " ! # " # # !""! # "## "" ! !" " ! "! "" " Al Ahalia!#" "!# " " "AL MAZROUI HOSPITAL Hospitalv# ! # # " " !#"# " # ! v# ! # ! #"#"" # " !! ! " # "" # ! ! #" " # ! "# # !# ! # NMC "Specialty"#!"HospitalDar Al Shifa Hospital " ## ! " # # v ""
" ! ## "# " ! " " !#

Hospital Center Clinic Pharmacy

# "
"

## " # # # !"" Shaikh Khalifa Hospital"OBAGI HOSPTAL " ! # # ! "" # # #"

"

" ## "" # " #### "#

! !# " " "

""" # !

# " #

# !
" !

" # " "

! "" " ! " " ""

!"

"

v v # # # # ## !
" " " # "

#
"

# "

# ## " # " # # # " # # !

"

" ! Gulf Diagnostic! Center Hospital ! # "

# "

"

" # # " " "

#" # # # #

Zayed Military Hospital v " New Al Noor Hospital

v
# " #
"

Source

HAAD Licensing database, GPS survey; not all Center and Clinic locations shown

C21

Supply projections
Number of beds Planned Anticipated Anticipated by 2013 5,730 4,298 2,837
Region Total Abu Dhab - Island Planned Completion Beds likelihood Type 5,730 1145 78 88 141 838 3425 20 25 30 35 50 52 99 100 100 100 119 120 125 150 156 180 200 210 240 250 300 364 400

As at 30 March 2012

Region Abu Dhabi - Not yet allocated/ On or Near Island

Planned Completion Beds likelihood Type

5 7 3 3 3 6 10 3 8 3 2 9 1 3 7 3 3 3 3 1 2 5 6 3 7 7 2

General Hospital Specialized Hospital General Hospital General Hospital Specialized Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital Rehabilition Hospital Specialized Hospital General Hospital General Hospital General Hospital General Hospital Rehabilition Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital

Abu Dhabi - Near Island

Al Ain*

Western

828 28 31 50 53 54 100 127 150 235 228 80 50 50 48 104 54 *50

2 3 2 1 1 10 10 2 1 1 1 1 1 1

General Hospital General Hospital General Hospital Specialized Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital General Hospital Rehabilition Hospital General Hospital 1 General Hospital

Note Source

*Completion likelihood from Land and Project State List (Maintained by HAAD Health Facility Licensing). Preliminary licensed facilities, HAAD Licensing and Strategy analysis.

C22

Population density

Source Department of Planning and Economy (2005 Census), Strategy Analysis

C23

Population growth, scenarios

5.0 4.5 High Low UPC

Population growth, scenarios National Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 445'600 457'200 468'600 479'600 490'500 501'000 511'500 521'500 531'500 541'000 550'500 Expatriate Low 1'966'500 1'977'500 1'988'000 1'997'500 2'007'000 2'016'000 2'024'000 2'032'000 2'038'000 2'044'000 2'049'000

4.0
Population (millions)

3.5 3.0 2.5 2.0 1.5 1.0

0.5
0.0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2030

High 1'989'000 2'042'000 2'112'000 2'187'000 2'255'500 2'320'000 2'381'000 2'440'000 2'496'000 2'551'000 2'603'000

Note

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source 2012 2022: SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan

C24

Demand projections
Clinical care volumes (outpatient, inpatient), Beds, Doctors and Nurses

Additional capacity needs over 10 years Current 2021 2011 Outpatients (m) Inpatients (000's) ALOS Occupancy Beds Doctors Nurses 11 152 5.71 71% 3,700 3,500 7,500 Low 15 205 5.00 80% 3,500 4,600 10,800 High 18 245 5.71 71% 5,400 5,400 12,800 CAGR Low 3.8 3.1 -1.3 1.2 -0.4 2.7 3.7 High 5.6 4.9 0.0 4.0 4.5 5.5 Absolute Low 5 53 0% 1,700 1,900 5,300 9% 200 1,100 3,300 High 8 93 20 100 280 Annualised Low .4 5 140 160 410 Low 800 1,200 High 900 1,500 High .6 7 Including churn

0.0 - 0.713

Notes Numbers have been rounded for clarity Assumptions Outpatient weight is 1, Inpatient weight is 10 ALOS remains at the 2011 level of 5.7 in the High scenario and reduces to 5.0 in the Low scenario Bed occupancy remains at the 2011 level of 71% (SEHA figure) in the High scenario and increases to 80% in the Low scenario Outpatients per Doctor remains at the 2011 rate of 2'382 in the High scenario and increases by 10% in the Low scenario. Outpatients per Nurse remains at the 2011 rate of 1'633 in the High and Low scenarios Churn will remain at the 2011 rate of 17% for Doctors and 11% for Nurses Source HAAD Demand Model 2011, HAAD Licensing Database

C25

Demand projections based on WHO disease classification

Inpatients
Deliveries 20 Signs, symptoms & 8 Cardiovascular 8 3 11 Digestive diseases Cancer 3 6 5 Genitourinary 8 3 2 Maternal & 10 11 RTA 4 5 2 7 12 Respiratory diseases Sense organ diseases 4 2 3 Neuropsychiatric 3 4 0 Respiratory infections 6 11 Musculoskeletal 3 11 Endocrine disorders 4 01 Diabetes mellitus 3 11 Infectious & 3 11 1 Occupational Injuries 3 0 Other Injuries 3 11 0 Skin diseases 2 0 0 Congenital anomalies 10 Oral conditions 10 Nutritional10
32
5 7 4 10 1

Outpatients CAGR Low High .0 .0 2.7 2.8 2.0 2.3 3.8 .8 .5 7.1 10.8 .4 .2 .6 2.4 4.6 .1 .0 .0 10.2 15.3 .4 .2 .6 3.0 5.1 .0 .3 .1 1.1 1.6 .0 .3 .0 8.1 10.2 .3 .2 .6 1.2 3.2 .4 .2 .6 3.2 7.8 .2 .3 .1 8.4 9.0 2.2 1.3 3.2 .0 .6 1.0 2.3 4.5 .3 .2 .1 0.8 2.6 1.0 .5 3.6 5.8 .4 .1.1 2.0 4.5 .0 .6 .1 0.5 2.4 .0 .0 1.9 3.8 .2 .1 .7 0.2 1.8 .0 .0 2.8 4.1 .2 .1 .5 1.6 2.4 .0 .2.1 1.6 2.8

.3 .5

.4

.4 .3

.4

CAGR Low High 0.0 0.0 1.3 2.8 10.7 14.3 4.9 6.5 10.9 14.4 5.2 7.1 3.2 3.5 0.6 1.6 4.1 5.8 5.5 7.7 10.7 11.8 -0.2 1.4 4.6 6.5 5.3 7.1 12.1 14.8 1.7 3.1 -0.1 1.6 1.3 2.9 3.0 4.4 4.7 6.4 3.8 4.5 4.0 5.2

Notes Inpatient Encounters in thousands, Outpatient Encounters in millions Definition CAGR = Compound Annual Growth Rate 2011-2021 Source HAAD Demand Model 2011, Categorization based on WHO classification of diagnoses ICD 9, modified to specify deliveries and RTAs

C26

Demand projections for Doctors by specialty

General medicine Dentistry Pediatrics Internal Medicine General Surgery Obstetric & Gynecology Anesthesiology Radiology Dermatology & Venerology Pathology Family Medicine Orthopaedic surgery Ophthalmology Otolaryngology Accident & Emergency Medicine Cardiology Urology Psychiatry Endocrinology & Diabetes Specialists Gastroenterology Oral & Maxillofacial surgery Alternative Medicine Intensive & Critical care Medicine Nephrology Rheumatology Neurology Pulmonology Cardio/Thoracic surgery Physical Medicine & Rehabiltation Oncology Neonatology Infectious Diesease Allergy & Immunology

2011

1'756 838 429 337 282 282 230 163 147 146 137 135 131 127 89 82 76 57 41 39 32 32 31 31 27 25 25 23 23 21 18 11 3 5'826

2021 Low

2'168 1'192 459 540 433 410 342 242 196 204 214 198 223 143 109 205 128 147 90 63 46 49 43 58 42 48 30 43 36 36 19 15 4 8'176

2021 High

3'185 1'825 576 1'060 801 678 606 431 300 342 401 348 465 189 158 679 260 420 245 120 71 90 71 131 79 111 42 103 68 75 24 26 6 13'986

Notes Demand projections as at 31 Dec 2011. Based on ActivityNet (claimed cost); May include duplicate claims; Total licensed physicians as of 31/12/2011 Source HAAD Demand Model, HAAD Licensing Database, KEH; Strategy analysis

C27

Model
Model of care How health services should be used
Patient self-care
DRAFT

Planning
Capacity Masterplan
Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way

Nationals

Facilities /10000

Hospitals

Hospitals

Clinics

Clinics

Remote support

Outpatient Clinic

Elective Admission

Screening

Ambulance

Check-up

Urgent Care Centre

Disease management

Triage

ER

Emergency Admission .

Preventative
Source

Emergency
Including diagnostics
11

Region District Abu Dhabi Desert Villages Al Falah Ghantoot District Abu Dhabi Island CBD/Financial Centre Musaffah Bani Yas Al Shahama Shamkhah Al Rahba New Port City Capital District South Bain Al Jesrain Khalifa City A Grand Mosque District Inner Islands Capital District North Al Mina Al Raha Yas Island Mohamed Bin Zayed City Saadiyat Airport District Lulu Island Capital District Mohamed Bin Zayed Centre South Hudayriat Island Marina Village Al Suwwah Al Reem Al Ain Umm Ghaffa Nahel Industrial City Al Salamat/Al Yaher Al Dhahra Abu Krayyah Al Saad Al Araad Abu Samra Al Ain City Al Quaa Al Wagan Al Hayer Al Dhaher Remah Sweihan Al Khazna Mezyad Al Shwaib Al Fagah Western Liwa Madinat Zayed Ruwais Mirfa Ghayathi Sila'a Delma Island

Gap now

Type Rural Rural Rural Urban Urban Urban Rural Rural Rural Rural Rural Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Urban Rural Urban Urban Urban Rural Rural Rural Urban Rural Rural Rural Rural Rural Urban Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural Rural

28,480 4,028 2,478 313,809 174,625 141,268 47,245 37,831 15,839 15,315 11,740 9,247 7,694 5,317 5,257 2,804 2,371 1,070 827 776 328 122 98 75

8,851 5,196 48,803 37,544 4,958 4,108 3,829 3,791 1,942 343,002 12,512 11,865 11,484 10,641 8,187 7,880 7,350 6,407 3,260 2,089 20,000 29,000 16,000 15,000 8,000 5,000 5,000

#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?

10,963 1,996 44,004 14,141 2,256 27,267 16,361 10,674 13,038 4,565 33 4,927 2,703 1,837 480 2,121 53 397 1 95 32

None None None 229 124 36 43 10 None 1 None None 3 11 None 2 7 2 None 2 None 6 None None None None 3 None None None None 8 1 None None None None None 186 1 1 3 1 1 1 2 None 1 1 5 16 4 4 6 1 1

13 5

182 86 31 37 10 1

2,529 1,131 161 162 45 132 1 1

3,878 1,663 194 106 47 325

430 241 21 57 14 5

1,284 539 68 73 24 89

6.2 5.2 2.2 7.8 2.6 0.7

8.1 6.5 1.1 3.4 1.2 8.6

12.4 9.5 1.4 2.2 1.2 21.2

3 10 1 1 1 4 1 2 4

33 78 2 426 87 41 1 8

42 74 4 792 103 42 2 11

10 17

17 75

3.9 20.7 3.6 8.4 37.4

4.3 14.7 0.7 179.7 81.3 49.6 3.0 81.6

5.5 13.9 1.4 334.0 96.3 50.8 6.1 112.2

1 1

36 25 9 4 5

302 62 12 2 11

5,873 2,377 18 23,400 715 655 702 139 286 100,298 4,912 3,330 2,570 7,325 683 713 1,071 3,809 1,546 378 661 6,785 1,270 3,676 3,898 2,139

5 1

14 3

5 1

1 6

1.0 0.3

0.3 0.1

0.1 0.0

7 1

148 1 3 1 1 1 2 1 1 1 1 11 3 3 5

1,733 8 17 25 13 6 8 4 3 3 8 175 50 32 38 22 23

2,864 13 29 34 20 9 11 13 4 3 17 256 100 61 63 39 25

318 1 1 4 3 1 1

968 3 4 3 4 2 1

4.5 0.8 0.8 2.6 0.9 1.2 1.3 2.7 3.1 4.8 1.0 4.5 2.5 2.7 7.5 2.0 2.0

5.1 0.6 1.4 2.2 1.2 0.7 1.0 0.5 0.9 1.4 0.4 6.0 3.1 2.1 4.8 4.4 4.6

8.3 1.0 2.4 3.0 1.9 1.1 1.4 1.8 1.2 1.4 0.9 8.8 6.3 4.1 7.9 7.8 5.0

1 2 1 1 1 1 1

5 23 7 3 5 2 2

32 107 14 17 18 10 10

81,520 95,972 97,522 111,191 15,375 (41,268) 22,755 72,169 114,161 94,685 138,260 45,753 17,306 64,683 114,743 17,196 67,629 98,930 119,173 99,224 49,672 119,878 49,902 19,925 240,000 80,000 100,000 5,000 30,000 200,000 3,049 4,804 30,937 36,456 1,042 892 1,171 209 558 364,298 10,488 18,135 20,516 3,709 1,313 32,120 1,650 1,993 2,240 1,411 45,000 11,000 114,000 60,000 7,000 65,000 5,000

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1

Clinics

Other

Total

Total

Population Growth

Hospitals

Dentists

Doctors /1000

Nearby hospital

Doctors

Nurses /1000

Nurses

Non-emergency/elective

1 1

3 4 1

1 1 6 1 3

1 1 1 1 2 1 1 1 1 1 8 1 1 2 1 1 2 1 1 1 1 1

3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Capacity Gap Severe Moderate None

Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

Assumptions
Population growth, scenarios
As at 31 December 2010 Draft

Recommendations
Land requirements Guidelines for urban planners
Population (000s people) Land provision options Land area Co-location GFA4 OR (m2 000s) (m2 000s) OR 6 ?3 2.5 7 Parking (spaces) Minimum service requirement

DRAFT

For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines:
Estimated Resources Residential Transient1
OR

4.0 High 3.5

Population (millions)

Population growth, Scenarios

Clinics2 4-5 8-12

12-15 24-36

25 30

Low
Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

National 411'200 416'150 422'200 429'400 437'800 445'800 453'600 460'500 467'600 473'600

3.0 2.5 2.0 1.5

1.0
0.5

Expatriate Low 1'945'000 1'970'000 2'060'000 2'130'000 2'175'000 2'250'000 2'310'000 2'360'000 2'400'000 2'475'000

High 2'045'000 2'190'000 2'350'000 2'505'000 2'675'000 2'850'000 3'045'000 3'240'000 3'400'000 3'575'000

?3 ?3
?3
n/a n/a

Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service

2 Physicians 4-6 Physicians

12-30
30-40 Hospitals5 60-80 90-110 Ambulance 10-16 Stations 16-40
Notes
1Transient

36-90
90-120 180-240 270-330 30-48 48-120

8.5
12 80 100 3 4

3.5
4.5 n/a n/a n/a n/a

35
45 3/bed 3/bed 10 15 Emergency services Laboratory services Radiology services Stand-alone building Ambulance service (land /air) Ambulance service (land /air)

7-14 Physicians
15-20 Physicians 180-240 Beds6 270-330 beds6 1 Ambulance 2 Ambulances

?7 ?7

0.0

Note

HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data`

73

population includes staff and other non-residential visitors Clinics, Centers and Polyclinics Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4Clinic GFA may be provided within larger commercial centre with adequate transport options and shared parking 5 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accesibility of existing hospital facilities 6Optimal hospital size is 200-600 beds 7Appropriate facilities for co-location with Ambulance Stations include Clinics, Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Source HAAD Health Facility Community Guidelines 2009, Strategy analysis
2Clinics collectively refers to 3Appropriate facilities for co-location with Clinics include Hospitals,

2030 Population
110,000 100,000 100,000 425,000 190,000 100,000 70,000 110,000 130,000 110,000 150,000 55,000 25,000 70,000 120,000 20,000 70,000 100,000 120,000 100,000 50,000 120,000 50,000 20,000 240,000 80,000 100,000 5,000 30,000 200,000 11,900 10,000 79,740 74,000 6,000 5,000 5,000 4,000 2,500 707,300 23,000 30,000 32,000 14,350 9,500 40,000 9,000 8,400 5,500 3,500 65,000 40,000 130,000 75,000 15,000 70,000 10,000

% National

Hospitals required

Clinic required

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Planning recommendations
Summary
The rapid population growth and development in the Emirate of Abu Dhabi requires careful attention to ensure the availability of suitable healthcare services for the population. This plan accordingly includes guidelines and recommendations for parties who play a key role in ensuring appropriate, quality healthcare services are available to the population in a timely manner:
Urban planners high level indications of health facility requirements for anticipated

populations to ensure that appropriate land is made available for these facilities at the planning phase
Developers a requirement for healthcare facility developers and operators to be engaged

before developments are approved to ensure the new population will have access to appropriate, quality healthcare services in a timely manner
Healthcare investors to support investors with information regarding health service use,

supply and demand and to meet regulatory requirements

Centralised services* For some clinical services centralisation of patient volumes results in

better quality and/or cost-efficiency; such services are typically complex, with low volume. HAAD will designate facilities that will provide such Centralised services.
Regional services* For certain moderately complex and time-dependent clinical services it is

required that these are provided within each Abu Dhabi region. HAAD will limit licenses for such Regional services to 1-5 Providers in each region of Abu Dhabi (based on demand).
Standard services* - The majority of clinical services may be offered by any suitable facility in

line with HAAD competency framework (set out in the Abu Dhabi Healthcare Regulations).
* Clinical services are specified at the level of DRGs; In emergency situations services designated as Regional or Centralised may be offered by any facility

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Facility recommendations for developers, investors, and healthcare Providers

Health facility developments must:

Meet HAAD licensing requirements (available at www.haad.ae). Ensure any designated minimum service requirements set out in the Land Requirements Guidelines for Urban Planners are met.

From 2013 Providers intending to provide inpatient services, at DRG level,

categorised as Centralised or Regional by HAAD must obtain HAAD approval and (re)licence1 prior to establishing services.

Additional guidance regarding healthcare capacity and demand projections are

available within this document, HAADs Health Statistics.

HAAD is currently amending its Licensing process to require submission and approval of all intended services specified at DRG level.

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Service recommendations for investors and developers Developers for projects with intended residential populations of 4,000 or more
must have engaged a developer and operator for the healthcare facilities within the development

Developers should notify the Executive Councils Social Development SubCommittee of their intended plans (copying UPC) in the context of combining/sharing healthcare facilities with other social infrastructure, e.g., community centers

Services must be designed and operated in accordance with the Abu Dhabi
Healthcare Regulations (available at www.haad.ae)

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Recommendation for allocation of land and service provision

For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines:
Population (000s people) Residential
OR

Land provision options (m2 000s) Land area 6 7 8.5 12 3 4 40 80 Co-located 3,6 OR GFA 2.5 3 3.5 4.5 1.5 2 n/a n/a

Parking (spaces)

Minimum service requirement

Estimated Resources

Transient1 12-15 24-36 36-90 90-120 30-48 48-120 180-270 270-330

Clinics2

4-5 8-12 12-30 30-40

25 30 35 45 10 15 3/bed 3/bed

Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service

2 Physicians 4-6 Physicians 7-14 Physicians 15-20 Physicians

Ambulance Stations Hospitals4

10-16 16-40 60-90 90-110

Ambulance service (land /air) Ambulance service (land /air) Emergency services Laboratory services Radiology services Stand-alone building

1 Ambulance 2 Ambulances 180-270 Beds5 270-330 beds5

Notes

population includes staff and other non-residential visitors collectively refers to Clinics, Centers and Polyclinics 3Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities 5Optimal hospital size is 200-600 beds 6GFA Ground Floor Area Source Strategy analysis
2Clinics

1Transient

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Access requirements
Healthcare services should be provided to meet the following access requirements in relation to routine/elective services and emergency services:

Routine/Elective Urban Rural Primary care services within 20 minutes drive at maximum speed of 60 kph Primary care services within 20 minutes drive at maximum speed of 120 kph

Emergency services Ambulance access within 15 minutes, if via land driving at maximum speed of 60 kph Ambulance access within 19 minutes, if via land driving at maximum speed of 120 kph

Note

Alternative solutions such as air ambulance should be utilised to achieve emergency service access requirements in rural and/or densely populated urban areas

Source Department of Health UK, Strategy analysis

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Case example (planning recommendations)

Villa and associated community facilities and retail development located adjacent to Al Rahba Anticipated residential population of 50,000 residents and transient (visitor) population expected to be less than 2,000
Population (000s people) Residential
OR

Land provision options (m2 000s) Land area Co-located OR GFA3

Transient1

Facilities 1 1

Population served (000s) 5 10

Land to be provided (m2 000s)

Clinics2

4-5
8-12 12-30 30-40

12-15
24-36 36-90 90-120

6
7 8.5 12

2.5
3 3.5 4.5

50

5.5 GFA +12 Land plot

1 1 1

35 12 38 50 2 GFA + 3 Land plot

Ambulance Stations

10-16
16-40

30-48
48-120 180-240 270-330

3
4 80 100

1.5
2 n/a n/a

Hospitals4

60-80 90-110

Development is for less than 60k residents, site analysis indicates that Al Rahba Hospital located nearby thus no need to provide hospital facility within development

Source Strategy analysis

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