Qatar Healthcare Facilities Master Plan Executive Summary

Transcription

1 1. Introduction This provides an overview of the Qatar Health Facilities Master Plan (QHFMP), a roadmap to guide investments in healthcare facilities and efficient allocation of resources up to The Supreme Council of Health (SCH), Qatar s highest health authority, developed QHFMP as the final output of National Health Strategy (NHS) Project 6.4, Health Infrastructure Master Plan. The methodology included workshops, interviews, and data collection, from over 107 stakeholders, representing 26 organizations, over 14 months. In parallel, the SCH established the legal, regulatory, IT and administrative framework to implement QHFMP. These were outputs of NHS Project 6. 5 i, Capital Expenditure Committee Establishment. QHFMP will be the roadmap for the next generation s healthcare infrastructure quality standards, requirements, investment priorities, service distribution and delivery alignments, guiding the entire continuum of healthcare capital allocation and advancing the health vision of the Nation. QHFMP establishes for the first time in the State of Qatar a comprehensive 20 year Strategy for Healthcare Facilities. A first five year Action Plan will guide new developments to meet identified priority requirements during the period from 2013 to Following this first period of implementation a next Action Plan will be developed which takes account of experiences gained and progress made and responds to capacity and demand projections which will be constantly updated. The implementation programme for the first Five Year Action Plan will deliver 48 new facilities:- Classification Duration Numbers Health Centre Diagnostic and Treatment Centre 8 8 General Hospital 1 1 Specialized Hospital 1 1 Long Term Facilities 2 2 Hospital Expansion Totals Current Population Demographics According to the latest data from Qatar Statistics Authority (QSA), the population has grown three times (184%) faster than healthcare capacity (62%) since The system is heavily burdened by this mismatch of capacity to population and Qatar cannot delay investment. Qatar is divided into seven municipalities: Doha; Al Rayyan; Al Wakra; Umm Slal; Al Khor and Al Thakhira; Madinat Al Shamal; and Al Daayen. Doha Municipality houses the majority of the Qatar s population (47%), followed by Al Rayyan Municipality (27%). According to latest population data published by Qatar Statistics Authority (QSA), the population of Qatar as of 31 st October 2013 was slightly more than 2 million. However, the most recent census with detailed demographics of Qatar was published in 2010 by QSA with a total population count of 1,699, census data has been used as the basis for Current Population Demographics in the QHFMP due to the lack of a more recent detailed population breakdown. In QHFMP the population in Qatar is divided into three groups as follows:- Nationals: citizens, the Qatari population; Single Male Laborers (SMLs), defined ii as people living in labor gatherings; and Figure 1 Population by Municipality (2010) Source: QSA, 2010 Page 1

2 General Medical/ Surgical Beds Obstetrics and Gynaecology Beds Paediatric Beds Physical Medicine & Rehabilitation Beds Psychiatric/ Behavioural Health Beds Skilled nursing & Geriatric Beds ICU Beds NICU/PICU Beds Non-SML Expatriates: the white collar expatriate population. According to the Qatar Census 2010:- Nationals over the age of 10 constitute 10.3% of the total population while Non-SML Expatriates of the same age group constitutes 30.1% of the total population; the National and Non-SML Expatriate population belonging to the age group below 10 years of age is estimated at approximately 9.9% of the total population; and the SML population constitutes 49.8% of the total population in Qatar. 3. Existing Healthcare Facilities in Qatar Inpatient services in Qatar are provided through 13 public and private sector hospitals. Beds in each hospital facility are grouped by type based on the bed type classification developed for QHFMP. The table below shows the latest number of available beds in each hospital classified based on QHFMP s beds by type definition. Facility Name Hamad General Hospital Total Rumailah Hospital Skilled Nursing Facility Women s Hospital Al Wakra Hospital Heart Hospital Al Khor Hospital National Centre for Cancer Care and Research Cuban Hospital Al Ahli Hospital* Al Emadi Hospital American Hospital Aspetar** Doha Clinic Hospital Total 1, ,375 Source: Project Team Analysis of Data from Providers, 2013 * While the number of designed beds is 250, the actual number of available beds (180) has been used to conduct gap analysis. ** While the number of designed beds is 50, the actual number of available beds (25) has been used to conduct gap analysis. Outpatient services are provided through hospital outpatient departments and health centres operated by the Primary Health Care Corporation (PHCC), Ministry of Interior (MoI), Qatar Petroleum (QP) and Qatar Red Crescent Society (QRCS) as well as various private health centres and clinics located throughout Qatar. Based on SCH Healthcare Facilities Licensing Department statistics, there are 302 health centres and clinics, 61 diagnostic facilities and 251 pharmacies in Qatar. Page 2

3 2033 HMC CT Cyclotron Dialysis IR/CL Litho MAMMO MRI RAD/RF Linac PET 4. Reported Patient Activity In 2011 there were 9,420,712 outpatient visits and 85,555 inpatient admissions. Outpatient services are provided to patients through the outpatient department at hospitals and through health centres/clinics in the community where no overnight stay is involved. Inpatient admissions are services that require patients to stay in a hospital, a rehabilitative or residential care facility for 24 hours or more. The government of the State of Qatar sponsors Nationals for overseas medical treatment, especially for services that are not available in the country. Approximately 2,500 patients were sent for overseas medical treatment in 2011: this number increased to 3,160 in Patients sponsored for overseas medical treatment mainly go to Germany, USA, UK and Thailand. 5. Existing Major Medical Equipment and Technology In order to identify the Major Medical Equipment (MME) required by QHFMP, the following criteria were used: devices tracked by the Organisation for Economic Co-operation and Development (OECD); MME having a cost threshold of USD $1 million and above; and MME that may not be in the OECD list or that may not exceed the cost threshold of USD $1 million, but which are required to treat diseases specific to the health demographic of the population of Qatar. The following table summarizes the MME by site based on the latest data collected from providers in Qatar:- Major Medical Equipment by Site 2013 Diagnostics & Treatment Capabilities Facility Name Al Ahli Hospital Al Emadi Hospital Future Medical Centre Al Wakra Hospital American Hospital 1 1 Aspetar Hospital Clinics & Polyclinics 6 13 Cuban Hospital Al Khor Hospital Hamad General Hospital Qatar Heart Hospital National Centre for Cancer Care and Research Rumailah Hospital Sidra Medical & Research Centre Total Source: Data from SCH, Providers and site visits by the Project Team 6. Future State Analysis QHFMP identifies the anticipated additional healthcare capacity required in 2018 and 2033 based on a bottom-up analysis using 2011 population and patient activity as the baseline to project demand. All major assumptions were validated with the relevant stakeholders. Based on the expected total population of 2.54 million in 2018 and 2.51 million in 2033, the analysis yielded the following results:- Services Demand Projections Required Capacity Available Supply Gap* Inpatient (IP) 402,719 IP admissions 5,686 beds 4,714 beds 1,452 beds Outpatient (OP) 38,327,715 OP visits 5,038 rooms 2,528 rooms 2,510 rooms *Gap calculated using estimated number of operational beds Page 3

4 Bed Type Gen. Med/Surg Obs & Gynae Paediatric PM&R Psychiatric Skilled nursing & Geriatric ICU NICU/PICU Total Beds Nationals and Non-SML Expatriates will access the same facilities and constitute 56% of the population and the SML Expatriates will constitute 44%. The number of beds per 1,000 population based on the recommended number of beds for Nationals and Non-SML Expatriates is 3.0 in 2033 (3.9 beds/1,000 for Nationals and 2.7 beds/1,000 for Non-SML Expatriates). The number of beds per 1,000 for SML Expatriates is 0.6 per 1,000, mainly due to the fact that this population group consists of young healthy males that have a relatively low utilization of healthcare services. In line with population projections, demand for healthcare services will witness a shift out of Metropolitan Doha. There will be a shift in healthcare service demand from inpatient services and hospital-based care to outpatient services, day case surgery and community-based care, in line with the expected implementation of various national programmes, including the National Primary Care Strategy iii. 7. Proposed Healthcare Facilities Planning healthcare facilities to cover Qatar s healthcare needs relied on four main elements: service planning, urban planning, service configuration scenarios and facilities classification. Based on service planning and urban planning drivers, a number of service configuration scenarios were developed for discussion and agreement. The consensus configuration supports a distribution strategy in accordance with the agreed facility classification. Proposed Inpatient Facilities include General Hospitals, Specialized Hospitals and Long Term Care Facilities. QHFMP proposes building five new inpatient facilities and expanding five facilities over the next few years:- * ** Abu Hamour Medical Campus Abu Hamour Mental Health Facility Umm Slal Mental Health Facility Umm Slal Skilled Nursing Facility Al Daayen Women s & Children s Hospital * 251 Al Wakra Hospital Expansion Sidra Medical & Research Center Expansion SML Hospital 1 Expansion SML Hospital 2 Expansion SML Hospital 3 Expansion Total Beds ** Shelled capacity; space that has been constructed but has not been developed for operational use The beds proposed by QHFMP slightly exceed the 2033 gap. This is intentional in order to properly distribute the different types of beds required using QHFMP facility guidelines and in consideration of urban planning principles Proposed Outpatient Facilities include Health Centres (HCs), Health & Wellness Centres (HWCs), Diagnostic & Treatment Centres (DTCs) and Diagnostic & Treatment Centres with Haemodialysis capability (HDTCs):- * HWC 45 HC 30 HC 15 HDTC DTC 45 Total Doha * 630 Al Wakra 2 SML Al Rayyan SML SML Umm Slal Al Daayen Al Khor SML Al Shamal - 1 SML SML Total Consult ,845 ** ** One of the proposed DTCs for Doha is 30 rooms. The consultation rooms listed only reflect those in non-hospital settings. QHFMP assumes the balance of the gap will be met by hospital-based consultation services, eg 50% of the supply of specialty clinics will be hospital-based. Page 4

5 Abu Hamour Medical Campus Trauma Mass Casualty, General Hospital & WIC Expansion at Sidra Expansion at Hamad Medical City Expansion at Al Khor Expansion at Al Wakra 3 SML Hospitals Tanween Hospital Aster Hospital Total As Qatar shifts from hospital-centric care to ambulatory medicine and population health management, significant outpatient utilization of MME should occur in Diagnostic Centres and DTCs. The following table summarizes the MME Distribution Strategy for 2033:- MME Devices Comments MRI Machines CT Scanners Interventional Medical Procedures Devices Haemodialysi s Units 8. Estimated Capital Expenditure Remaining 18 MRIs distributed over DTCs and other Hospitals Remaining 12 CT Scans distributed over DTCs and other Hospitals Very limited occurrence in DTCs. The potential for shifting equipment to DTCs will be based on case-by-case review Distribute remaining 115 dialysis stations across 3 HDTCs collocated with DTC and Specialty Clinics Source: QHFMP Project Team Analysis A Capital Cost Estimates Model has been developed to derive an indicative estimate of the capital cost of the infrastructure proposed. Based on the inputs provided, the total estimated capital cost to deliver the direct patient care infrastructure required to fulfil the projections set out in the QHFMP by 2033 is:- Facility type 9. Legal and Regulatory Considerations Total cost (in QAR millions) Health Centres 6, Health and Wellness Centres 4, DTCs and HDTCs 13, Hospitals 28, Long-term Care facilities 3, Total 56, Source: QHFMP Project Team Analysis An effective legal framework is critical for the successful implementation of QHFMP. Qatar s healthcare sector is governed by legislative requirements such as Emiri Decrees, Council of Ministers Decisions and Ministerial Decisions: QHFMP is based on a clear understanding of the laws that regulate the provision of healthcare services in Qatar and includes recommendations on how they can be amended to facilitate implementation of QHFMP. The Qatar Certificate of Need (QCON) process will be used as a tool to implement QHFMP which will be administered by the Capital Expenditure Committee. 10. Five Year Action Plan The Five Year Action Plan spells out the projects to be rolled out to implement the initial phases of the 20 Year Strategy, identifying when each proposed facility (Inpatient, Outpatient and Pharmacies) should be inaugurated to ensure that service gaps are closed in a timely fashion. The plan makes a distinction between facilities which will be used by Nationals and Non-SML Expatriates and by SML Expatriates, although in practice it is expected that SML Expatriates will access services at facilities Page 5

6 mainly intended for use by other population groups (e.g. emergency, tertiary care). The table below summarizes the action plan for inaugurating the proposed facilities:- Nationals & Non-SML Expatriates No Action Land Allocation/Plan Phase/Design Phase Build Phase Operate Facility Name Municipality SML Expatriates Nationality Group Expansion of the 3 SML Hospitals SML sites Abu Hamour Medical Campus Phase 1 Al Rayyan Abu Hamour Medical Campus Phase 2 Al Rayyan Abu Hamour Medical Campus Phase 3 Al Rayyan Abu Hamour Mental Health Facility Al Rayyan Umm Slal Mental Health Facility Umm Slal Women s and Children s Hospital (TMCH site) Al Daayen Sidra Hospital Expansion Al Rayyan Al Wakra Hospital Expansion Al Wakra Umm Slal Skilled Nursing Facility Umm Slal DTC 45- Trauma Mass Casualty Hospital (TMCH) Al Daayen DTC 45 - Lusail 2 Al Daayen DTC 45 - Abu Hamour Al Rayyan DTC 45- Ar Rayyan Al Rayyan HDTC - Ar Rayyan Al Rayyan DTC 45- Al Wakra Waterfront Al Wakra HDTC - Al Wakra Al Wakra HC30 - Aster Doha HC45 - Gate Doha HC45 - Messila Doha HC45 - Najma D-Ring Doha HC45 - Al Khubaib Doha HC45 - Al Maamoura Doha HC45 - C Ring Doha HC45 - Fareej Al Ali Doha DTC - Umm Slal Umm Slal HC15 - TMCH Al Daayen HC15 - Aspire Al Rayyan HC15 - Abu Hamour Al Rayyan HC30 - Al Sadd Al Rayyan HC45 - Luqta Al Rayyan HC30 - Al Wakra North Al Wakra HC30 - Al Wakra South Al Wakra HC30 - Medna Centre Doha HC30 - Msheireb Doha HC30 - New Airport Doha HC30 - Souq Doha HC45 - Fareej Kulaib Doha HC30 - Zekreet Umm Slal HC45 - North of Mesaieed Al Wakra HC45 (x2) - Rawdat Rasid Al Rayyan HC30 - Qasasil Al Rayyan HC45 (x2) - Simsimah - Al Ghuwayriyah Al Khor HC45 - Mesaieed Al Wakra HC45 (x2) - Ash Shahaniya Al Rayyan HC30 - Ras Laffan Al Shamal Required action over the next five years i For details of NHS Project 6.5, see: ii QHFMP uses the definition of SML Expatriates from the 2012 General Secretariat General Secretariat for Development Planning report Population and Employment Projections iii For NPHCS see: Page 6