Health Statistics 2013

Transcription

1 Health Statistics 2013 Health Authority Abu Dhabi Reliable Excellence in Healthcare November 2014

2 Contents Overview Stable vision 2 Achieving our vision the journey so far 3 Statistical highlights 4 Public Health highlights 5 Investor highlights 6 Benchmarks 7 Population Population various breakdowns 9 Births and Deaths 11 Leading causes of death 13 Injury deaths 15 Communicable diseases 16 Cancer 17 Episodes and activities Episodes various analyses 22 Activities by type 25 Providers Provider overview 27 Labour productivity 28 Hospitals 29 Hospital inpatient profile 30 Beds including critical care 31 Centres and Clinics 33 Blood bank 34 Market structure 35 Claims Claims 38 Payers Payer members 40 Payer claims 41 Financing Enhanced plans premiums 43 Enhanced plans limits 44 Enhanced plans benefits 45 Financing model, spend distribution 46 1 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.

3 Stable vision Elements of the HAAD 2006 vision have guided significant healthcare reform: In the Emirate of Abu Dhabi, everyone has access to healthcare. 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 There is mandatory health insurance for all Abu Dhabi residents. The financing system is flexible to manage for change over time and the degree of subsidy should be managed as efficiently as possible. 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

4 Achieving our vision the journey so far In 2006 we first defined a vision for Abu Dhabi s 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 realising 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 does not 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 largest public provider; it owns and develops existing public healthcare facilities, including partnerships with 2 renowned overseas operators to manage its facilities. Everyone has access to healthcare via mandatory health insurance. A first in the region, in 2006 Abu Dhabi guaranteed access to healthcare for all expatriates by mandating health insurance and linking it to resident permits. In 2008 the old Ministry of Health s health cards for Nationals were replaced with Thiqa health insurance, which provided free at the point of care access to care in both public and private sectors and the freedom to choose the provider. World-class quality care and outcomes with quality regularly monitored and published. In support of improving quality, HAAD develops clinical care and service standards tailored to Abu Dhabi across the health sector. In 2012, Abu Dhabi Health Regulations (Policy Manuals) were published for implementation across the healthcare sector. Since 2011, we have been working on the development of a comprehensive, consistent and trustworthy provider rating system that would allow benchmarking of the quality of services among Abu Dhabi providers as well as internationally. HAAD has disseminated a number of quality metrics to improve quality. Capacity has improved, for instance, since 2009 the number of hospital beds available to the population has increased by 21% (681). However, many challenges remain, for example, whilst under 5 year olds mortality rate (8 per live births) is among the best of GCC countries, it is still above that of the UK (5 per live births) and Singapore (3 per live births). Full spectrum of health services. Our model of care sets out services which are appropriate, convenient and well coordinated around patients needs. Prevention. Disease prevention and health promotion are cornerstones of our public health strategy to reduce burden of diseases at onset in vulnerable population. This requires continuous collaboration with strategic 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 first screened for various health risk factors in a programme called Weqaya (Arabic for prevention ), it showed that 71% had at least one cardiovascular diseases (CVD) risk factor; many were unaware thus unable to seek care, and risk factors are projected to increase. Community-based services help patients manage their chronic conditions, like diabetes, on a daily basis. Some diabetes services now offer integrated consultation, diagnostic and pharmacy services to people with diabetes. Another creative solution is to treat patients, particularly those who are frail, in their homes. Specialty care. Competition for patients has helped the creation of new services and increased convenience and efficiency for existing services. There is clear evidence that the Strategy to encourage investment in both public and private healthcare provision is now delivering major benefits. During 2013 there has been a marked reduction of existing service gaps. There has been 20% growth in the numbers of Emergency Physicians, 41% growth in Neonatologists and 21% increase in Paediatric and Orthopedic doctors respectively. Critical care doctors have grown by 14%. Obstetrics and Gynecology doctors have grown by 30%. Full detail of these improvements are included in The Capacity Masterplan Pages C8 and C9. Health facilities and clinicians. The desire is to treat patients outside hospitals wherever possible, however, to account for population increase, several private providers have opened new acute and sub-acute care facilities. 10 new private hospitals have opened in the last 5 years adding 780 beds. In addition, 350 new clinics and centres have opened, with more planned, in both private and public sectors. During 2013 the number of facilities offering healthcare has also grown by 11% to The challenge is to manage potential oversupply in some areas and to ensure hospitals operate with both quality and cost comparable with international benchmarks. In the last 5 years the number of doctors per population has increased from 23 to 25 (9% increase) and nurses from 42 per population to 52 (24% increase). Ambulance services. Good hospitals are worthless if patients cannot get there. The police provide emergency ambulance services. HAAD is working with them to develop a more integrated service that responds to a wider range of health emergencies and ensures the patients are taken to the most appropriate facility. Predominantly private providers. Based on positive experience both locally and regionally, we would like private operators to provide most healthcare, as well as to continue to add required new capacity. Private Investors are generally more responsive to market needs than the public sector. During 2013 the private sector was responsible for 74% of the growth in physician numbers and most of the growth in facilities C8,C9. HAAD continues close monitoring of providers both public and private against robust clinical indicators to ensure high quality of care is provided. 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 public providers. The DRG system introduced in 2010, and fully implemented for all hospitals inpatients in 2013, promotes efficiency: it pays hospitals on the basis of how sick patients are, not how long they stay or how many health services they are provided with. HAAD is focussed on improving the reimbursement system to ensure adequate reimbursement levels that are based on reference prices and a revision of the tariff is expected soon. 3

5 Statistical highlights There are more insurance contracts (3.3m) than residents Population 2.73m residents, 18% Nationals Median age 19.6 for Nationals and 31.7 for Expatriates births and deaths Financing Episodes* Payers Claims Providers 14.3 million Episodes*: 1.4% inpatient ( ) 39% by Nationals 49% by hospitals 83.9 million Activities**: 44% Consultations 7% Services and procedures 5% Dental 20% Drugs 4% Materials 21% DRGs (HCPCS) 39 licensed payers provide health insurance for the entire population 21.3 Million claims submitted 99.1 % of claims for outpatients physicians, dentists, nurses and allied health professionals and pharmacists licensed facilities including: 41 hospitals (3 864 beds***) 922 centres and clinics 502 pharmacies 4 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), and principal diagnosis. An Episode clinician is the clinician responsible for consultation.** percentages by value ***the total number of reported operational beds and licensed beds for new facilities

6 Public health highlights Population. 18% of residents are Nationals, of whom 69% are under 30 and more than half are under Expatriates are predominantly aged between 20 and A significant share are employed in construction and accommodated in labour camps. The introduction of mandatory health insurance in 2006 provided all residents in Abu Dhabi access to high quality care. The population continues to grow rapidly. Birth. The UAE s Total Fertility Rate has declined from 4.4 to 1.7 per woman between 1990 and 2011 (World Health Statistics 2013 (WHO)). Declining birth rates are attributed to urbanisation, delayed marriage, changing attitudes about family size, and increased education and work opportunities for women. Death. Mortality rates have also declined steadily 11,12 over the past years. Infant mortality is now comparable with other developed countries 7 and the WHO has reported a decrease in the under 5 mortality rate from 22 to 7 per live births between 1990 and 2011 across the UAE. In 2013, the diseases of circulatory system caused the highest number of deaths, accounting for 36.7% 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 death 13,14. Injuries. Injuries are the second leading cause of death (19.6%) and healthy life years lost in Abu Dhabi. Fatal injuries are caused primarily by road traffic (62%), followed by injuries due to falls and falling objects (11%), and suicide (8%). Occupational injuries and childhood injuries are accounting for 18.4% and 12.2% of total injury deaths, respectively Non-communicable diseases. The Emirate has high rates of chronic diseases related to lifestyle, such as obesity, diabetes, and cardiovascular diseases. Cardiovascular diseases accounted for 36.7% of all death cases in Adult Nationals were screened for cardiovascular risk factors in 2008 as a condition for enrollment in Thiqa insurance. 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. Cancer caused 12.9% of all deaths in the Emirate in Lymphoid, Haematopoietic and related tissue cancers are the dominant cancers in Abu Dhabi. Late detection of breast cancer leads to significant increases in mortality. Adult female Nationals aged are being screened for breast cancer as part of their Thiqa insurance renewal. Education and awareness campaigns have increased screening rates for all nationalities. Communicable diseases. Rates of childhood communicable diseases are very low, due to immunization programs targeting children aged <5 years 16. Expatriates are screened for communicable diseases before acquiring residence status 16. Respiratory infections are the second most common non-life threatening condition in the Emirate after signs, symptoms and illdefined conditions, accounting for 11.1% of Episodes across all healthcare facilities 23. Respiratory infections mostly impact workforce productivity and quality of life. 5 Notes The superscripts in pages 5 and 6 refer to the specific pages of this publication where more detailed information can be found

7 Investor highlights Population. The population is concentrated on or nearby Abu Dhabi island C34. 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 2013 there were 0.48m National Thiqa members, 1.34m Basic members and 1.49m Enhanced members 41. Recent annual population growth has averaged 7.7% and is considered to be among the highest population growth rates in the world*. Demand. Aggressive growth in demand is expected for general medical services and services linked to lifestyle-related diseases, e.g. diabetes and cardiovascular diseases and cancer with larger volume increases in outpatient settings C37. Supply. Since the end of 2012 there has been 22% growth in the number of licensed physicians and dentists C8,C9 and 11% growth in the number of licensed facilities**. It is estimated that by 2022 up to additional doctors and nurses will be required. If turnover remains high, this translates into up to doctors and nurses to be recruited annually C36. HAAD demand projections C26 also indicate that in 2020 demand for inpatient services may require over additional beds (based on current occupancy rate). However, there are currently 16 hospitals under construction that are more than 50% complete, which should provide up to beds C31,C32. This is an increase of 700 beds under construction compared to 2012, which signals significant future capacity to meet the required demand C32. Capacity gaps. Capacity gaps exist in Intensive and Critical Care Medicine, Emergency Care, Neonatology, Paediatrics, Oncology, Orthopaedics, Rehabilitation and Psychiatry C9. Sub-specialty gaps exist in Paediatric and Paediatric Surgery. Adult Surgical sub-specialties including Neurosurgery, Plastics, Surgical Oncology are all undersupplied in Abu Dhabi. Significant new inpatient capacity is anticipated during 2014 and 2015 C30,C31 particularly in acute care services with the planned supply of Intensive and Critical care and Emergency Bays addressing the current shortfalls in these types of services by 2016 C32. Overall bed occupancy rates vary by facility, but are lower than optimal 30 indicating low efficiency. Bed occupancy in ICU, NICU, PICU, CICU, CCU and Isolation was consistently over the optimal 75% during 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 Daman s most generous Enhanced plan. DRGs were introduced for the Basic product in 2010, and mandated for all hospital inpatients in In 2013, more outpatient payments were needed based on Evaluation and Management (E & M) codes, where payment reflected the severity of the patient s condition not the grade of doctor seen. Provider market. Government-subsidised SEHA hospitals provided care in 61% of all inpatient Episodes (2% increase from 2012) and 38% of all hospital outpatients (1% decrease from 2012) 23. The largest independent groups are Al Noor and NMC 30. International providers have come to Abu Dhabi, generally on the basis of a management service agreement, such as the Cleveland Clinic for SEHA s SKMC and Johns Hopkins for SEHA s Tawam. Payer market. Overall, the competitive Enhanced health insurance market has increased to almost 1.49m members. Over 50% of this market is held by three payers Daman (34%), ADNIC (14%) and Oman (7.5%) 42. Average Enhanced premium per member increased in 2013 by 10% to 3 380AED 40. Daman also administers Thiqa and Basic products. Claims per member have risen from 4.6 in 2009 to 6.5 in On average payers take 51 days to remit claims Note *SCAD, ** Percentage growth needs to be interpreted with caution, due to the fact of having some services within SEHA facilities holding a separate license.

8 Benchmarks Abu Dhabi Population growth, Life expectancy at birth (years), Males 75.2 Females 78.7 Injury mortality/100'000 population 29 Bahrain Germany Kuwait Oman Qatar Saudi Arabia Singapore UAE UK USA Abu Dhabi Bahrain Germany Kuwait Oman Qatar Under 5 mortality rate /1000 live births Infant mortality rate / 1'000 live birth Beds/1'000 population Adjusted* Physicians /10'000 population Nurses / 10'000 population Saudi Arabia Singapore UAE UK USA Notes Sources * Adjusted for fair international comparisons as the population in Abu Dhabi is young and is not expected to use hospital beds as frequently as older populations. The adjustment is made by mapping the population age structure of Abu Dhabi to that of Germany, using German resource consumption profiles. Life expectancy 2012 for Abu Dhabi Emirate, 2011 for others, Infant and under 5 mortality rates and clinicians Abu Dhabi 2013 others WHO Statistical Information System/World Health Statistics 2013, Public health department, HAAD population estimates, SCAD, and Health Statistics Analysis

9 Population Financing Episodes Payers Claims Providers 8

10 Population by age, gender and nationality National Expatriate Age band All Male Female Total Male Female Total 85+ 2' ' ' ' ' '898 1'375 1'163 2'538 1'059 1'301 2' Female Male 8'709 2'168 2'083 4'251 2'211 2'248 4' National 14'369 2'809 2'671 5'480 5'175 3'715 8' Expatriate 31'964 3'419 3'902 7'321 17'896 6'746 24' '431 4'122 5'790 9'911 49'630 12'890 62' '350 4'743 6'687 11'430 76'921 19'998 96' '803 6'741 8'651 15' '005 28' ' '306 8'766 11'607 20' '354 43' ' '479 13'939 17'390 31' '278 63' ' '231 19'355 22'270 41' '837 85' ' '623 22'372 24'011 46' '737 90' ' '154 23'591 23'412 47' '384 45' ' '511 24'790 23'621 48'411 30'879 24'221 55' '720 27'862 27'303 55'165 33'879 31'676 65' '667 34'351 33'262 67'613 43'903 41'150 85' '190 39'707 37'990 77'696 54'839 51' '494 Total 2'732' ' ' '368 1'682' '475 2'237'189 Notes HAAD is collaborating with SCAD to align figures with official SCAD estimates The total National population and the regional distribution are based on SCAD data 9 Source SCAD population estimates for Nationals, as well as additional HAAD assumptions and analysis based on raw insurance data

11 Population by region and nationality 6.0% 13.9% 40.8% 23.0% Western Eastern Abu Dhabi 53.1% 63.1% Region National Expatriate Total National Expatriate Abu Dhabi 263'207 1'411'639 1'674' % 84.3% Eastern 202' ' ' % 71.8% Western 29' ' ' % 91.2% Total 495'368 2'237'189 2'732'557 Notes HAAD is collaborating with SCAD to align figures with official SCAD estimates The total National population and the regional distribution are based on SCAD data 10 Source SCAD population estimates for Nationals, as well as additional HAAD assumptions and analysis based on raw insurance data

12 Births and deaths Total By Region Rates By Nationality and Gender Number % Number National Expatriate NA National Males Abu Dhabi Eastern Western NA Abroad Live Births 34'358 35'945 43% 51% 22'250 12'144 1' '958 7'618 10'301 10' Deaths 2'923 3'015 31% 70% 1' Total Still births % 30% Neonatal mortality % 48% Infant mortality % 50% Child mortality (1-4) % 56% Abu Dhabi Eastern Western Male Female NA Male Female NA Male Female NA Death by Age Group 0-6 days % 49% % 4% 4% 1% days % 48% % 2% 2% 1% days % 54% % 2% 3% 2% % 56% % 2% 3% 2% % 53% % 1% 1% 0% % 69% % 1% 2% 2% % 76% % 1% 2% 2% % 89% % 4% 2% 8% % 83% % 6% 5% 13% % 88% % 7% 4% 13% % 84% % 6% 5% 9% % 87% % 6% 4% 11% % 84% % 8% 6% 8% % 80% % 7% 8% 12% % 77% % 8% 9% 8% % 65% % 7% 8% 4% % 64% % 7% 8% 1% % 52% % 6% 7% 1% % 52% % 5% 5% 1% % 51% % 4% 6% 1% % 45% % 6% 7% 5% Note Rates: crude birth and death rates calculation are based on internal HAAD population estimates (per 1 000) other rates based on crude births (per 1 000), data s of 31st March 2014; HAAD and SCAD are collaborating to align with official SCAD data 11 Source Birth and Death notifications; Health Statistics Analysis

13 Births and deaths time series Note Crude birth rates 50 National Expatriate Aggregate Crude death rates 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 Year Total National Rate Expatriate Rate % Nationals '874 6' ' % '700 6' ' % '667 6' ' % '113 6' ' % '686 6' ' % '750 6' ' % '246 6' ' % '456 7' ' % '410 7' ' % '505 8' ' % '425 8' ' % '095 8' ' % '017 8' ' % '348 8' ' % '303 8' ' % '525 9' ' % '974 10' ' % '317 10' ' % '990 11' ' % '215 12' ' % '112 12' ' % '738 12' ' % '002 12' ' % '456 13' ' % '044 13' , % '502 13' , % '034 14' , % ,358 15' , % '945 15' , % Year Total National Rate Expatriate Rate % Nationals ' % ' % ' % ' % ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' , % ' , % ' , % 12 Source MOH statistics, Preventive Medicine Department annual reports, Public Health and Policy; Health Statistics Analysis

14 Causes of death Endocrine, nutritional and metabolic diseases 2% Congenital malformations, deformations and chromosomal abnormalities 2% Injury, poisoning and certain other consequences of external causes 3% Other causes 24% Neoplasms 16% Diseases of the circulatory system 37% External causes of morbidity 16% Codes Total 3'015 2'923 2'902 2'879 2'988 2'949 2'742 2'450 2'446 2'489 2'492 2'617 2'574 I00-I99 Diseases of the circulatory system 1'107 1'135 1' V00-Y99 External causes of morbidity S00-T98 Injury, poisoning and certain other consequences of external causes C00-D49 Neoplasms Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities E00-E89 Endocrine, nutritional and metabolic diseases Other Note Causes of death classified according to WHO ICD-10; where Neoplasms include: malignant (388 death cases), Other (80 death cases): benign, uncertain, and other unspecified behavior. Injury codes are part of the group codes S00-Y Source Death notifications; Health Statistics Analysis

15 Causes of death National Expatriate By Gender By Age Group By Gender By Age Group Cases NA Codes Total 3' ' I00-I99 Diseases of the circulatory system 1' V00-Y99 External causes of morbidity C00-D49 Neoplasms R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified A00-B99 Certain infectious and parasitic diseases J00-J99 Diseases of the respiratory system S00-T98 Injury, poisoning and certain other consequences of external causes P00-P96 Certain conditions originating in the perinatal period Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities K00-K95 Diseases of the digestive system N00-N99 Diseases of the genitourinary system E00-E89 Endocrine, nutritional and metabolic diseases G00-G99 Diseases of the nervous system O00-O99 Pregnancy, childbirth and the puerperium M00-M99 Diseases of the musculoskeletal system and connective tissue D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism L00-L99 Diseases of the skin and subcutaneous tissue NA Note Causes of death classified according to WHO ICD-10; where Neoplasms include: malignant, benign, uncertain, and other unspecified behavior, and Injuries codes are part of the group codes S00-Y Source Death notifications; Health Statistics Analysis

16 Injury deaths Homicide Drowning 3% 4% Fire/Flame, Burn 4% Poisoning 4% Suicide 8% Falls/Falling Object 11% Electricity 1% Other 3% Road Traffic Injuries (RTI) 62% Cases, by Year* Mechanism Road Traffic Injuries (RTI) Falls/Falling Object Suicide Poisoning Fire/Flame, Burn Drowning Homicide Electricity Other Total Rates per 100'000** Road Traffic Injuries (RTI) Poisoning Homicide 4.0 Falls/Falling Object Fire/Flames Electricity Nationals Expatriates Total Suicide Drowning Other Road Traffic Deaths, N=365 Occupational Injury Deaths, N=109 Childhood Injury Deaths (0-19 yrs), N=72 Car Pedestrian Truck Bus Pickup/van/minibus 7% 6% 6% 18% 55% Falls/Falling Object Road Traffic Injuries (RTI) Suffocation Electricity 6% 5% 30% 42% Road Traffic Injuries (RTI) Falls/Falling Object Homicide 8% 8% 60% Motorcycle Bicycle All-terrain vehicle Unknown/Other 2% 1% 1% 5% Fire/Flame, Burn Drowning Other 3% 1% 14% Drowning Poisoning Other 7% 4% 13% * Definition of fatal injuries: Mortality cases with underlying cause of death codes (S00-T98) in ICD-10 Chapter 19 and external cause codes (V01-Y98) excluding complications of medical and surgical care (Y40-Y84). ** Scales differ across charts. For data source please refer to 15 Source Active Surveillance. HAAD Death notification data complemented by investigation into the causes of injury using medical records and police reports - Public Health and Research Division; Health Statistics Analysis.

17 Communicable diseases Preventable Screened Disease Total National Expatriate Chickenpox 11'768 9'872 4' Malaria 2'731 2'719 2' Other Food Poisoning 667 1'147 1' Scabies ' Viral Hepatitis B Viral Hepatitis C Seasonal Infuenza Pulmonary Tuberculosis Viral Hepatitis A Typhoid Fever Scarlet Fever Mumps Extra Pulmonary Tuberculosis Syphilis Other STIs Measles Brucellosis Giardia Lambia Gonorrhoea Viral Meningitis Whooping Cough Rubella Acute Encephalitis Acute Flaccid Paralysis Other Viral Hepatitis Tetanus Other ' Note 16 Preventable: Diseases preventable by vaccination; Screened: Adult expatriates are screened on application or renewal of residence visa, some data where updated by the Communicable Diseases Department. Source HAAD infectious diseases notification data BI report - Public Health and Policy; Health Statistics Analysis

18 Cancer incidence 2012 By nationality National 28% Expatriate 72% By gender Cancer incidence 2012 Rate per 100'000 population Total Male Female Total Male Female Total 1' National Expatriate 1' Female 53% Male 47% 17 Source Cancer incidence data for 2012 are based on data as of April 2013, Cancer Prevention and Control Section, Public Health and Research Dept., Health Statistics Analysis

19 Cancer incidence 2012 Total Male Female National Expatriate NA Breast (Excludes Skin Of Breast C44.5) 26% 380 Hematopoietic And Reticuloendothelial Systems 29% 187 Breast (Excludes Skin Of Breast C44.5) 26% Hematopoietic And Reticuloendothelial Systems Colorectal 351 Lymph Nodes Thyroid Gland Prostate Gland Bronchus And Lung Stomach Bladder 35% 25% 35% 33% 23% % 56 26% 53 30% Lymphoid, haematopoietic and related tissue Breast Female Genital Organs Digestive Organs Thyroid and Other Endocrine Glands Eye, Brain and Other Parts of Central Nervous System Mesothelial and soft tissue Urinary Tract Respiratory System and Intrathoracic Organs 44% 8% 11% 41% 54% 43% 54 34% 44 45% 40 15% 26 Colorectal 15% Lymph Nodes 34% Prostate Gland Bladder Bronchus And Lung % 23% 26% Brain 13% 30 Stomach 29% 24 Thyroid Gland 9% Hematopoietic And Reticuloendothelial Systems Lymphoid, haematopoietic and related tissue Digestive Organs Male Genital Organs Urinary Tract Eye, Brain and Other Parts of Central Nervous System Respiratory System and Intrathoracic Organs Mesothelial and soft tissue Thyroid and Other Endocrine Glands Unknown Primary Site 37% 28% 36% 33% 26% 21% 31% 56% 39 47% 34 Colorectal Thyroid Gland Lymph Nodes Corpus Uteri 66 Ovary Cervix Uteri Stomach 46% % 64 44% % 48 45% 47 24% 37 19% 31 31% Corpus Uteri 45% 47 Skin 0% 25 Pancreas 15% 20 Lip, Oral Cavity and Pharynx 19% 27 Brain 29% 17 Other Sites 22% Unknown Primary Site % 25 Other Sites 18% Bones, Joints and Articular Cartilage of Limbs % 14 Other Sites 32% 123 Lip, Oral Cavity and Pharynx Bones, Joints and Articular Cartilage of Limbs 25% Skin Other and ill Defined- Sites 0% Other and ill Defined- Sites 7 18 Source Cancer incidence data for 2012 are based on data reported as of April 2013, Cancer Prevention and Control Section, Public Health and Research Dept., Health Statistics Analysis Breast 2

20 Cancer death cases By nationality By gender Expatriate 67% National 33% Cancer death cases Rate per 100'000 population Total Male Female Total Male Female Total Female 45% Male 55% National By site Expatriate All Male Female Trachea, bronchus and lung 11.6% Trachea, bronchus and lung 16.5% Breast 25.6% Breast 11.6% Leukaemia 13.7% Liver and intrahepatic bile ducts 8.5% Leukaemia 11.1% Liver and intrahepatic bile ducts 13.2% Leukaemia 8.0% Liver and intrahepatic bile ducts 11.1% Colorectum 9.0% Colorectum 7.4% Colorectum 8.2% Stomach 6.6% Cervix uteri 6.8% Stomach 6.4% Brain, nervous system 6.6% Stomach 6.3% Brain, nervous system 5.7% Pancreas 6.1% Trachea, bronchus and lung 5.7% Pancreas 5.1% Prostate 4.2% Ovary 5.1% Cervix uteri 3.3% Bladder 3.3% Brain, nervous system 4.5% Kidney, renal pelvis and ureter 2.6% Multiple myeloma 3.3% Pancreas 4.0% Other 23.4% Other 17.5% Other 18.2% 19 Note Source Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator) Death Notifications 2013, Health Statistics Analysis

21 Cancer death cases by age group Cases Rate per Age %National %Female % 22% % 60% % 22% % 33% % 33% % 63% % 33% % 53% % 50% % 59% % 47% % 50% % 58% % 43% % 41% % 29% % 36% % 28% Note Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator). 20 Source Death Notifications 2013, Health Statistics Analysis

22 Population Financing Episodes Payers Claims Providers 21

23 Episodes by type, setting and nationality Clinic Inpatient ER N/A Center National Hospital Outpatient Expatriate Provider type Setting Nationality 2013 SEHA 2012 SEHA 2011 SEHA 2010 SEHA Total 14'344'192 35% 12'765'198 37% 11'361'157 37% 10'998'469 34% Hospital 6'969'966 39% 6'311'459 40% 5'774'551 40% 5'954'723 38% Inpatient 193'996 61% 163'859 59% 130'219 65% 136'725 63% ER 64'967 88% 60'124 88% 45'138 94% 36'576 95% National 26'492 95% 29'886 94% 21'216 97% 18'311 98% Expatriate 25'281 86% 26'102 87% 21'232 92% 17'469 95% N/A 13'194 80% 4'136 43% 2'690 76% % Non-ER 129'029 47% 103'735 42% 85'081 49% 100'149 51% National 40'941 63% 33'484 66% 28'894 67% 40'878 75% Expatriate 56'931 41% 44'576 37% 40'135 41% 43'793 45% N/A 31'157 37% 25'675 21% 16'052 39% 15'478 4% Outpatient 6'775'970 38% 6'147'600 39% 5'644'332 40% 5'817'998 38% ER 728'900 72% 828'293 81% 655'394 97% 575'654 95% National 365'826 78% 440'637 87% 354'837 99% 321'781 96% Expatriate 330'358 66% 368'230 75% 297'177 96% 251'751 93% N/A 32'717 64% 19'426 46% 3'380 61% 2'123 61% Non-ER 6'047'070 34% 5'319'307 33% 4'988'938 32% 5'242'343 31% National 1'935'277 57% 1'779'900 58% 1'647'896 57% 1'875'221 53% Expatriate 3'695'273 24% 3'121'611 22% 2'907'096 22% 3'000'493 21% N/A 416'520 14% 417'796 6% 433'946 2% 366'629 2% Centre 6'765'800 35% 5'860'605 38% 5'049'446 38% 4'528'463 31% National 3'107'622 54% 2'771'498 60% 2'269'165 63% 1'974'079 54% Expatriate 3'366'210 19% 2'794'952 19% 2'497'339 19% 2'340'605 15% N/A 291'969 11% 294'155 5% 282'941 1% 213'779 1% Clinic 608'425 0% 593'134 3% 537'160 2% 515'283 1% National 137'855 1% 131'091 5% 103'564 7% 107'613 2% Expatriate 444'167 0% 425'743 2% 394'009 0% 380'371 0% N/A 26'403 0% 36'300 1% 39'588 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), and principal diagnosis. An Episode clinician is the clinician responsible for consultation. 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 data represents estimates based on Encounters reported in 2010 eclaims and Encounter/Episode ratios. SEHA episodes include Self-pay. Centres and Clinics episodes are outpatients. 22 Source Cube 2013; Health Statistics Analysis

24 Episodes by diagnosis group, % of volume 23 Outpatient Inpatient Total Non-ER ER Non-ER ER % of Total Episodes Signs, symptoms and ill-defined conditions Respiratory infections Musculoskeletal diseases Endocrine disorders excluding diabetes Respiratory diseases Digestive diseases Cardiovascular diseases Nutritional deficiencies Infectious and parasitic diseases Genitourinary diseases Skin diseases Diabetes mellitus Sense organ diseases Injuries Neuropsychiatric conditions Oral conditions Maternal and Perinatal conditions Cancer Congenital anomalies RTA Notes Episodes are attributed to diagnosis groups according to principal diagnoses. Data should be interpreted with caution, particularly for categories with low counts. Source Cube 2013; Health Statistics Analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

25 Episodes by diagnosis group, % of value Total Outpatient Inpatient 100.0% 66.8% 33.2% Break down * Break down * Procedures Drugs Supplies Services DRG Procedures Services Drugs Supplies % of Total value Signs, symptoms and ill-defined conditions Diabetes mellitus Cardiovascular diseases Respiratory infections Musculoskeletal diseases Maternal and Perinatal conditions Genitourinary diseases Digestive diseases Oral conditions Endocrine disorders excluding diabetes Respiratory diseases Neuropsychiatric conditions Injuries Infectious and parasitic diseases Sense organ diseases Skin diseases Cancer Nutritional deficiencies Congenital anomalies RTA * Breakdown values reflect proportions of the total value (claimed amount) of each grouping (Outpatient and Inpatient) 24 Notes Episodes are attributed to diagnosis groups according to principal diagnoses. Data should be interpreted with caution, particularly for categories with low counts. Source Cube 2013; Health Statistics Analysis; diagnosis groups based on WHO classification of diagnoses ICD 9.

26 Activities by classification type, % of value Drug 20% Service 7% HCPCS 4% Dental 4% DRG 21% * Dark area indicates proportion of outpatients CPT 44% Current Procedural Terminology (CPT) Sections 100% OP* Drug 100% OP* Pathology & Laboratory 39.7% Antineoplastic And Immunomodulating Agents 15.7% Evaluation & Management (E&M) 36.8% Cardiovascular System 13.9% Diagnostic Ultrasound 7.2% Alimentary Tract And Metabolism (Excluding Drugs Used In Diabetes) 12.7% Radiology 5.5% Drugs used in diabates 12.5% Eye & Ocular Adnexa 1.7% Antiinfectives For Systemic Use 11.2% Integumentary 1.4% Blood And Blood Forming Organs 8.1% Musculoskeletal 1.4% Respiratory System 8.1% Respiratory System 1.4% Musculo-Skeletal System 4.7% Digestive System 1.2% Nervous System 4.5% Urinary System.8% Dermatologicals 2.2% Nuclear Medicine.8% Genito-Urinary System And Sex Hormones 2.1% Auditory System.4% Sensory Organs 1.8% Cardiovascular System.3% Systemic Hormonal Preparations, Excluding Sex Hormones And Insulins 1.4% Radiation Oncology.3% Various.9% Female Genital System.3% Antiparasitic Products, Insecticides And Repellents.2% Maternity Care & Delivery.3% Male Genital System.2% DRG 100% OP* Nervous System.1% Newborns & Other Neonates 19.1% Breast Mammography.2% Respiratory System 13.7% Other CPT.1% Childbirth 13.6% Circulatory System 10.6% Digestive System 7.9% Service Codes ** 100% OP* Musculoskeletal System & Connective Tissue 6.4% Per Diem - Long Term Stay 38.5% Nervous System 4.1% Per Diem - Haemodialysis 25.6% Female Reproductive System 3.2% Per Diem - Day Stay (Day care) Surgical Case - Inclusive 13.9% Skin, Subcutaneous Tissue & Breast 3.2% Outlier Payment 10.0% Ear, Nose, Mouth & Throat 3.0% Per Diem - Short Stay 6.8% Infectious & Parasitic Diseases Of Systemic Or Unspecified Sites 2.7% Per Diem - Day Stay (Day care) Medical Case - Inclusive 1.1% Hepatobiliary System & Pancreas 2.6% Per Diem - ICU/CCU - Daily Rate (Day 1 to 7).5% Urinary Tract 2.6% Comprehensive Screening Evaluation and Management by Clinician.4% Endocrine, Nutritional & Metabolic Systems 2.1% Per Diem - Automated Peritoneal Dialysis.4% Diseases & Disorders Of Blood, Blood Forming Organs, Immunological System 1.1% Per Diem - Ward or Shared Room - Daily Rate (Day 1 to 3).3% Myeloproliferative System & Poorly Differentiated Neoplasms 1.1% Per Diem Intensive - Care Unit.2% Mental Diseases & Disorders 1.0% Per Diem - NICU - Daily Rate (Day 22 and More).2% Male Reproductive System.6% Per Diem - NICU - Daily Rate (Day 1 to 7).2% Injuries, Poisonings & Toxic Effects Of Drugs.5% Non-Surgical Cleansing of a Wound.2% Eye.2% Room and Board: First Class Room.2% Other DRG.8% Operating Room and Services.2%.0% Intensive Care Unit.2% Dental 100% OP* Per Diem - Ward or Shared Room - Daily Rate (Day 4 to 8).1% Restoration 35.4% Neonatal Intensive Care Unit.1% Diagnostic 11.7% Per Diem - Ward or Shared Room - Daily Rate (Day 8 and More).1% Oral And Maxillofacial 10.9% Per Diem - SCU - Daily Rate (Day 1 to 3).1% Orthodontics 10.0% Per Diem - PICU - Daily Rate (Day 22 and More).1% Endodontics 9.2% Per Diem - NICU - Daily Rate (Day 8 to 14).1% Adjunctive General Procedures 9.0% Operating Room Services - General Classification.1% Prevention 6.4% Per Diem - Special Care Baby Unit.0% Fixed Prosthodontic Procedure 4.8% Other services.4% Periodontics 2.0% Removable Prosthodontic Procedure 0.7% Notes Not all drugs have been mapped to the appropriate ATC code HCPCS CMS Hospital Outpatient Payment system includes 90% unclassified drugs. **Service codes are an Abu Dhabi Emirate specific classification maintained by HAAD HSF to complement the CPT classification for billing purposes. DRG: Diagnosis-Related Group. 25 Source Cube 2013; Health Statistics Analysis

27 Population Financing Episodes Payers Claims Providers 26

28 Providers Store 4% Clinic 21% Other 5% Hospital 3% Pharmacy 31% Centers (various) 36% Facilities Clinicians Total SEHA Abu Dhabi Eastern Western Total Physicians SEHA Dentists SEHA Nurses& Pharmacists Alternative SEHA AHP SEHA Midwifes Medicine SEHA Total 1'626 10% 1' '083 6'864 43% 1'220 21% 14'235 49% 5'332 40% 2'396 30% 36 0% Hospital 41 32% '915 4'536 53% % 9'375 60% 2'753 58% 33 45% 4 0% Centers (various) % '265 1'647 24% % 2'172 32% 1'542 32% 4 75% 31 0% Center % '519 1'567 24% % 1'952 29% 1'113 37% 3 100% 17 0% Mobile 16 56% % 8 50% 14 93% Rehabilitation 121 1% % 1 0% 36 0% 205 2% 1 0% 14 0% Diagnostic 23 30% % 10 80% % Dialysis % % 5 100% Fertilization 6 17% % 48 13% 24 33% Clinic 335 1% % % 34 0% Pharmacy % '065 2'065 32% Store 72 8% % Other 89 2% ' % 48 63% 2'335 25% 1'003 7% % 1 0% National Male % 35 37% 26 4% 89 30% 3 0 Female % % % % 53 60% 0 Expatriate Male 4'130 39% % 3'220 35% 2'379 32% 1'272 27% 21 0% Growth rate (CAGR ) Female 1'811 40% % 10'718 53% 2'489 46% 1'066 32% 15 0% CAGR NA Male 2 100% 1 0% 2 50% 1 0% 1 0% 0 Hospital Female 2 50% 0 2 0% 2 0% 1 0% 0 Centers (various) Breakdown by Region Clinic Abu Dhabi 4'724 35% % 9'633 44% 3'853 31% 1'613 22% 32 0% Pharmacy Eastern 1'811 57% % 3'925 58% 1'245 61% % 4 0% Store Western % 39 64% % % % 0 Notes Definitions of categories as per Health Facilities Licensing criteria, see Behavioral Science Pavilion is considered part of SKMC as it is under SKMC management Liwa licensed as a hospital, however, doesn't have inpatients, therefore classified as a Centre Zayed Military Hospital is excluded from the Hospital list, but counted in the provider page both facility and clinicians 27 Source Clinicians licensing database; facility licensing database

29 Hospital labour productivity 28 Source Cube 2013; HAAD licensing database; Health Statistics Analysis

30 Hospitals Episodes, 000's Staff Beds Indicators Ambulances Region Hospital Inpatient Outpatient ER Non-ER ER Non-ER Total ' '354 4' '202 2'669 3'864 56% * 3.7 * 93 SEHA ' '725 2' '652 1'622 2'503 64% * 4.7 * 49 Eastern MF2058 Tawam ' ' % Abu Dhabi MF1079 Al Corniche % Eastern MF2057 Al Ain ' % Abu Dhabi MF2006 Al Mafraq ' % Abu Dhabi MF2007 SKMC ' ' % Abu Dhabi MF2003 Al Rahba % Western MF2066 Madinat Zayed % Western MF2065 Ghayathi % Western MF2064 Al Silla % Eastern MF2060 Al Wagan % Western MF2046 Delma % Western MF2009 Al Mirfa % Total licensed staff Physicians Dentists Nurses & Midwifes AHP &Pharmacists Bed Capacity Bed Occupancy ALOS Notes Mubadala Abu Dhabi MF2467 Health Point Other ' '511 1' '496 1'012 1'281 36% * 1.8* 44 Abu Dhabi MF104 Emirates French % Abu Dhabi MF118 Al Noor - Khalifa St % Abu Dhabi MF131 Al Salama % Abu Dhabi MF1954 Life Line % Abu Dhabi MF213 Dar Al Shifa % Abu Dhabi MF2222 Life Line - Al Musafah % Abu Dhabi MF2270 Al Noor - Airport Road % Abu Dhabi MF23 Al Ahalia % Abu Dhabi MF2349 Lifecare - Al Mafraq Abu Dhabi MF2503 Burjeel % 0.9 Abu Dhabi MF254 Al Raha % Abu Dhabi MF2934 Universal Abu Dhabi MF3048 Provita International Medical Centre % Abu Dhabi MF3078 Long Term Custodial Care Centre % Abu Dhabi MF394 N M C Specialty % Abu Dhabi MF687 Gulf Diagnostic Centre % Abu Dhabi MF772 National % Eastern MF1589 Al Noor - Al Ain % Eastern MF1974 N M C Specialty - Al Ain % Eastern MF2259 Al Ain Cromwell Women & Children Hospital % Eastern MF233 Emirates International % Eastern MF2555 Ain Al Khaleej Eastern MF3345 Provita International Medical Centre - Al Ain % Eastern MF3590 Long Term Medical And Rehabilitation Hospital % Eastern MF404 Oasis % Eastern MF464 Specialised Medical Care % Western MF439 Al Rewaise % Total number of beds for SEHA facilities as of July, 2014, Others as of 31st December 13 and licensed beds for the new facilities was used; Episodes are attributed to facilities according to Episode Clinician facility as per clinician licensing database, Military Hospital is excluded. * These totals exclude Western Region facilities (Average Occupancy = 28%, ALOS = 3.0) and new facilities that are still ramping up their activity with less than two years of operations (Average Occupancy = 6%, ALOS = 0.8). 29 Source Hospital submissions, Operation Centre, Clinician Licensing Database

31 Hospital inpatient profile by value Hospital 100 Top 5* 1st 2nd 3rd 4th 5th Tawam 16 Signs, Symptoms And Ill-Defined (23.7%) Maternal And Perinatal Conditions (11.5%) Cardiovascular Diseases (8.2%) Cancer (8.0%) Infectious And Parasitic Diseases (7.6%) SKMC 16 Cardiovascular Diseases (23.6%) Neuropsychiatric Conditions (10.3%) Congenital Anomalies (9.1%) Infectious And Parasitic Diseases (8.7%) Signs, Symptoms And Ill-Defined (8.0%) Al Mafraq 12 Injuries (18.4%) Signs, Symptoms And Ill-Defined (17.1%) Cardiovascular Diseases (15.7%) Maternal And Perinatal Conditions (10.1%) Digestive Diseases (6.2%) Al Ain 10 Signs, Symptoms And Ill-Defined (19.0%) Cardiovascular Diseases (14.4%) Maternal And Perinatal Conditions (12.5%) Injuries (10.9%) Digestive Diseases (8.1%) Al Corniche 8 Signs, Symptoms And Ill-Defined (52.5%) Maternal And Perinatal Conditions (45.8%) Genitourinary Diseases (1.1%) Cancer (0.3%) Endocrine Disorders (0.2%) Al Noor - Airport Road 5 Maternal And Perinatal Conditions (27.4%) Signs, Symptoms And Ill-Defined (27.3%) Cardiovascular Diseases (14.5%) Digestive Diseases (8.5%) Injuries (4.1%) Al Rahba 5 Signs, Symptoms And Ill-Defined (29.3%) Maternal And Perinatal Conditions (22.8%) Cardiovascular Diseases (10.1%) Injuries (8.1%) Infectious And Parasitic Diseases (7.6%) N M C Specialty 3 Cardiovascular Diseases (24.3%) Maternal And Perinatal Conditions (12.8%) Signs, Symptoms And Ill-Defined (11.4%) Digestive Diseases (11.4%) Respiratory Infections (9.1%) Burjeel 3 Maternal And Perinatal Conditions (18.9%) Cardiovascular Diseases (18.3%) Signs, Symptoms And Ill-Defined (12.8%) Digestive Diseases (11.3%) Respiratory Diseases (6.5%) Al Noor - Khalifa St. 3 Maternal And Perinatal Conditions (25.4%) Signs, Symptoms And Ill-Defined (19.9%) Endocrine Disorders (12.3%) Digestive Diseases (11.9%) Cardiovascular Diseases (8.7%) Provita International Medical Centre 2 Neuropsychiatric Conditions (68.0%) Injuries (18.2%) Respiratory Diseases (6.8%) Congenital Anomalies (5.2%) Cardiovascular Diseases (1.3%) Al Ahalia 2 Cardiovascular Diseases (21.7%) Digestive Diseases (14.4%) Maternal And Perinatal Conditions (11.7%) Musculoskeletal Diseases (10.0%) Signs, Symptoms And Ill-Defined (9.0%) Madinat Zayed 2 Maternal And Perinatal Conditions (13.4%) Injuries (12.9%) Cardiovascular Diseases (12.7%) Signs, Symptoms And Ill-Defined (12.5%) Digestive Diseases (10.9%) Oasis 1 Maternal And Perinatal Conditions (42.5%) Signs, Symptoms And Ill-Defined (37.2%) Respiratory Infections (6.0%) Digestive Diseases (4.9%) Respiratory Diseases (3.0%) Al Noor - Al Ain 1 Maternal And Perinatal Conditions (18.4%) Digestive Diseases (15.6%) Musculoskeletal Diseases (12.8%) Signs, Symptoms And Ill-Defined (11.3%) Cardiovascular Diseases (10.7%) Long Term Medical And Rehabilitation Hospital 1 Neuropsychiatric Conditions (62.4%) Cardiovascular Diseases (20.0%) Congenital Anomalies (6.3%) Sense Organ Diseases (5.2%) Respiratory Diseases (4.0%) N M C Specialty - Al Ain 1 Cardiovascular Diseases (18.9%) Maternal And Perinatal Conditions (18.4%) Digestive Diseases (14.6%) Signs, Symptoms And Ill-Defined (13.9%) Musculoskeletal Diseases (8.5%) Behavioral Sciences Pavilion 1 Neuropsychiatric Conditions (99.0%) Oral Conditions (1.8%) Signs, Symptoms And Ill-Defined (0.6%) Cardiovascular Diseases (0.3%) Infectious And Parasitic Diseases (0.1%) Life Line 1 Maternal And Perinatal Conditions (19.2%) Digestive Diseases (18.9%) Cardiovascular Diseases (15.9%) Signs, Symptoms And Ill-Defined (11.5%) Respiratory Infections (6.2%) Al Ain Cromwell Women & Children Hospital 1 Maternal And Perinatal Conditions (46.0%) Signs, Symptoms And Ill-Defined (22.3%) Respiratory Infections (9.9%) Digestive Diseases (9.1%) Respiratory Diseases (7.5%) Life Line - Al Musafah 1 Digestive Diseases (22.9%) Cardiovascular Diseases (21.4%) Respiratory Infections (15.8%) Respiratory Diseases (9.0%) Infectious And Parasitic Diseases (6.2%) Al Salama 1 Musculoskeletal Diseases (17.3%) Maternal And Perinatal Conditions (15.6%) Digestive Diseases (14.7%) Signs, Symptoms And Ill-Defined (13.6%) Respiratory Infections (9.1%) Al Rewaise Maternal And Perinatal Conditions (29.1%) Signs, Symptoms And Ill-Defined (18.9%) Digestive Diseases (14.9%) Cardiovascular Diseases (12.5%) Respiratory Infections (10.4%) Provita International Medical Centre - Al Ain Neuropsychiatric Conditions (41.8%) Cardiovascular Diseases (23.8%) Congenital Anomalies (16.7%) Injuries (16.2%) Maternal And Perinatal Conditions (1.6%) Emirates International Endocrine Disorders (31.3%) Digestive Diseases (15.5%) Maternal And Perinatal Conditions (12.0%) Signs, Symptoms And Ill-Defined (9.3%) Cardiovascular Diseases (6.8%) Ghayathi Cardiovascular Diseases (22.3%) Digestive Diseases (13.7%) Respiratory Infections (13.3%) Neuropsychiatric Conditions (9.9%) Maternal And Perinatal Conditions (8.3%) Dar Al Shifa Maternal And Perinatal Conditions (37.1%) Signs, Symptoms And Ill-Defined (18.9%) Digestive Diseases (16.8%) Respiratory Infections (6.3%) Respiratory Diseases (5.2%) Gulf Diagnostic Centre Respiratory Diseases (35.6%) Cardiovascular Diseases (10.0%) Genitourinary Diseases (9.0%) Musculoskeletal Diseases (8.3%) Digestive Diseases (7.7%) Al Raha Respiratory Diseases (17.6%) Maternal And Perinatal Conditions (15.8%) Respiratory Infections (14.8%) Musculoskeletal Diseases (11.7%) Signs, Symptoms And Ill-Defined (10.1%) Al Wagan Respiratory Infections (53.2%) Respiratory Diseases (13.6%) Endocrine Disorders (9.9%) Neuropsychiatric Conditions (6.3%) Digestive Diseases (6.2%) Al Silla Maternal And Perinatal Conditions (21.5%) Cardiovascular Diseases (16.3%) Respiratory Infections (12.0%) Signs, Symptoms And Ill-Defined (11.5%) Neuropsychiatric Conditions (11.4%) Al Mirfa Maternal And Perinatal Conditions (31.4%) Signs, Symptoms And Ill-Defined (15.2%) Cardiovascular Diseases (15.1%) Respiratory Infections (10.1%) Digestive Diseases (5.4%) Specialised Medical Care Genitourinary Diseases (24.4%) Respiratory Infections (23.0%) Maternal And Perinatal Conditions (16.8%) Respiratory Diseases (13.8%) Digestive Diseases (9.7%) Ain Al Khaleej Endocrine Disorders (24.4%) Digestive Diseases (16.8%) Respiratory Infections (14.6%) Respiratory Diseases (8.7%) Signs, Symptoms And Ill-Defined (6.2%) Delma Maternal And Perinatal Conditions (24.3%) Signs, Symptoms And Ill-Defined (19.7%) Digestive Diseases (14.1%) Infectious And Parasitic Diseases (9.4%) Cardiovascular Diseases (6.9%) National Digestive Diseases (30.0%) Injuries (13.6%) Genitourinary Diseases (12.3%) Cardiovascular Diseases (10.4%) Skin Diseases (8.2%) Emirates French Injuries (14.6%) Maternal And Perinatal Conditions (13.9%) Genitourinary Diseases (13.9%) Respiratory Diseases (11.9%) Digestive Diseases (11.4%) Lifecare - Al Mafraq Infectious And Parasitic Diseases (80.5%) Respiratory Diseases (17.9%) Respiratory Infections (1.6%) 0 (0.0%) 0 (0.0%) Universal Cardiovascular Diseases (16.5%) Neuropsychiatric Conditions (15.1%) Injuries (13.6%) Genitourinary Diseases (12.1%) Respiratory Infections (9.5%) * Dark area in pie chart represents share of top 5 Diagnosis groups within the total value of provider s services 30 Note Attribution to diagnosis groups is based on principal diagnosis and does not necessarily reflect the full spectrum of services provided by respective healthcare facilities Source Cube 2013; Health Statistics Analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

32 Bed capacity by bed type Facility Acute Acute Intermediate Acute Specialty Adult Critical Care Pediatric Critical Care SubAcute Designation Subset General Med / Surg Obstetrics/GYN Paediatric VIP Med/Surg Intermediate Care Unit Pediatric Intermediate Care Special Care Baby Unit Total All 3'864 SEHA 2' Telemetry Al Ain Al Corniche Al Mafraq Al Mirfa Al Rahba Al Silla Al Wagan Delma Ghayathi Madinat Zayed SKMC Tawam Other 1'361 N M C Specialty Al Noor Al Noor - Airport Road Burjeel Hospital Al Noor - Al Ain Life Line Hospital Al Musafah N M C Specialty - Al Ain Al Rewaise Dar Al Shifaa Emirates International Gulf Diagnostic Centre 9 8 Specialized Medical Care 21 7 Al Ain Cromwell Women & Childrens Hospital Provita International Medical Centre Al Salama Al Ahalia Oasis Emirates French 12 5 LLH Al Raha Disabled Custodial Care Centre Provita International Medical Centre - Al Ain Long Term Medical And Rehabilitation National Lifecare* 50 Ain Al Khaleej Hospital* 80 Universal* 31 Health Point* 80 Thereof: Isolation Burn Unit Cardiac Care Unit (CCU) Medical Intensive Care Unit Medical/ Surgical ICU Surgical Intensive Care Unit NICU PICU Behavioural Sciences Long-term-care/ LTVU Pediatric Extended Care Unit (PECU) Notes SEHA Facilities bed capacity as of July 2013, Other than SEHA bed capacity as of 31st December 2013 Bed type breakdown for Other than SEHA facilities does not match with the totals due to the different reporting time period and the change in bed type classification during 2012 and * Licensed beds are reported for new facilities. 31 Source Operation Centre, SEHA

33 Bed occupancy 100% CICU 100% NICU SEHA Other 75% 75% 50% 50% 25% 25% 0% 100% 75% 50% 25% CCU 0% PICU 100% 75% 50% 25% 0% 100% Medical/Surgical ICU 0% 100% SCBU 75% 75% 50% 50% 25% 25% 0% Notes Jan Apr Jul Oct Presented bed occupancy is for the selected bed type Incomplete submissions from some facilities Optimal occupancy is 85% for normal beds and 75% for critical care beds 0% Jan Apr Jul Oct 32 Source 2013 Bed census (HAAD Operation Centre)

34 Centres & clinics SEHA Other Notes Non-SEHA facilities with more than 10 clinicians; Some centres Episodes were reported under the managing hospital Includes estimates based on the number of clinicians and average productivity Physicians Dentists Nurses AHP&Pharmacists Episodes (best estimate) Region Facility Episodes (best estimate) Region Facility Episodes (best estimate) Total 2'339' Total 5'034'581 1' '827 1'082 Dr. Ahmed Abu Sharia Medical Centre 13' Abu Dhabi Baniyas 163' Abu Dhabi Imperial College London Diabetes Centre 123' Samaya Specialized Hospital 13' Khalifa A 146' Al Noor Hospital Speciality Clinics- Al Musafah 99' American Center For Psychiatry & Neurology 12' Bain Al Gesreen 120' Al Musaffah Al Alhli Medical Centre 73' Gulf International Cancer Center 11' Other 115' Proficiency Central Laboratories 62' Capital Medical Centre For Health Screening 11' Al Bateen 88' Prince Specialized Medical Centre 60' Open Mri For Spine Surgery-Abu Dhabi Branch 11' Shahama 69' Nmc Day Surgery Centre 59' National Petroleum Construction Company Medical Centre 11' Al Khalidiya Urgent Care 61' Al Musaffah Al Alhli Medical Centre 59' Al Bustan Medical Centre 10' Al Ettihad Urgent Care 56' Al Noor Hospital Clinics - Al Mussaffah 57' Adco Medical Centre 10' Al Zafarana 50' Advance Cure Diagnostic Centre 51' Dr. Firas Dental And Orthodontic Centre 9' Samha 46' Amrita Midical Centre 49' Alnoor Hospital Medical Center - Alsalam Living City 9' Al Rowda 43' New National Medical Centre 49' Fakih Medical Centre 9' Disease Prevention And Screening Centre 40' Al Salama One Day Surgery Center 47' Middle East Specialized Medical Centre 9' Al Mafraq Dental Centre 31' Ibn Al Nafis Medical Centre 46' Mezyad Medical Centre 9' Abu Dhabi City Dental Centre 27' Al Kamal Medicdal Poly Clinics 42' Healthway Medical Centre 8' Disease Prevention And Screening Centre - Mussafah 23' Home Health Medical Centre 40' Health Plus Fertility Centre 8' Al Zafra Dental Centre 22' Taha Medical Centre 40' Tabarak Medical Centre 7' Al Khatim 18' Al Wahda Medical Centre 39' Advanced Center For Day Care Surgery 6' Madinat Mohamed Bin Zayed Healthcare Centre 16' Al Borg Diagnostic Centre For Laboratories & X Ray Merhi Dental & Orthodontic Centre 6' Seha Dialysis Services Sheikh Khalifa Medical City 13' Gulf Radiology &Laboratory 36' Health Plus Family Health Centre 6' Mafraq Dialysis Centre 13' Cosmesurge Emarites Hospital For One Day Surgery 36' American Fertility Centre 6' Abu Dhabi Blood Bank 7' Abu Dhabi Marine Operating Company Clinic 35' Cosmesurge & Emarites Hospital For One Day Surgery Branch 6' Eastern Al Yahar 95' Harley Street Medical Centre 35' Abu Dhabi Knee And Sports Medicine Centre 5' Al Jahili 94' Nadia Medical Centre 34' Nora Medical Poly Clinics 4' Neima 94' Advanced American Dental Centre 30' Lotus Holistic Alternative Medical Centre 4' Mezyed 90' Al Mafraq Medical Centre 29' Al Reyada Medical Centre 4' Al Maqam 78' Solutions Medical Center 28' American Crescent Health Care Centre 4' Muweiji 78' Magrabi Specialized Hospital 26' Royal Spanish Center Lasik Eyes & Cosmetic 4' Al Masoudi Primary Health Care Centre 72' Al Hendawy Medical Centre 26' Shadi International Dental & Orthodontic Centre 4' Al Khabisi Clinic 64' Apollo Medical Centre 26' Dr.Munir Silwadi Dental Centre 4' Al Qua'A 51' Al Rafa Medical Centre 24' Canadian Medical Centre 3' Hili 49' American European Medical Centre 24' Adams Medical Centre 3' Tawam Dental Centre 42' Dar Alshifa Medical Centre 22' Mekkah Specialized Polyclinic 3' Niyadat 41' Adnoc Medical Centre 22' Al Ahli Specialists Medical Centre 3' Oud Al Toba Primary Health Care Centre 39' Alriyadh Medical Centre 22' Venecia Medical Center For Rehabilitation 2' Zakher 39' Sadd Maareb Medical Centre 22' National Reference Laboratory 1' Al Hayer 30' Miami Emirates Medical Complex 22' Other 1'424' SEHA Dialysis Services Tawam Hospital 28' Prime Medical Centre 22' Eastern Imperial College Diabetes Centre - Al Ain Branch 74' Swaihan 24' Well Health Medical Centre Al Sultan Advanced Medical Clinics 58' Remah 22' Almadina Medical Center For Special Clinics 21' Al Madar Medical Centre - Branch 53' Other 14' Zakum Development Zadco Medical Centre 21' Al Noor Hospital Clinics - Al Ain 42' Disease Prevention And Screening Centre-Alain 11' Remax Medical Centre 21' Bin Sulaiman Medical Centre 29' Al Khazna 9' Health Plus Diabetes And Endocrinology 21' Mubarak Medical Centre 24' Tawam ivf Centre 6' Dr. Ahmed Hassan Fikri Medical Centre 20' Dr. Khalid Aljamal Medical Center 17' Blood Bank Centre 2' Al Rayyan Medical Clinic 20' Royal Care Medical Centre 16' Western Al Dhafra Family Medicine Centre 42' Oxford Medical Centre 19' Fine Care Specialized Medical Centre 16' Liwa Hospital 21' Almazroui Hospital One Day Surgery 19' Al Khaleej Medical Centre 13' Other 14' Dar Al Mouasah Diagnostic Centre 19' Arabic Canadian Medical Centre 11' Etihad Airways Polyclinic 19' Alnoor Hospital Clinics - Alain-Branch 7' National Rehabilitation Centre 19' Morani Orthodontic Center & General Medical 5' Universal Specialty Medical Center 19' Emirates International Poly Clinic 5' Physicians Dentists Nurses AHP & Pharmacists Golden Sand Medical Centre 18' Cosmo Health Medical Polyclinics 4' Al Amal Medical Centre 16' Ideal Medical Center - Al Ain Branch 4' First Medical Center 16' Cosmesurge & Emirates Hospital For One Day Surgery Polyclinic 3' Aesthetic Skin Care Centre 16' Health & Beauty Polyclinic 2' Health & Life Medical Centre 16' Uae University Clinics - Tawam Clinic 2' Grace Medical Centre 16' Other 690' Seha Emirates One Day Surgery Centre 15' Western Al- Noor Hospital Clinics - Madinat Zayed 58' Healthplus Womens Health Centre 15' Alnoor Hospital Speciality Clinics - Madinet Zayed 30' Consultant Medical Centre 14' Al Noor Hospital Speciality Clinics - Almirfa 14' Exeter Medical Centre 14' Habshan Clinic 2' Ruwais Housing Medical Centre 14' Other 135' Physicians Dentists Nurses AHP & Pharmacists 33 Source Cube 2013; Professionals licensing database; Extrapolation and Facility submissions

35 Blood bank donors National Expatriate Year Donors 33'059 26'819 27'094 25'850 24'758 21'834 19'461 16'737 National 5'747 5'077 3'794 4'240 4'116 3'832 3'311 2'664 Expatriate 27'312 21'742 23'300 21'610 20'642 18'002 16'150 14'073 14'073 16'150 18'002 20'642 21'610 23'300 21'742 27'312 Units donated 30'315 26'819 27'094 25'850 24'758 22'379 19'849 17'129 O + 11'356 10'279 10'141 9'441 8'960 8'314 7'242 6'396 A + 7'448 6'705 6'704 6'620 1'430 5'840 5'263 4'548 B + 6'384 5'364 5'740 5'423 6'421 4'294 4'040 3'396 AB + 1'843 1'555 1'767 1' '302 1' O - 1'688 1'501 1'310 1'274 5'130 1'346 1' '664 3'311 3'832 4'116 4'240 3'794 5'077 5' A B ' AB Source Abu Dhabi Blood Bank, Health Statistics Analysis

36 Inpatient market by value Diagnosis group 100 Top 5* 1st 2nd 3rd 4th 5th Signs, symptoms and ill-defined conditions 19 Al Corniche (21.6%) Tawam (20.2%) Al Mafraq (10.6%) Al Ain (9.4%) Al Rahba (7.0%) Maternal and Perinatal conditions 15 Al Corniche (24.2%) Tawam (12.5%) Al Noor - Airport Road (8.8%) Al Mafraq (8.0%) Al Ain (8.0%) Cardiovascular diseases 13 SKMC (28.2%) Al Mafraq (14.0%) Al Ain (10.3%) Tawam (10.2%) N M C Specialty (5.8%) Injuries 8 Al Mafraq (27.6%) SKMC (14.9%) Tawam (14.3%) Al Ain (13.1%) Neuropsychiatric conditions 7 SKMC (21.5%) Provita International Medical Centre (19.7%) Behavioral Sciences Pavilion (14.6%) Long Term Medical And Rehabilitation Hospital (12.2%) Provita International Medical Centre (5.0%) Tawam (10.8%) Digestive diseases 7 SKMC (12.8%) Al Ain (11.6%) Al Mafraq (11.1%) Tawam (9.6%) Al Noor - Airport Road (6.1%) Respiratory diseases 5 Tawam (21.4%) SKMC (21.3%) Al Mafraq (11.5%) Al Ain (10.6%) Burjeel (3.9%) Infectious and parasitic diseases 5 SKMC (28.4%) Tawam (25.7%) Al Mafraq (10.8%) Al Ain (8.0%) Al Rahba (7.3%) Musculoskeletal diseases 5 Abu Dhabi Knee And Sports Medicine Centre (44.3%) SKMC (9.6%) Tawam (6.8%) Al Mafraq (6.4%) Al Ain (6.3%) Respiratory infections 4 SKMC (14.8%) Al Ain (13.4%) Tawam (11.5%) Al Mafraq (10.5%) N M C Specialty (6.6%) Endocrine disorders excluding diabetes 4 Tawam (30.4%) SKMC (20.5%) Al Noor - Khalifa St. (9.6%) Al Mafraq (8.8%) Al Ain (5.5%) Cancer 3 Tawam (42.4%) SKMC (22.9%) Al Mafraq (12.3%) Al Ain (6.7%) N M C Specialty (2.6%) Genitourinary diseases 3 Tawam (21.2%) SKMC (13.3%) Al Mafraq (12.1%) Al Ain (9.1%) Burjeel (5.8%) Congenital anomalies 2 SKMC (65.6%) Tawam (9.9%) Provita International Medical Centre (5.3%) Long Term Medical And Rehabilitation Hospital (4.3%) Provita International Medical Centre - Al Ain (3.4%) Diabetes mellitus 1 SKMC (23.2%) Al Mafraq (21.1%) Al Ain (15.1%) Tawam (12.8%) Al Rahba (4.9%) Skin diseases 1 SKMC (20.3%) Al Mafraq (17.7%) Al Ain (13.8%) Tawam (9.0%) N M C Specialty (6.1%) Sense organ diseases 1 Al Mafraq (44.0%) Long Term Medical And Rehabilitation Hospital (12.7%) Al Ain (12.2%) SKMC (9.2%) Tawam (6.0%) Oral conditions SKMC (52.4%) Tawam (16.7%) Al Mafraq (10.1%) Behavioral Sciences Pavilion (6.8%) Al Rahba (3.0%) Nutritional deficiencies SKMC (24.2%) Tawam (17.8%) Al Mafraq (10.6%) Al Ain (8.4%) Al Noor - Airport Road (7.8%) RTA Al Rahba (43.9%) Al Mafraq (25.8%) Al Ain (15.9%) Madinat Zayed (14.3%) * Dark area in pie chart represents share of top 5 providers within the total value of diagnosis group 35 Note Attribution to diagnosis groups is based on principal diagnosis and does not necessarily reflect the full spectrum of services provided by respective healthcare facilities Source Cube 2013; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

37 Population Financing Episodes Payers Claims Providers 36

38 Outpatient market by value Diagnosis group 100 Top 5* 1st 2nd 3rd 4th 5th Signs, symptoms and ill-defined conditions Diabetes mellitus Tawam (15.8%) SKMC (7.3%) Al Mafraq (4.6%) Imperial College London Diabetes Centre - Abu Dhabi (44.5%) Imperial College London Diabetes Centre - Al Ain (19.8%) Oral conditions 7 Tawam Dental Centre (9.4%) Al Mafraq Dental Centre (6.4%) SEHA Dialysis Services Sheikh Khalifa Medical City (4.2%) SKMC (3.7%) Tawam (3.2%) Al Ain (2.1%) Abu Dhabi City Dental Centre (4.3%) SEHA Dialysis Services Tawam Hospital (3.4%) Bain Al Gesreen (3.5%) Al Zafra Dental Centre (3.0%) Respiratory infections 7 Al Noor - Khalifa St. (5.4%) Al Noor - Airport Road (5.0%) N M C Specialty (3.3%) Burjeel (2.7%) Tawam (2.7%) Musculoskeletal diseases 7 SKMC (7.1%) Al Noor - Khalifa St. (5.8%) Burjeel (5.7%) Tawam (5.0%) Al Mafraq (4.8%) Genitourinary diseases 6 SKMC (7.4%) American Fertility Centre (7.3%) Tawam (5.2%) Al Noor - Khalifa St. (4.6%) Burjeel (4.5%) Cardiovascular diseases 5 SKMC (10.8%) Al Mafraq (5.6%) Al Noor - Khalifa St. (5.4%) Tawam (5.3%) Burjeel (4.9%) Endocrine disorders excluding diabetes Sense organ diseases 4 5 Tawam (20.5%) SKMC (16.1%) Samaya Specialised Hospital (12.3%) Imperial College London Diabetes Centre - Abu Dhabi (12.6%) Imperial College London Diabetes Centre - Al Ain (6.5%) Al Mafraq (5.8%) Al Noor - Khalifa St. (9.4%) Magrabi Specialised (8.1%) SKMC (6.1%) Al Mafraq (5.5%) Respiratory diseases 4 SKMC (7.6%) Al Noor - Airport Road (7.2%) Al Noor - Khalifa St. (6.9%) Tawam (4.5%) Al Noor - Al Ain (4.1%) Digestive diseases 4 SKMC (7.6%) Burjeel (6.5%) Tawam (6.3%) Gulf Diagnostic Centre (4.9%) Al Noor - Khalifa St. (4.9%) Neuropsychiatric conditions 4 Behavioral Sciences Pavilion (15.6%) SKMC (10.6%) Tawam (8.3%) Al Ain (8.3%) Al Mafraq (4.8%) Maternal and Perinatal conditions 3 Al Corniche (13.5%) Al Noor - Airport Road (9.3%) Al Noor - Khalifa St. (7.3%) Tawam (4.8%) Injuries 3 SKMC (7.0%) Al Mafraq (6.6%) Al Ain (6.1%) Al Noor - Airport Road (5.9%) Tawam (4.7%) Skin diseases 3 SKMC (8.9%) Al Noor - Khalifa St. (6.6%) Al Mafraq (5.0%) Tawam (4.4%) Al Ain (4.2%) Infectious and parasitic diseases 2 Tawam (9.4%) SKMC (7.4%) Burjeel (7.4%) Al Noor - Khalifa St. (5.4%) Al Noor - Airport Road (4.1%) Cancer 2 Tawam (25.0%) Al Mafraq (23.5%) SKMC (22.0%) Nutritional deficiencies 2 Imperial College London Imperial College London Diabetes Diabetes Centre - Al Ain (23.5%) Centre - Abu Dhabi (14.9%) Congenital anomalies SKMC (31.6%) Tawam (15.7%) Al Noor - Airport Road (8.2%) Gulf International Cancer Centre (5.3%) SKMC (7.5%) Gulf Diagnostic Centre (3.0%) Tawam (2.9%) Emirates Outreach Healthcare Services (6.0%) Tawam Molecular Imaging Centre (4.3%) Al Mafraq (5.4%) RTA SKMC (29.3%) Al Mafraq (16.0%) N M C Specialty (11.9%) Al Ain (9.5%) Al Rewaise (5.2%) Notes Pharmacies are excluded. Attribution to diagnosis groups is based on principal diagnosis and does not necessarily reflect the full spectrum of services provided by respective healthcare facilities. * Dark area in pie chart represents share of top 5 providers within the total value of diagnosis group 37 Source Cube 2013; Health Statistics analysis; diagnosis groups based on WHO classification of diagnoses ICD 9

39 Population Financing Episodes Payers Claims Providers 38

40 Claims Average Claim net per Claim (AED) (1) Claims (000) (2) Claims per member Inpatient 11' Inpatient Basic 9' Inpatient Enhanced 10' Inpatient Thiqa 14' Outpatient '069 19'684 17'186 12'918 10' Outpatient Basic 174 5'260 4'964 4'029 2'928 2' Outpatient Enhanced 339 8'841 7'620 6'963 4'146 3' Outpatient Thiqa 513 6'968 7'100 6'193 5'844 4' Total '266 19'850 17'331 13'084 10' Notes (1) Average Claim net per Claim, represents amount claimed by provider, subject to full or partial rejection by the payer (2) Numbers of claims with Encounter start date in respective years. These include electronic claims of Abu Dhabi providers for members with insurance provided by payers from outside of Abu Dhabi, self-pay and funded mandates 39 Source Cube 2013; Health Statistics Analysis

41 Payer members Enhanced 45% Notes Members Thiqa 15% Basic 40% Members Market Share Change from Contracts 2013 PPMPA (1) 2013 Total 3'307'365 3'163'795 2'812'307 2'671'391 2'312'569 2'260' '570 3'321'968 2'763 Thiqa 482' ' ' ' ' '795 24' '803 Basic 1'335'680 1'341'405 1'306'931 1'204' ' '344-5'725 1'340' Total Enhanced 100.0% 1'489'233 1'364'545 1'057'233 1'044' ' ' '688 1'498'801 3'380 Daman 40.0% 596' ' ' ' ' ' ' '230 4'450 Oman 10.7% 159' '933 73' ' ' '735-8' '376 2'844 ADNIC 9.6% 142' ' ' '654 90'190 97' '373 4'483 Al Dhafra 8.8% 130' '635 71'009 12' '087-61' ' Al Hilal Takaful 3.9% 57'760 26'809 20'964 11'075 5'003 30'951 57'763 1'762 Al Wathba 2.8% 41'257 52'140 52'034 48'038 41'583-10'883 41'265 3'337 Orient 2.7% 40'842 34'580 30'476 26'742 1'524 24'337 6'262 40'844 2'548 Insurance House - PSC 2.2% 33'147 25'834 7'313 33'147 1'378 AXA 2.1% 32'007 11'938 22' '537 3'044 20'069 32'158 4'288 Takaful Emarat 1.9% 28'795 25' '600 16'222 12'721 3'430 28'795 1'050 Al Buhaira 1.8% 26'593 30'479 61'983 49'838 51'215 25'083-3'886 26'595 1'158 Green Crescent 1.3% 20'091 24'969 43'894 70'881 21'341-4'878 20'498 2'081 EIC 1.3% 19'877 20'849 29'691 17'721 15'167 26' '877 2'714 Al Ain Ahlia 1.3% 18'938 8'441 4'154 24'419 23'857 4'707 10'497 18'938 2'606 Al Sagr 1.1% 16'304 19'741 15'327 27'661 94'758-3'437 16'318 2'442 Abu Dhabi Takaful 0.9% 13'281 14'086 22'233 1' '282 4'007 Aman 0.9% 13'161 4'663 4' '498 13'178 1'207 Qatar 0.9% 12'736 7'691 11'569 6'305 9'332 10'381 5'045 12'737 3'907 RAK 0.8% 12'049 8'331 8'966 10'508 11'368 8'827 3'718 12'152 2'464 ALICO 0.8% 11'228 11'350 8'566 10'384 1'030 6' '532 4'412 Al Khazna 0.5% 7'293 20'039 11'532 78' '648 90'229-12'746 8'518 1'545 NoorTakaful 0.5% 6'910 5'376 1'625 2' '534 6'910 3'512 Dubai National 0.4% 5' '763 5'828 2'648 Saudi Arabian 0.3% 4'956 3'656 2'602 2' '300 4'968 6'834 Union 0.3% 4'867 4'092 1' '867 3'000 Al Fujairah 0.3% 4'730 7'584 5'676 4' '112-2'854 4'730 1'423 Al-Ittihad 0.3% 4'355 4'292 3' '385 3'074 Arabia 0.3% 3'882 4'660 1'660 1' '882 2'842 United 0.2% 3'408 9'409 4' '645 1'887-6'001 3'408 2'934 Arabian Scandinavian 0.2% 3'379 4' '489-1'117 3'386 1'493 NGI 0.2% 2' '026 2' '717 2'674 3'891 Alliance 0.2% 2'546 2' ' ' '546 2'926 Salama 0.1% 2'133 1' ' '133 3'289 Royal and Sun Alliance 0.1% 1'843 1' ' '843 7'414 Dubai Insurance Co. 0.1% 1'735 1' ' '749 3'958 Methaq Takaful 0.1% 1' '659 17'002 1'076 1'462 2'208 Lebanese 0.0% 517 2'363 6'139 7'044 3'596 1'437-1' '904 Sharjah 0.0% 193 3'332 4'110-3' (1) Average Premium per Member Per Annum Market share applies to Enhanced products, some of the payers reported Enhanced members from other Emirates Members of Al Watania insurance are not included The Basic Product: for individuals (including limited income investors) with limited income in accordance with the threshold set by the Regulations and dependents of non- Nationals who are not eligible to be covered by the non-national s employment based insurance The Enhanced Product: for individuals above the income threshold set by the Regulations for the Basic Product and available to all non-nationals 40 Source Cube 2013; Health Statistics Analysis

42 Payer claims Enhanced 40.77% Enhanced 37% Basic 13% Claim count Basic 25.51% Claim net (1) Thiqa 33.72% Thiqa 50% Claim net (1) Claim count Change Days to Remit (2) 2013 Average Claim net per Claim 2013 Claims per Member 2013 Total 100% 100% 100% 100% 100% 100% 6% Thiqa 33.72% 36.42% 35.49% 45.35% 42.22% 0.00% -1% Basic 25.51% 25.40% 23.12% 22.47% 20.12% 32.83% 7% Total Enhanced 100% 40.77% 38.18% 41.40% 32.18% 37.66% 67.17% 14% Daman 34.0% 13.85% 11.44% 11.65% 15.27% 15.63% 32.02% 29% ADNIC 14.5% 5.92% 6.21% 6.89% 5.62% 0.40% 0.82% 1% Oman 7.5% 3.04% 2.86% 2.52% 3.31% 7.61% 13.03% 13% Al Wathba 4.8% 1.97% 2.06% 2.02% 1.33% 0.85% 0.00% 2% Al Dhafra 4.6% 1.89% 1.83% 1.06% 0.00% 0.30% 0.80% 10% AXA 2.6% 1.07% 1.10% 0.67% 0.00% 0.14% 0.00% 3% Al Hilal Takaful 3.8% 1.57% 1.01% 0.80% 0.32% 0.00% 0.00% 65% Saudi Arabian 1.5% 0.63% 0.45% 0.33% 0.13% 0.01% 0.09% 50% Qatar 2.6% 1.07% 0.93% 0.82% 0.26% 0.14% 0.92% 22% Insurance House - PSC 3.0% 1.22% 0.57% 0.00% 0.00% 0.00% 0.00% 126% Takaful Emarat 2.5% 1.02% 0.28% 0.03% 0.00% 0.00% 0.00% 283% EIC 2.5% 1.02% 1.14% 1.24% 0.51% 0.66% 1.81% -5% ALICO 1.5% 0.61% 0.65% 1.17% 0.29% 1.18% 1.19% 0% Al Ain Ahlia 1.6% 0.63% 0.50% 0.97% 0.75% 0.69% 0.16% 35% Orient 1.5% 0.62% 0.60% 0.99% 0.36% 3.46% 3.34% 10% Abu Dhabi Takaful 1.5% 0.62% 0.66% 0.78% 0.40% 0.46% 1.18% 0% Green Crescent 1.1% 0.47% 1.16% 3.77% 1.12% 0.63% 0.00% -57% RAK 1.2% 0.49% 0.28% 0.50% 0.31% 0.38% 0.73% 85% Al Sagr 1.0% 0.42% 0.49% 0.79% 0.02% 3.05% 6.65% -7% Aman 1.1% 0.46% 0.15% 0.09% 0.00% 0.02% 0.00% 235% Al Buhaira 0.9% 0.36% 0.70% 1.50% 0.98% 0.79% 1.38% -45% NGI 0.6% 0.23% 0.31% 0.35% 0.01% 0.02% 0.06% -22% NoorTakaful 0.5% 0.20% 0.17% 0.17% 0.06% 0.01% 0.00% 24% Dubai Insurance Co. 0.4% 0.15% 0.49% 0.14% 0.00% 0.00% 0.00% -68% Arabia 0.4% 0.15% 0.07% 0.15% 0.07% 0.01% 0.03% 129% Royal and Sun Alliance 0.2% 0.09% 0.04% 0.04% 0.03% 0.01% 0.00% 112% United 0.4% 0.18% 0.25% 0.17% 0.00% 0.16% 0.07% -26% Al Khazna 0.5% 0.19% 0.65% 0.57% 0.85% 0.75% 2.51% -70% Al-Ittihad 0.3% 0.14% 0.16% 0.04% 0.00% 0.00% 0.00% -9% Union 0.2% 0.10% 0.03% 0.05% 0.00% 0.00% 0.00% 312% Alliance 0.2% 0.07% 0.06% 0.07% 0.00% 0.17% 0.00% 32% Salama 0.1% 0.04% 0.04% 0.05% 0.02% 0.01% 0.12% 31% Arabian Scandinavian 0.3% 0.11% 0.10% 0.03% 0.00% 0.00% 0.06% 8% Al Fujairah 0.1% 0.05% 0.07% 0.08% 0.01% 0.07% 0.09% -27% Sharjah 0.1% 0.06% 0.34% 0.15% 0.00% 0.00% 0.00% -82% Methaq Takaful 0.1% 0.04% 0.24% 0.67% 0.09% 0.00% 0.00% -84% Dubai National 0.1% 0.03% 0.00% 0.00% 0.00% 0.00% 0.00% 5728% Lebanese 0.1% 0.01% 0.08% 0.11% 0.04% 0.06% 0.01% -83% Notes (1) Claim net represents amount claimed by provider, subject to full or partial rejection by the payer (2) Days to Remit is measured as average number of days to submit AED 1 from first Claim Submission Date to first Remittance Date Claims of Al Watania Insurance are not included; The Basic Product: for individuals (including limited income investors) with limited income in accordance with the threshold set by the Regulations dependents of non- Nationals who are not eligible to be covered by the non-national s employment based insurance; the Enhanced Product: for individuals above the income threshold set by the Regulations for the Basic Product and available to all non-nationals 41 Source Cube 2013; Health Statistics Analysis

43 Population Financing Episodes Payers Claims Providers 42

44 Enhanced plans premiums Average Gross Premium for Enhanced Product 7'893AED 4'456AED 3'458AED 2'527AED 680AED [ AED] 1'533AED [1'000-1'999 AED] [2'000-2'999 AED] [3'000-3'999 AED] [4'000-4'999AED] Number of Contracts [5'000+ AED] 434' ' ' ' ' '980 Notes This data is only for Enhanced products The Enhanced Product: for individuals above the income threshold set by the Regulations for the Basic Product and available to all non-national The Basic Product: for individuals (including limited income investors) with limited income in accordance with the threshold set by the Regulations and dependents of non- Nationals who are not eligible to be covered by the non-national s employment based insurance 43 Source Cube 2013 and Products Search Engine Database; Health Financing Strategy Analysis

45 Enhanced plans limits 2012 Benefit Level Equivalent to Basic product benefit level Better than Basic product benefit level Geographic Coverage Annual Limit AED millions % Cover Outside Network + Home Country, 11% Other (7%) 5.00 (1%) 2.50 (3%) 1.50 (2%) 100 (20%) 1.00 (14%) Member % + International, 56%.50 (17%).35 (2%) 80 (37%).30 (27%) 70 (4%) 50 (4%) 20 (1%) + Other Emirates, 33%.25 (27%) 0 (34%) Note This data is only for Enhanced products. About 21% of the enhanced plans contracts are excluded due to non compliance with reporting of benefits information. 44 Source Cube 2012 and Products Search Engine Database; Health Financing Strategy Analysis

46 Capacity Masterplan 27 November 2014

47 Contents Model of Care Abu Dhabi s model of care Model of care How health services are currently used, what s wrong? Model of care what s new Key themes for healthcare reforms Capacity Gaps* Current service balance Service capacity balance by specialty Clinician sub-specialty gaps IPC capacity gap, top Medical Board reasons for sending paediatric patients abroad IPC capacity gap, Medical Board classified reasons for sending abroad IPC Medical Board approvals for treatment abroad compared to the Abu Dhabi population trends IPC capacity gap, categorised as Services not available breakdown by volume of patient treated abroad Capacity Management* Planning for healthcare services Service capacity balance by location 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 Centralised, Regional and Standard services, by % total Abu Dhabi DRG volumes (Paediatric) Paediatric DRGs coverage in Abu Dhabi Emirate Coverage of Regionally required DRG in Abu Dhabi Emirate C3 C4 C5 C6 C8 C9 C10 C11 C12 C13 C14 C16 & C17 C18 C19 C20 C21 C22 C23 C24 *Detailed plans for specific locations and services are available on 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

48 Contents Demand & Supply Projections* Inpatient current supply and projected demand C26 Projected demand by Abu Dhabi planning region C27 Projected inpatient demand by Abu Dhabi planning region, by number of beds C28 Current health facility locations C29 Supply projections C30 & 31 Inpatient current and projected demand, by number of beds and Emergency bays C32 Assumptions Population density Population growth, scenarios Demand projections Demand projections based on WHO disease classification Demand projections for doctors by specialty Recommendations Planning recommendations Facility recommendations for developers, investors, and healthcare Providers Service recommendations for investors and developers Recommendation for allocation of land and service provision Access requirements C34 C35 C36 C37 C38 C40 C41 C42 C43 C44 *Detailed plans for specific locations and services are available on 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. 47 C1

49 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Capacity Gaps Capacity Management Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Assumptions Population (millions) Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 48 C2

50 Abu Dhabi s model of care Healthcare in Abu Dhabi faces growing demand for services arising from an expanding population C18, C35. The current population is young and has a 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. Also, patients have undirected access to services and specialty care which leads to inappropriate use and, in turn, over-supply of services C4,C17,C18. In response HAAD is further developing its capacity management processes, its Weqaya screening programme and its approach to the continuum of care. Specialty care is not equally distributed across the 3 regions of Abu Dhabi Emirate. In addition rural primary care and subacute care is not well developed in the Emirate. In response HAAD is developing its comprehensive capacity planning process to address these issues including resolving critical shortages including rural areas in the Western and Eastern Regions. Historically, Abu Dhabi has had a relatively limited supply of healthcare services, particularly hospital beds, which led to investment in infrastructure. Achieving world-class quality care, however, is about much more than new buildings C5,C6. 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 Dhabi s model of care 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 and supported by well developed primary and subacute care including home care and the integrated use of telemedicine**. In order to promote the use of home care and telemedicine HAAD has developed new At Home and telemedicine standards. This has been shown to improve quality, and improve access in rural areas. There needs to be improved access to appropriate elective and emergency care, and this should be streamlined and optimised from the patient s perspective through an emphasis on early clinical triage. Diagnostics, for instance, should be more readily available to enable one-stop-treatment. Making such ambitious changes to our healthcare system will require many decisions on what to do and what not to do. The proposed healthcare reforms with consensus from major health stakeholders C6 help clarify how priorities should be made in delivering health services and transitioning to the new model of care. 49 C3 * Impact of home care on hospital days: a meta analysis. Hughes, SL et al (1997). ** A randomised controlled trial of child psychiatric assessment conducted by videoconferencing. Alford, R et al (2000).

51 Model of care How health services are currently used. What s wrong? There are no systems in place to support patient self-care and management of chronic disease Ambulance Open access 1 Outpatient Primary care centre/ clinic Hospital ER Inpatient Subacute care is not (yet) fully aligned and many long term care patients are occupying acute beds Specialist Hospital admission Hospital specialist Screening Screening programmes are not (yet) fully aligned towards preventing and treating chronic conditions Notes Source Patient access to services is not streamlined: leading to over-servicing, oversupply and inappropriate service use Laboratory and radiology Diagnostics 1 Access 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 Diagnostic services are not optimally integrated into treatment paths 50 C4

52 Desired model of care. What s new? Primary and Community Care / Prevention Home Healthcare OUTPATIENT Subacute care INPATIENT Telemedicine Remote support Disease management Consultant led Family based Care Check-up Outpatient Tertiary/Quaternary level Acute Care Ambulance Vaccination and public health programmes Urgent Care Centre ER Triage Screening Secondary level Acute care Centralized Emergency specialist services e.g., Trauma Centre, Stroke and Cardiac 51 C5 Source Strategy analysis

53 Key themes for healthcare reforms The following 7 major priorities have been identified: 1 Integrated continuum of care for individuals 5 Wellness and prevention public Health approach 2 Drive quality and safety as well as enhance patient experience 6 Ensure value for money + Sustainability of healthcare spend 3 Attract/retain/train workforce 7 Integrated Health Informatics and ehealth 4 Emergency preparedness Governance as a key enabler of the reform effort 52 C6 Source Abu Dhabi Health Sector Strategic Review and Performance Evaluation. May 2013.

54 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Capacity Gaps Capacity Management Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Population (millions) Assumptions Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 53 C7

55 Current service balance To obtain an accurate picture of capacity balance in the Emirate, international benchmarking of demand by population and population type is analysed & projected forward. This data along with a number of quantitative sources including International Patient Care (IPC) data is monitored and compared to Abu Dhabi current and planned supply. Historic Capacity Gaps are in Intensive and Critical Care medicine, Emergency care, Neonatology, Paediatric, Oncology, Orthopaedic, Rehabilitation and Psychiatry C9. In previous years only modest increases in supply have occurred, however 2013 has seen major progress in addressing specialties in shortage. There has been significant growth in the specialties where capacity gaps exist, for example since the end of 2012 there has been 20% growth in Emergency Physicians, 41% growth in Neonatologists and a 21% increase in Paediatric and Orthopedic doctors respectively. Critical care doctors have grown by 14%. Obstetrics & Gynecology doctors have grown by 30%, Ophthalmologists have grown by 28% and Neurologists by 32%. Mental Health Physicians have increased by 35%. In each case additional facilities have also been opened. Further general and specialised capacity is also due to be expanded by new and existing providers in the future C31,C32. The private sector has been responsible for the largest proportion of growth (74%) in licensed physicians. Sub-specialty gaps Paediatric and Paediatric surgery sub-specialties and adult surgical sub-specialties including Neurosurgery, Plastics, Surgical Oncology remain undersupplied in Abu Dhabi C9. Health challenges. Growth in demand for healthcare services associated with the prevention and treatment of cancer, cardiovascular disease, diabetes, respiratory conditions, emergency medicine and neuropsychiatric conditions is expected to be particularly high. Growth. The number of physicians and dentists licensed within the emirate has grown by 1427 (22%) since the end of 2012 continuing to ensure wider coverage across the range of specialties. The number of facilities offering healthcare has also grown to 1, (11% increase on 2012 level) Centralised and Regional services. In order to improve coverage, concentrate clinical expertise and improve quality and cost efficiency HAAD has designated a limited number of Regional services each serving a population of ~250,000 residents. For complex and highly specialised Centralised services HAAD has designated certain highly specialised services that will only be provided by a small number of Abu Dhabi Providers to serve the whole Emirate. The detailed plans are included in pages C19 to C24. Improving capacity management through regulating clinical service lines. Since January 2013 HAAD has began licensing hospital providers for clinical services at DRG level in order to reduce duplication of services, improve the coverage of capacity gaps both at a specialty and geographic level and to meet future demand. There is clear risk of oversupply within the Emirate. HAAD is developing measures including improved alignment of supply with demand. International Patient Care Programme. The percentage of the medical board approval for the patient travel abroad as compared to the total population is showing a reducing trend and has reduced by 14 % during the period Pages C10, C13 and C14 detail the major capacity gaps. 54 C8

56 Service capacity balance by specialty As at 31 December 2013 Specialty Gaps Physicians/Dentists % Growth in Physicians/Dentists Public Private Capacity Balance No Capacity Gap Moderate Capacity Gap Severe Capacity Gap % Private / Public Capacity Notes Growth compares 2013 to Sources: Gaps: Defined by analysis of IPC data, international benchmarking from doctors per capita, bed census analysis and analysis of regional DRG coverage, Strategy analysis. Physicians and Facilities: Licensing database. Facilities Private % Growth of Facilities Providing the Services Intensive & Critical Care Medicine 42 14% % 2 Emergency Medicine % % -1 3 Neonatology 41 41% % 1 2 Cardiology 95 20% % 5 Psychiatry 84 35% % 5 Obstetrics & Gynecology % % 3 7 Paediatrics % % 1 14 Oncology 27 4% % 1 General Surgery % % Paediatric Surgery 23 21% % 2 Internal Medicine % % 1 14 Physical Medicine & Rehabilitation Allergy & Immunology 4 4 Cardio-thoracic Surgery 32-11% % -2-1 Orthopedics % % -1 9 Family Medicine % % 3 3 Radiology % % 8 Neurology 41 41% % 1 5 Anesthesiology % % 6 Preventive Medicine Ophthalmology % % 5 Infectious Diseases % 1 Dentistry 1,213 28% % 3 38 Urology % % 10 General Medicine 2,392 20% % Pulmonology 36 24% % -1 5 Pathology % % -3 9 Nephrology 40 33% % -1 4 Endocrinology 55 28% % 1 Dermatology % % Gastroenterology 49 17% % 3 Alternative Therapies 36 6% % 1 Oral & Maxillofacial Surgery % Rheumatology 25 39% % 3 Otolaryngology (ENT) % % 2 5 Total 8,021 22% 26% 74% % Public Private Increase No change Decrease 55 C9

57 Clinician sub-specialty gaps Doctor not available Classification of Disease Reason for Sending Abroad Count of patients Count of patients Count of patients Paediatric Ophthalmology Paediatric retina specialist not available 1 4 Paediatric glaucoma specialist not available Paediatric corneal specialist not available 2 2 Paediatric medical retina specialist not available 1 1 Post enucleation services specialist not available 1 Paediatric Spinal surgery Paediatric spinal surgeon specialist not available Paediatric Orthorpedic Surgery Brachial plexus multidisciplinary team not available Hand specialist not available 3 1 Hand/upper arm deformities specialist not available 1 Paediatric Orth-oncology Paediatric ortho-oncology specialist not available Neurology Dystonia specialist not available 2 1 Specialized neuromuscular disorder specialist not available Movement disorder specialist not available 1 1 Orthopedic Surgery Foot and ankle specialist not available 1 Hand specialist not available 2 1 Ortho-oncology specialist (Sarcoma) not available Paediatric Cardiology Paediatric electrophysiology specialist not available Paediatric Rheumatology Paediatric rheumatology not available Paediatric Pulmonology Cystic fibrosis multidisciplinary unit not available Paediatric Neurology Neuromuscular disorder specialist not available 1 1 Muscle pathologist not available 2 1 Cardiology Congenital heart disease in adult services not available 1 Metabolic Disease Expertise in metabolic field not available 1 Paediatric Ophthalmic Oncology Ophthalmic oncology specialist not available Ophthalmic Oncology Onco-ophthalmology services not available Neurosurgery Neuro-oncology specialist, Neuro-ophthalmic specialist not available Plastic Surgery Micro vascular plastic reconstruction not available 1 Facial palsy plastic surgeon not available 1 Ear reconstruction plastic surgeon not available 2 1 Colrectal Surgery Required pelvic floor expertise not available 1 Paediatric Vascular Surgery Specialized paediatric vascular centre not available Ophthalmology Glaucoma specialist not available Notes Clinician sub-specialty gaps are subject to dynamic change. Source IPC 2011,2012 & 2013 Annual Statistics Report. Analysis of Medical Board referrals abroad for treatment (under International Patient Care, IPC). 56 C10

58 IPC capacity gap, top Medical Board reasons for sending paediatric patients abroad Medical Board Paedatric Reason for Abroad Treatment Paediatric Oncology Paediatric Orthopedic Surgery Paediatric Cardiac Surgery Paediatric Neurology Paediatric Ophthalmology Paediatric Gastroenterolo gy Paediatric Pulmonology Paediatric Cardiology Paediatric Oncology/Haem atology Paediatric Plastic Surgery Paediatric Spine Surgery Paediatric Haematology Paediatric General Surgery Paediatric Rehabilitation Paediatric Neurosurgery Paediatric ENT Paediatric Urology Paediatric Brachial Plexus Injury Paediatric BMT follow up BMT Paediatric Note Source Paediatric age is defined to be inclusive of ages from birth and up to 18 years old. HAAD- IPC 2013 Statistic Report, IPC capacity gap analysis- planning analysis. 57 C11

59 IPC capacity gap, Medical Board classified reasons for sending abroad Follow up previous Treatment Abroad Limited Services Emergency Treatment while Abroad High Risk/Complexity Service Not Available Donor Others Medical Board Classification of Reason for Sending Abroad Count of Patients % Follow up previous treatment abroad % Limited services % Emergency treatment while abroad % High risk/complexity % Service not available 108 8% Donor 14 1% Others 37 3% Grand Total 1, C12 Source IPC 2013 Statistics Report- Medical Board sub reason for sending and approving treatment abroad.

60 IPC Medical Board approvals for treatment abroad compared to the Abu Dhabi population trends % Medical Board approval to the total population Linear (% Medical Board approval to the total population) The percentage of the Medical Board approvals for treatment abroad as compared to the population is showing a reducing trend and has reduced by 14% during the period Note 26% of HAAD IPC approvals relate to UAE patients from Non Abu Dhabi Emirate. 59 C13 Source HAAD IPC 2013 Statistics Report; planning analysis

61 IPC capacity gap, categorised as Services not available breakdown by volume of patient treated abroad Pre-implantation genetic diagnosis (PGD) Paediatric Ophthalmology Paediatric Neurosurgery Renal Transplant Cardiology Paediatric Vascular Surgery Brachial Plexus Injury Paediatric Cardiology Urology Spine Surgery Ophthalmic Onocology Paediatric Pulmonology Paediatric Orthopedic Surgery Paediatric Electrophysiology Post Cardiac Transplant ENT Gastroenterology Orthopedic Surgery Paediatric Plastic Surgery BMT Plastic Surgery Ortho-Oncology Paediatric Rheumatology Paediatric Neurology Ophthalmology Neurosurgery Paediatric Ortho-Oncology Liver Transplant Post BMT Follow up Paediatric Rehabilitation Paediatric BMT Follow Up Paediatric Bone Marrow Transplant BMT follow up Donor Paediatric Spine Surgery C14 Note Source Services not available classification by Medical Board includes the non-availability of facilities, specialised centres, equipment, programmes, clinical staff etc. IPC 2013 statistic report- Medical Board sub reason for sending abroad (Services not available) and approving treatment abroad.

62 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Gaps Capacity Management Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Assumptions Population (millions) Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 61 C15

63 Planning for healthcare services Current capacity gaps. Geographic coverage in the urban parts of the Emirate is generally good. There are, however, severe capacity shortfalls in rural areas: During 2014/2015 HAAD seeks to centrally procure for primary care facilities to serve these locations. In more remote rural areas innovation in delivering services is required, 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; as the population grows so does the requirement for more specialised services to be available within the region. Region Abu Dhabi Eastern Western Mid-term Primary Healthcare Clinics Mobile Clinics Rotation Permanent Permanent Khalifa B North Nahel 1 1 East Umm Ghaffa 1 1 Al Dhaher 1 Al Raad 1 Abu Karayyah 1 Abu Samarah 1 Al Saad 1 Al Sila Liwa -Hmeem -Brier Short Term HAAD analysis C24 shows that the Western region is significantly underserved at a regional specialty level. HAAD is addressing this issue through the alignment of HAAD licensing process with healthcare demand. Significant population growth. The Abu Dhabi Urban Planning Council (UPC) 2030 Plan envisages the population of Abu Dhabi Emirate doubling C18, C35. In Abu Dhabi region Abu Dhabi Island and Musaffah population 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. 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 corridor C18. The Al Ain city population is projected to double by 2030 with more modest growth expected in the surrounding rural areas C18. Western region population is projected to almost double to over 378,000 with the biggest growth in Ruwais, Ghayathi, Mirfa, and Liwa C18. Source Districts Ghantoot Desert Villages (Al Wathba) South West HAAD Strategy Analysis; Abu Dhabi Urban Planning Council C16 Note Number and location of unserved areas will be subject to review during 2014.

64 Planning for healthcare services Significant additional capacity is required to meet growth in demand for healthcare services as the population grows C35 and ages. In existing developed areas the emphasis is on growing existing facilities to facilitate specialisation and scale. Future development plans should be focused on the areas where there is new residential and commercial development and planned population growth. Hospitals and clinics. In compliance with the requirements of the UPC Community Facility Planning Standards C43 the 2030 projected populations, which are largely predicated on new, suburban residential developments, may require a maximum of 16 new small-to-medium general hospitals and 56 (31 Large,11 Medium and 14 Small) new clinics C18 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 and the accessibility of new facilities already planned or under construction C30,C31 to the new residential developments. HAAD analysis of current and projected inpatient supply C30,C31,C32 shows that the number of hospital beds planned, and under construction, is sufficient to meet the projected future demand. Specialty Care. Encouraging investment in specialised care remains a key objective. Whilst significant improvements in addressing specialty shortages have been achieved more needs to be done particularly in the area of reducing the number of patients required to travel abroad for treatment. HAAD will continue to work intensively with public and private providers and investors to ensure that the planned capacity provides the right balance of specialties and service types and is located in the most appropriate locations to further reduce capacity gaps. Emergency, Critical and Intensive Care. The analysis C32 shows that sufficient capacity is planned and under construction to meet the current shortfall by The current ambulance service network will also need to expand to support populations in newly developed and remote areas C18. Clinical staff. Attracting and retaining qualified staff remains a challenge for healthcare services across the Emirate, particularly in rural areas. It is estimated that by 2022 up to 4,800 additional doctors and 13,000 nurses will be required. If turnover remains high, this translates into up to 1,700 doctors and 2900 nurses to be recruited annually C36. 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 over-supply of healthcare, particularly of acute hospital beds C32, requires careful management. For example, Khalifa City currently has 4 hospital projects C18 under construction despite a projected 2030 population of only 80,000 C18. Similarly, Al Ain city has 15 provisional hospital projects C18 with potential demand for only 3 C18. In contrast to these examples, there are few health facility projects in rural areas of the Emirate C18. HAAD will regulate to align planned supply with demand through below 3 recommendations: 1) To control over-supply, future land is to be allocated only via the UPC in accordance with planned residential developments and the healthcare needs as determined by HAAD planning. 2) Upon review of projects with allocated land in already oversupplied locations HAAD to consider, on a case by case basis, reallocating existing land to the under-supplied locations as determined by HAAD Capacity Masterplan. 3) Pre-approval for highly specialised and regionally required services be obtained via HAAD planning section prior to issuance of preliminary licence for hospitals. HAAD recommendations for urban planners and developers aim to ensure building of healthcare facilities occurs when and where demand exists, not years in anticipation C C17

65 Service capacity balance by location Region District Gap Now Type Population Facilities Clinicians 2030 Plan growth Total Total Hospitals Clinics & Centres Nearby hospital Doctors /1000 Population Growth Abu Dhabi Desert Villages Rural 52, ,040 1L 1 110,000 Al Falah Rural 7,490 None 52, M ,427 Ghantoot District Rural 4,608 None 3,282 1M 1 7,890 Abu Dhabi Island Urban 583, (313,278) ,265 CBD/Financial Centre Urban 324, M 325,390 Musaffah Urban 262, (223,587) ,108 Bani Yas Rural 87, (3,403) 4 0 1M 1 84,451 Al Shahama Rural 70, (8,339) ,010 Shamkhah Rural 29, , M ,281 Al Rahba Rural 28, (11,304) 17,175 New Port City Rural 21,831 None 1 1,063 1L 1 22,894 Capital District South Urban 17,195 None 1 37, L 1 55,000 Bain Al Jesrain Urban 14, , M 1 43,298 Khalifa City Urban - None 2 80, ,000 Grand Mosque District Urban 9,776 None 1 32, M 42,194 Inner Islands Urban 5, ,937 1M 1 11,151 Capital District North Urban 4, , M 1 78,000 Al Mina Urban 1, ,553 1L 66,543 Al Raha Urban 1, , L 1 104,699 Yas Island Urban 1,443 None 67, l 1 68,735 Mohamed Bin Zayed City Urban , L ,000 Saadiyat Urban 227 None 82, L 1 82,285 Airport District Urban , L 1 64,485 Lulu Island Urban 139 None 23,089 1M 1 23,228 Capital District Urban 2,238 None 267, L 1 270,106 Mohamed Bin Zayed Centre Urban 5,969 None 74, ,000 South Hudayriat Island Rural 5,969 None 94, L 100,000 Marina Village Urban 5, ,163 1S 14,132 Al Suwwah Urban 5,969 None 22, ,907 Al Reem Urban 5,969 None 163,919 2L 1 169,888 Al Ain Umm Ghaffa Rural 11,725 None 1,280 1S 1 13,005 Nahel Rural 6,883 None 3,117 1S 1 10,000 Industrial City Rural 64, (29,122) 35,527 Al Salamat/Al Yaher Urban 49, (32,460) ,274 Al Dhahra Rural 6,568 None (1,032) 1S 5,536 Abu Krayyah Rural 5,442 None 715 1S 6,157 Al Saad Rural 5,072 None (1,380) 1S 3,692 Al Araad Rural 5,022 None (1,330) 1S 3,692 Abu Samra Rural 2,573 None (1,504) 1,069 Al Ain City Urban 454, , M 2 707,300 Al Quaa Rural 16, ,912 1M 1 20,487 Al Wagan Rural 15, ,050 1S 1 25,768 Al Hayer Rural 15, ,443 1M ,656 Al Dhaher Rural 14, ,902 1M 1 17,998 Remah Rural 10, ,499 1S 12,344 Sweihan Rural 10, ,884 1L ,323 Al Khazna Rural 9, S 9,837 Mezyad Rural 8,487 None 1 2,861 1S 11,348 Al Shwaib Rural 4, S 4,655 Al Fagah Rural 2, (552) 2,215 Western Liwa Rural 50, ,818 1L 1 65,000 Madinat Zayed Rural 72, (10,864) 2 0 1L ,900 Ruwais Rural 40, , L 1 106,000 Mirfa Rural 37, ,363 1L ,000 Ghayathi Rural 20, , ,900 Sila'a Rural 12, , L 1 17,500 Delma Island Rural 12, (4,246) 1 8,300 4,223,025 need Hospitals under way Under Construction need Clinics under way Ambulance station 2030 Population Under Process Subject to Change Capacity Gap Supply Severe Moderate None Undersupply/underserved Potential over supply L, M, S Clinic size, large, medium, small 64 C18 Source Population: SCAD, 2011 Estimate, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

66 Improving capacity management through regulating clinical service lines Description Examples Centralised 1 Highly specialised Strong volumebased competency Low volume High cost Burn Care Open Heart Surgery Oncology Surgery Regional 2 (Island/Middle, Eastern and Western) Moderate complexity Time dependency Some volumebased competency Middle volume Middle cost Cardiac Catheterisation Specialist Diabetes Care Standard Non-complex High volume Low cost 1 HAAD will restrict provision of these services to a few facilities 2 HAAD will issue licenses for these services on the basis of 1 per 250,000 population Source: Categories maintained by HAAD with input from Providers, Payers, and other stakeholders Basic Diabetes Care Family Medicine Preventive Services General Surgery 65 C19

67 List of Abu Dhabi clinical service lines For Planning and Licensing purposes HAAD will designate Centralised, Regional and Standard services for both adult and paediatric services at Diagnostic Resource Group level (DRG) level within the following 32 clinical service lines: Burns Gynecology Orthopaedic Cardiology - Invasive Haematology Plastic surgery Cardiology - Medical Immunology and infectious disease Psychiatry Cardiothoracic surgery Neonatology Rehabilitation Dentistry Nephrology Respiratory medicine Dermatology Neurological surgery Rheumatology Endocrinology Neurology Transplant surgery ENT Obstetrics Trauma Gastroenterology Obstetric - Delivery Urology General medicine Oncology Vascular surgery General surgery Ophthalmology Notes Source As the service lines are derived from IR-DRGs, which apply to all ages, the same classification applies to both adult and paediatric service lines but is differentiated by age. Paediatric service lines are differentiated from adult as those applicable to services planned or provided for ages from birth and up to 18 years old. Paediatric service lines exclude DRGs that are not applicable to paediatric categories. All stated services line encompass all patient setting except Long Term Care (LTC). Categories maintained by HAAD with input from Providers, Payers, and other stakeholders. 66 C20

68 Centralised, Regional and Standard services, by % total Abu Dhabi DRG volumes 67 C21 # HAAD Service Line Centralised Regional Standard 1 Burns 99.5% 0.5% 0.0% 2 Cardiology - Invasive 5.3% 82.7% 12.0% 3 Cardiology - Medical 3.5% 44.9% 51.6% 4 Cardiothoracic surgery 100.0% 0.0% 0.0% 5 Dentistry 0.0% 0.0% 100.0% 6 Dermatology 0.0% 8.0% 92.0% 7 Endocrinology 0.5% 13.3% 86.2% 8 ENT surgery 0.5% 8.3% 91.3% 9 Gastroenterology 0.0% 1.0% 99.0% 10 General medicine 5.6% 26.6% 67.7% 11 General surgery 1.2% 4.7% 94.0% 12 Gynecology 11.1% 3.7% 85.2% 13 Haematology 3.5% 44.9% 51.6% 14 Immunology and infectious disease 0.4% 0.6% 99.0% 15 Neonatology 4.0% 13.1% 82.9% 16 Nephrology 0.0% 2.8% 97.2% 17 Neurological surgery 40.1% 4.5% 55.5% 18 Neurology 0.0% 34.4% 65.6% 19 Obstetrics 0.0% 13.3% 86.7% 20 Obstetric - Delivery 0.0% 0.0% 100.0% 21 Medical oncology 30.7% 69.3% 0.0% 22 Ophthalmology 0.0% 81.1% 18.9% 23 Orthopaedic 0.6% 13.3% 86.2% 24 Plastic surgery 0.0% 26.8% 73.1% 25 Psychiatric 0.0% 20.8% 79.2% 26 Rehabilitation 0.0% 100.0% 0.0% 27 Respiratory medicine 0.7% 7.9% 91.4% 28 Rheumatology 0.0% 39.6% 60.4% 29 Transplant surgery 100.0% 0.0% 0.0% 30 Trauma % 0.0% 0.0% 31 Urology 0.4% 30.5% 69.1% 32 Vascular surgery 32.5% 67.5% 0.0% Notes Centralised services may only be provided by Providers designated by HAAD to do so. Regional services may only be offered by Providers designated by HAAD to do so. The number regional providers that may be designated within each region is detailed on page C27. 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. Percentage figures are % by volume of all DRGs within each clinical service line; Details to be published on HAAD website ( 1 Trauma Service Line contains only 3 DRGs related to Head Trauma. Source Categories maintained by HAAD with input from Providers, Payers, and other stakeholders.

69 Centralised, Regional and Standard services, by % total Abu Dhabi DRG volumes (Paediatric) Notes # HAAD Paediatric Service Line Centralised Regional Standard 1 Paediatric Burns 96.6% 3.4% 0.0% 2 Gynecological Surg 24.1% 1.2% 72.3% 3 Neonatology 2.2% 2.8% 95.0% 4 Obstetrics 0.0% 13.3% 86.7% 5 Obstetrics/Delivery 0.0% 0.0% 100.0% 6 Paediatric Cardiology - Invasive 100.0% 0.0% 0.0% 7 Paediatric Cardiology - Medical 53.6% 27.0% 19.4% 8 Paediatric Cardiology - Open Heart Surgery 100.0% 0.0% 0.0% 9 Paediatric Dental 0.0% 0.0% 100.0% 10 Paediatric Dermatology 0.0% 47.7% 52.3% 11 Paediatric Endocrinology 0.0% 1.5% 98.4% 12 Paediatric ENT Surgery 0.5% 0.6% 98.9% 13 Paediatric Gastroenterology 0.6% 2.8% 96.5% 14 Paediatric General Medicine 6.9% 4.0% 89.2% 15 Paediatric General Surgery 0.5% 3.5% 96.0% 16 Paediatric Haematology 2.2% 49.2% 48.6% 17 Paediatric Infectious Disease 0.0% 16.7% 83.3% 18 Paediatric Nephrology 0.0% 7.4% 92.6% 19 Paediatric Neurological surgery 58.1% 39.5% 0.0% 20 Paediatric Neurology 0.0% 17.6% 82.4% 21 Paediatric Oncology 53.0% 46.8% 0.0% 22 Paediatric Ophthalmology 46.7% 0.0% 53.3% 23 Paediatric Orthopedic Surgery 2.6% 26.6% 70.9% 24 Paediatric Plastic Surgery 0.5% 31.6% 67.8% 25 Paediatric Rehabilitation 0.0% 100.0% 0.0% 26 Paediatric Respiratory 0.2% 0.4% 99.4% 27 Paediatric Rheumatology 0.0% 7.8% 92.2% 28 Paediatric Vascular Surgery 3.1% 96.9% 0.0% 29 Paeditric Urology 6.7% 49.9% 43.4% 30 Psychiatry 1.4% 95.7% 2.9% 31 Paediatric Transplant Surgery 100.0% 0.0% 0.0% 32 Paediatric Trauma 9.4% 11.3% 79.2% Grand Total 2.9% 6.0% 90.7% Centralised services may only be provided by Providers designated by HAAD to do so. Regional services may only be offered by Providers designated by HAAD to do so. The number regional providers that may be designated within each region is detailed on page C27. 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. Percentage figures are % by volume of all DRGs within each clinical service line; Details to be published on HAAD website ( Paediatric age is defined to be inclusive of ages from birth and up to 18 years old. 68 C22 Source Categories maintained by HAAD with input from Providers, Payers, and other stakeholders.

70 Paediatric DRG coverage in Abu Dhabi Emirate # HAAD Paediatric Service Line Count of Total DRGs Non Available DRG Percent of coverage 1 Paediatric Burns % 2 Gynecological Surg % 3 Neonatology % 4 Obstetrics % 5 Obstetrics/Delivery % 6 Paediatric Cardiology - Invasive % 7 Paediatric Cardiology - Medical % 8 Paediatric Cardiology - Open Heart Surgery % 9 Paediatric Dental % 10 Paediatric Dermatology % 11 Paediatric Endocrinology % 12 Paediatric ENT Surgery % 13 Paediatric Gastroenterology % 14 Paediatric General Medicine % 15 Paediatric General Surgery % 16 Paediatric Haematology % 17 Paediatric Infectious Disease % 18 Paediatric Nephrology % 19 Paediatric Neurological surgery % 20 Paediatric Neurology % 21 Paediatric Oncology % 22 Paediatric Ophthalmology % 23 Paediatric Orthopedic Surgery % 24 Paediatric Plastic Surgery % 25 Paediatric Rehabilitation % 26 Paediatric Respiratory % 27 Paediatric Rheumatology % 28 Paediatric Vascular Surgery % 29 Paeditric Urology % 30 Psychiatry % 31 Paediatric Transplant Surgery 9 9 0% 32 Paediatric Trauma 3 3 0% Grand Total % SEHA Market Share % Capacity Gap Severe Moderate None Note Percentage figures are % by volume of all DRGs within each clinical service line; Details to be published on HAAD website ( Paediatric age is defined to be inclusive of ages from birth and up to 18 years old. 69 C23 Source HAAD Strategy department, health statistics, planning analysis.

71 Coverage of Regionally required DRGs in Abu Dhabi Emirate Severe Gap/Coverage of <= 55 Moderate Gap/ Coverage of >= 65 No gap/coverage of >= 75 Low Volume of DRGs < 15% Moderate Volume of DRGs >= 15 % High Volume of DRGs >= 40% Abu Dhabi Region Eastern Region Western Region HAAD Service Line Number of Non Available Regional DRGs Count of Regional DRGs % of Regional Coverage Burns* (Transferred DRG) 2 2 0% Cardiology - Invasive % Cardiology - Medical % Dermatology % Endocrinology % ENT Surgery % Gastroenterology % General Medicine % General Surgery % Gynecological Surg 1 1 0% Hematology % Infectious Disease % Neonatology % Nephrology % Neurological surgery % Neurology % Obstetrics % Oncology % Ophthalmology % Orthopedic Surgery % Plastic Surgery % Psychiatry % Rehabilitation % Respiratory % Rheumatology % Trauma % Urology % Vascular Surgery % Grand Total % SEHA Market Share % HAAD Service Line Number of Non Available Regional DRGs Count of Regional DRGs % of Regional Coverage Burns* (Transferred DRG) % Cardiology - Invasive % Cardiology - Medical % Dermatology % Endocrinology % ENT Surgery % Gastroenterology % General Medicine % General Surgery % Gynecological Surg 1 1 0% Hematology % Infectious Disease % Neonatology % Nephrology % Neurological surgery % Neurology % Obstetrics % Oncology % Ophthalmology % Orthopedic Surgery % Plastic Surgery % Psychiatry % Rehabilitation % Respiratory % Rheumatology % Trauma % Urology % Vascular Surgery % Grand Total % SEHA Market Share % HAAD Service Line Number of Non Available Regional DRGs Count of Regional DRGs % of Regional Coverage Burns* (Transferred DRG) % Cardiology - Invasive % Cardiology - Medical % Dermatology % Endocrinology % ENT Surgery % Gastroenterology % General Medicine % General Surgery % Gynecological Surg 1 1 0% Hematology % Infectious Disease 3 3 0% Neonatology % Nephrology % Neurological surgery 3 3 0% Neurology % Obstetrics % Oncology % Ophthalmology % Orthopedic Surgery % Plastic Surgery % Psychiatry % Rehabilitation 3 3 0% Respiratory % Rheumatology % Trauma % Urology % Vascular Surgery % Grand Total % SEHA Market Share 70 C24 Source Note HAAD Strategy Department analysis based on 18 months of DRGs claims data. *Burns DRGs in this analysis are 2 DRGS relating to medical treatment received by a patient while transferring from one facility to another facility. They do not refer to the full treatment of burns which is a centralised service.

72 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Gaps Capacity Management Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Assumptions Population (millions) Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 71 C25

73 Inpatient current supply and projected demand, by number of beds (Acute, Subacute and Intensive Care) plus Emergency bays Beds / Service Types Current Supply Demand Based on Bed Occupancy Total Beds 50% 5,843 7,238 8,767 11,365 3,864 56% (current) 5,264 6,517 7,890 10,217 60% 4,942 6,116 7,402 9,046 70% 4,298 5,314 6,428 7,858 Acute Overnight Beds 50% 5,408 6,734 8,186 10,710 3,617 56% (current) 4,828 6,012 7,308 9,562 60% 4,506 5,611 6,821 8,404 70% 3,863 4,810 5,847 7,203 Subacute Overnight Beds % Intensive Care Beds % Emergency Bays C26 Assumptions Notes Sources Projected bed numbers from 2015 onwards are based on International Average ALOS. Rate of 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. Subacute 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. Demand projections are subject to further review and change as new reference data & methodology becomes available. Current supply: HAAD Operations Centre Bed Census, HAAD Planning analysis of New Facility Applications (NFAs), SEHA. Demand Projections: TAHPI, Health Facility Briefing System, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES).

74 Projected demand by Abu Dhabi planning region Number of Regional Providers From 2013 Regional inpatient services may only be provided by providers designated by HAAD to do so. HAAD has determined the current and future maximum number of Regional facilities for each region: Abu Dhabi and Middle Region population 1,498,000 1,723,000 1,930,549 2,276,464 2,622,379 Regional Providers (Abu Dhabi and Middle Region) Al-Ain (Eastern) Region population 652, , , ,902 1,002,466 Regional Providers (Al Ain Region) Al Gharbia (Western) Region population 236, , , , ,600 Regional Providers (Al Gharbia Region) Total Regional Facilities in Abu Dhabi Methodology Based on UPC Plan 2030 projected population and derived compound annual growth rate Note HAAD may vary the number of Regional facilities depending on demand and supply factors. 73 C27

75 Projected inpatient demand by Abu Dhabi planning region, by number of beds (Acute, Subacute and Intensive Care) plus Emergency bays 74 C28 Assumptions Notes Sources Region Bed/Service Type Curent Supply Projected Demand Beds Required By Year Actual Bed Occupancy Abu Dhabi & Middle Total Beds 50% 3,329 4,094 4,944 6,407 2,379 56% (current) 2,998 3,687 4,451 5,762 60% 2,814 3,461 4,177 5,105 70% 2,446 3,008 3,630 4,435 Acute Overnight 50% 3,092 3,801 4,602 6,021 2,194 56% (current) 2,761 3,394 4,109 5,376 60% 2,577 3,168 3,835 4,725 70% 2,209 2,715 3,287 4,050 Subacute % Intensive Care Beds % Emergency Bays Al Ain Total Beds 50% 2,057 2,593 3,163 4,133 1,239 56% (current) 1,855 2,334 2,846 3,718 60% 1,742 2,190 2,669 3,262 70% 1,528 1,941 2,370 2,896 Acute Overnight 50% 1,885 2,414 2,965 3,879 1,177 56% (current) 1,683 2,155 2,647 3,463 60% 1,571 2,012 2,471 3,044 70% 1,347 1,724 2,118 2,609 Subacute 62 70% Intensive Care Beds 41 75% Emergency Bays Western Total Beds 50% % (current) % % % % (current) Acute Overnight % % Subacute - 70% Intensive Care Beds 7 75% Emergency Bays Rate of 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. Subacute 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. Current supply: HAAD Operations Centre Bed Census, HAAD Planning analysis of New Facility Applications (NFAs), SEHA. Demand Projections: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES)

76 Current health facility locations H Hospital Centre Clinic Pharmacy Al 75 C29 Source HAAD Licensing database, GPS survey; not all Centre and Clinic locations shown.

77 Supply projections Region Total Hospital Beds With Preliminary license No. of Beds For Hospital >50% Construction No. of Beds For Hospital <50% Construction No Construction Status Total Abu Dhabi & Middle Districts Hospital Sub Type No. of Beds Construction Status Completion Date Land Public/ Private Districts Hospital Sub Type No. of Beds Construction Status Completion Date Land Public/ Private Abu Dhabi Island General Hospital 141 >50% 2015 N Private Specialised Hospital 88 >50% 2015 Y Private Al Karama Specialised Hospital 825 Planned 2019 Y Public Al Shamkha General Hospital 125 Planned Y Public Al Maryah Island General Hospital 364 >50% 2015 Y Public Bain Al Jesrain General Hospital 300 <50% 2015 Y Private Bani Yas General Hospital 25 Planned Y Private General Hospital 100 Planned Y Private General Hospital 120 Planned Y Private General Hospital 118 Planned Y Private General Hospital 90 Planned Y Private Nursing Home 72 Planned Y Private Grand Mosque District General Hospital 100 >50% Y Private General Hospital 150 >50% 2015 Y Private Specialised Hospital 100 Planned Y Private General Hospital 10 <50% Y Private General Hospital 250 >50% 2014 Y Private Specialised Hospital 100 Planned Y Private General Hospital 52 >50% Y Private General Hospital 52 Planned Y Private Shakbhout City General Hospital 99 Planned Y Private Nursing Home 72 >50% Y Private General Hospital 100 Planned Y Private Mafraq General Hospital 732 >50% 2016 Y Public Mohamed Bin Zayed City General Hospital 37 Planned Y Private General Hospital 50 >50% 2014 Y Private General Hospital 300 Planned Y Private General Hospital 210 Planned Y Private Mussafah General Hospital 100 Planned Y Private General Hospital 35 Planned Y Private General Hospital 100 >50% 2014 Y Private General Hospital 119 >50% 2014 N Private General Hospital 400 Planned N Private Rehabilitation Hospital 140 Planned N Private Rehabilitation Hospital 90 Planned N Private General Hospital 125 Planned N Private General Hospital 50 Planned N Private General Hospital 100 Planned N Private General Hospital 25 Planned N Private General Hospital 150 Planned N Private General Hospital 50 Planned N Private General Hospital 150 Planned N Private General Hospital 150 Planned N Private General Hospital 50 Planned N Private General Hospital 50 Planned N Private General Hospital 72 Planned N Private General Hospital 140 Planned N Private General Hospital 150 Planned N Private General Hospital 100 Planned Y Private General Hospital 100 Planned N Private General Hospital 50 Planned N Private General Hospital 54 Planned N Private Rehabilitation Hospital 140 Planned N Private General Hospital 180 Planned N Private Specialised Hospital 53 Planned N Private General Hospital 100 Planned N Private General Hospital 50 Planned N Private Rehabilitation Hospital 40 Planned N Private General Hospital 300 Planned N Private General Hospital 300 Planned N Private General Hospital 250 Planned N Private General Hospital 235 Planned N Private General Hospital 28 Planned N Private General Hospital 100 Planned N Private Shahama General Hospital 100 >50% Y Private Zaied Militarism City Specialised Hospital 20 Planned Y Private Notes Completion likelihood from Land and Project State List (Maintained by HAAD Health Facility Licensing). Mafraq & Al Ain Hospital existing beds numbers are additional planned beds over and above the existing bed numbers. 76 C30 Source Preliminary licensed facilities, HAAD Licensing and Strategy analysis.

78 Supply projections Region Eastern Total Total Hospital Beds With Preliminary license No. of Beds For Hospital >50% Construction No. of Beds For Hospital <50% Construction No Construction Status Districts Hospital Sub Type No. of Beds Construction Status Completion date Land Public/ Private Al Ain City Specialised Hospital 713 <50% 2019 Y Public General Hospital 50 >50% 2015 Y Private Rehabilitation Hospital 25 >50% 2015 N Private General Hospital 36 Planned Y Private General Hospital 112 Planned Y Private Al Hili General Hospital 30 Planned Y Private General Hospital 100 Planned Y Private Al Jimi General Hospital 100 Planned Y Private Al Khabasi One Day Surgry 6 Planned Y Private Al Towaya General Hospital 54 Planned Y Private General Hospital 100 Planned Y Private Al Yahar General Hospital 60 Planned Y Private Al Jimi General Hospital 30 Planned Y Private Falej Hazza General Hospital 46 Planned Y Private General Hospital 40 Planned Y Private General Hospital 126 Planned N Private General Hospital 50 Planned N Private General Hospital 60 Planned N Private Specialised Hospital 71 Planned N Private Specialised Hospital 70 Planned N Private General Hospital 50 Planned N Private Rehabilitation Hospital 32 Planned N Private General Hospital 50 Planned N Private General Hospital 50 <50% 2015 Y Private General Hospital 96 Planned N Private Rehabilitation Hospital 32 Planned N Private General Hospital 100 Planned Y Private Region Western Total Hospital Beds With Preliminary license No. of Beds For Hospital >50% Construction No. of Beds For Hospital <50% Construction No Construction Status Total Districts Hospital Sub Type No. of Beds Construction Status Completion date Land Public/ Private Gayathi General Hospital 50 Planned Y Public Madinat Zayed General Hospital 54 Planned Y Private Specialized Hospital 23 <50% 2015 N Private General Hospital 50 Planned N Private General Hospital 30 Planned N Private Sila General Hospital 36 Planned 2015 Y Public Notes Completion likelihood from Land and Project State List (Maintained by HAAD Health Facility Licensing). Mafraq & Al Ain Hospital existing beds numbers are additional planned beds over and above the existing bed numbers. 77 C31 Source Preliminary licensed facilities, HAAD Licensing and Strategy analysis.

79 Inpatient current and projected supply by number of beds (Acute, Subacute and Intensive Care) plus Emergency Bays Provider Bed/Service Type Current Supply Planned Supply SEHA Total Beds 2,489 2,489 2,516 3,079 3,079 3,079 3,641 3,826 3,876 3,876 Acute Overnight 2,444 2,444 2,471 3,034 3,210 3,210 3,596 3,781 3,831 3,831 Subacute Under-supply Potential over-supply Adequate supply Intensive Care Beds Emergency Bays Mubadala Total Beds Acute Overnight Subacute Intensive Care Beds Emergency Bays Private Total Beds 1,295 1,814 2,660 2,760 2,860 2,960 3,060 3,160 3,660 4,160 Acute Overnight 1,093 1,612 2,391 2,491 2,573 2,655 2,737 2,819 3,319 3,819 Subacute Intensive Care Beds Emergency Bays Emirate Total Beds 3,864 4,383 5,406 6,169 6,383 6,483 7,145 7,556 8,106 8,606 Acute Overnight 3,617 4,136 5,092 5,855 6,227 6,309 6,777 7,170 7,720 8,220 Subacute Intensive Care Beds Emergency Bays Notes Subacute Beds include: rehabilitation, palliative care, maintenance, older persons and psychogeriatric care but exclude behavioral science beds; Intensive Care Beds are a subset of Acute Overnight Beds and exclude PICU, NICU, CCU, etc.; Acute Overnight beds exclude day case beds. Analysis excludes military beds. Demand projections are subject to further review and change as new reference data & methodology becomes available. 1 Both existing Mafraq and Al Ain hospitals have been identified to be re-used for subacute care, mental health care and isolation facilities once the new SEHA hospitals are operational. These beds are not included in the above supply projections as the exact usage has yet to be determined. 78 C32 Sources Supply projections: Private providers planned supply based on HAAD HFL database; SEHA planned supply based on SEHA communication to HAAD dated 8/10/2014; Mubadala projections based on HAAD HFL database and Mubadala communication to HAAD dated 24/10/2013. Current supply: HAAD Operations Centre Bed Census, HAAD Planning analysis of New Facility Applications (NFAs), SEHA.

80 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Gaps Capacity Management Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Assumptions Population (millions) Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 79 C33

81 Population density 80 C34 Source Department of Planning and Economy (2005 Census), Strategy Analysis.

82 Population growth, scenarios Population (millions) Low High Population growth, scenarios National Expatriate Year Low High '300 2'117'000 2'233' '600 2'128'500 2'279' '600 2'140'000 2'341' '200 2'150'500 2'407' '500 2'160'500 2'466' '000 2'170'000 2'520' '500 2'179'000 2'570' '000 2'187'000 2'617' '500 2'195'000 2'660' '000 2'201'000 2'701' '500 2'206'000 2'739'000 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%. 81 C35 Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan.

83 Demand projections Doctors and Nurses Under Process Subject to Change Additional capacity needs 2022 CAGR Absolute Annualised Including churn Low High Low High Low High Low High Low High Doctors not including Dentists 7,100 10, ,600 4, ,200 1,700 Nurses 17,500 25, ,100 13, ,000 2,900 Notes These projections present 2 alternative scenarios based on high and low population estimates. Numbers have been rounded for clarity. This page is under process and subject to change. CARG Compound Annual Growth Rate. The actual number needed each year changes is compounded- and this is a mid-period figure. Assumptions Churn (staff turnover) will remain at the 2011 rate of 17% for doctors and 11% for nurses. Source HAAD Demand Model 2012, HAAD Licensing Database. 82 C36

84 Demand projections based on WHO disease classification Low 2022 High Deliveries Signs, symptoms & ill-defined Maternal & Perinatal conditions Digestive diseases Cardiovascular diseases Respiratory infections Respiratory diseases Genitourinary diseases Endocrine disorders Infectious & parasitic diseases Occupational Injuries Musculoskeletal diseases Neuropsychiatric conditions Other Injuries Cancer Skin diseases Diabetes mellitus Sense organ diseases Congenital anomalies Oral conditions Nutritional deficiencies RTA Inpatients (Thousands) CAGR Outpatients CAGR Low High Low High (Millions) Definition CAGR = Compound Annual Growth Rate Notes This page is under process and subject to change. 83 C37 Source HAAD Demand Model 2012, Categorization based on WHO classification of diagnoses ICD 9, modified to specify deliveries and RTAs

85 Demand projections for doctors by specialty 84 C38

86 Population Facilities Clinicians Ratios 2030 Plan growth 2030 requirements 2030 planned Projects under way Population Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 #NAME? 10,963 None 81, ,000 Al Falah Rural 4,028 #NAME? 1,996 None 95, ,000 Ghantoot District Rural 2,478 #NAME? - None 97, ,000 Abu Dhabi Island Urban 313,809 #NAME? 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 #NAME? 14, ,131 1, , ,000 Musaffah Urban 141,268 #NAME? 2, (41,268) ,000 Bani Yas Rural 47,245 #NAME? 27, , ,000 Al Shahama Rural 37,831 #NAME? 16, , ,000 Shamkhah Rural 15,839 #NAME? 10,674 None 1 114, ,000 Al Rahba Rural 15,315 #NAME? 13, , ,000 New Port City Rural 11,740 #NAME? 4,565 None 138, ,000 Capital District South Urban 9,247 #NAME? 33 None 1 45, ,000 Bain Al Jesrain Urban 7,694 #NAME? 4, , ,000 Khalifa City A Urban 5,317 #NAME? 2, , ,000 Grand Mosque District Urban 5,257 #NAME? 1,837 None 1 114, ,000 Inner Islands Urban 2,804 #NAME? , ,000 Capital District North Urban 2,371 #NAME? 2, , ,000 Al Mina Urban 1,070 #NAME? , ,000 Al Raha Urban 827 #NAME? , ,000 Yas Island Urban 776 #NAME? 1 None 99, ,000 Mohamed Bin Zayed City Urban 328 #NAME? , ,000 Saadiyat Urban 122 #NAME? None 119, ,000 Airport District Urban 98 #NAME? ,902 50,000 Lulu Island Urban 75 #NAME? None 19, ,000 Capital District Urban #NAME? None 240, ,000 Mohamed Bin Zayed Centre Urban #NAME? None 80, ,000 South Hudayriat Island Rural #NAME? None 100, ,000 Marina Village Urban #NAME? ,000 5,000 Al Suwwah Urban #NAME? None 30, ,000 Al Reem Urban #NAME? None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 #NAME? 5,873 None 3,049 11,900 Nahel Rural 5,196 #NAME? 2,377 None 4, ,000 Industrial City Rural 48,803 #NAME? , ,740 Al Salamat/Al Yaher Urban 37,544 #NAME? 23, , ,000 Al Dhahra Rural 4,958 #NAME? 715 None 1,042 6,000 Abu Krayyah Rural 4,108 #NAME? 655 None ,000 Al Saad Rural 3,829 #NAME? 702 None 1, ,000 Al Araad Rural 3,791 #NAME? 139 None ,000 Abu Samra Rural 1,942 #NAME? 286 None ,500 Al Ain City Urban 343,002 #NAME? 100, ,733 2, , ,300 Al Quaa Rural 12,512 #NAME? 4, ,488 23,000 Al Wagan Rural 11,865 #NAME? 3, , ,000 Al Hayer Rural 11,484 #NAME? 2, , ,000 Al Dhaher Rural 10,641 #NAME? 7, , ,350 Remah Rural 8,187 #NAME? , ,500 Sweihan Rural 7,880 #NAME? , ,000 Al Khazna Rural 7,350 #NAME? 1, ,650 9,000 Mezyad Rural 6,407 #NAME? 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 #NAME? 1, , ,500 Al Fagah Rural 2,089 #NAME? , ,500 Western Liwa Rural 20,000 #NAME? ,000 65,000 Madinat Zayed Rural 29,000 #NAME? 6, , ,000 Ruwais Rural 16,000 #NAME? 1, , ,000 Mirfa Rural 15,000 #NAME? 3, ,000 75,000 Ghayathi Rural 8,000 #NAME? 3, , ,000 Sila'a Rural 5,000 #NAME? ,000 70,000 Delma Island Rural 5,000 #NAME? 2, , ,000 Capacity Gap Severe Note: Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Moderate Source: Population: SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. None Model of Care Model of care How health services should be used DRAFT Patient self-care Non-emergency/elective Capacity Gaps Capacity Management Capacity Masterplan Total % National Nationals Total Hospitals Clinics Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Hospitals required Clinic required Hospitals Clinics Hospitals Clinics 2030 Population Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease Emergency Triage ER management Admission. Preventative Emergency Including diagnostics Source 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 11 Demand & Supply Projections Current and projected demand, by Episodes and beds Acute Overnight Episodes Bed Occupancy 2011 Actual , , , , ,040 Acute Overnight Beds Current (58%) 3,289 3,992 5,223 6,769 7,061 Sub Acute Overnight Episodes Sub Acute Overnight Beds Intermediate (70%) 3,308 4,328 5,609 5,850 Target (85%) 2,724 3,564 4,619 4,818 N/A 3,216 4,233 5,461 6, ICU beds Emergency Bays N/A ,182 1,379 Notes :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. Sub acute numbers of beds adjusted Source: TAHPI, Health Facility briefing system, reference data is based on data extracted from the Australian Institute of Health and Welfare, supplemented by data from the USA inpatient sample and UK Hospital Episode Statistics Online (HES) Assumptions 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 number of beds adjusted to meet international benchmark C17 Assumptions Population (millions) Population growth, scenarios As at 31 December 2010 Draft 4.0 Population growth, Scenarios High 3.5 Low National Expatriate Year Low High '200 1'945'000 2'045' '150 1'970'000 2'190' '200 2'060'000 2'350' '400 2'130'000 2'505' '800 2'175'000 2'675' '800 2'250'000 2'850' '600 2'310'000 3'045' '500 2'360'000 3'240' '600 2'400'000 3'400' '600 2'475'000 3'575' 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 Recommendations Land requirements Guidelines for urban planners DRAFT For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Population (000 s people) Land provision options Residential Transient1 Land area Co-location GFA 4 OR (m s) OR OR (m s) Parking (spaces) Minimum service requirement Estimated Resources Clinics ? Primary care 2 Physicians Pharmacy services (on-site or ? 3 within 10 min walk) Physicians Laboratory service ? Physicians ? Physicians Hospitals n/a n/a 3/bed Emergency services Laboratory services Beds 6 Radiology services n/a n/a 3/bed Stand-alone building beds 6 Ambulance Stations ? 7 n/a 10 Ambulance service (land /air) 1 Ambulance ? 7 n/a 15 Ambulance service (land /air) 2 Ambulances Notes 1 Transient population includes staff and other non-residential visitors 2 Clinics collectively refers to Clinics, Centers and Polyclinics 3 Appropriate facilities for co-location with Clinics include Hospitals, Ambulance Stations, Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices, 4 Clinic 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 6 Optimal hospital size is beds 7 Appropriate 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 5 85 C39

87 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 as detailed on page C27. 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). Notes *Clinical services are specified at the level of DRGs; In emergency situations services designated as Regional or Centralised may be offered by any facility. 86 C40

88 Facility recommendations for developers, investors, and healthcare providers Health facility developments must: Meet HAAD licensing requirements (available at 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)licence 1 prior to establishing services. Additional guidance regarding healthcare capacity and demand projections are available within this document, HAAD s Health Statistics. 1 HAAD has amended its Licensing process to require submission and approval of all intended services specified at DRG level. 87 C41

89 Service recommendations for investors and developers Developers for projects with intended residential populations in excess of 4,000 (rural) or 6,000 (suburban and urban) must have engaged a developer and operator for the healthcare facilities within the development. Developers should notify the Executive Council s Social Development Sub- Committee of their intended plans (copying UPC) in the context of combining/sharing healthcare facilities with other social infrastructure, e.g., community centres. Services must be designed and operated in accordance with HAAD Regulations (available at 88 C42

90 Requirements for allocation of land and service provision These requirements have been established in partnership with Abu Dhabi Urban Planning Council (UPC) and comprise the healthcare element of the UPC Community Facility Planning Standards. For new residential developments land and facilities must be provided as per the following: Population Land provision options Car parking Facility Type Residential (000 s people) Urban Suburban Rural Transient 1 Minimum Land area Minimum Including if Co-located GFA 3,6 Minimum Land area (m s) Urban Suburban Rural Minimum Including if Co-located GFA 3,6 Minimum Land area Minimum Including if Co-located GFA 3,6 (spaces) Minimum service requirement Estimated Resources per facility Clinic 2 (Village) NA NA NA NA NA NA Physicians Primary care Clinic (Small) Physicians Clinic (Medium) Pharmacy services (on-site or within 10 min walk) 7-14 Physicians Clinic (Large) Laboratory service Physicians Hospitals NA 40 NA 80 NA 3/bed Emergency services Radiology services Beds 5 Laboratory services NA NA 80 NA NA NA 3/bed Stand-alone building Beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centres and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Where facilities are co-located, adequate transport options and shared parking must be made available. 4 Evaluation of the need for provision of a healthcare facility will be carried out on a case by case basis which considers the accessibility of existing and planned facilities close to the new development. 5 Optimal hospital size is beds 6 GFA Ground Floor Area. 89 C43 Sources Strategy analysis, UPC Community Facility Planning Standards.

91 Access requirements Healthcare services should be provided to meet the following access requirements in relation to routine/elective services and emergency services: Urban Rural Routine/Elective Primary care services within 20 minutes drive at maximum speed of 60 km/h Primary care services within 20 minutes drive at maximum speed of 120 km/h Emergency services Ambulance access within 15 minutes, if via land driving at maximum speed of 60 km/h Ambulance access within 19 minutes, if via land driving at maximum speed of 120 km/h Note Source Alternative solutions such as air ambulance should be utilised to achieve emergency service access requirements in rural and/or densely populated urban areas. Department of Health UK, Strategy analysis. 90 C44