Mall Medicine

Mall Medicine

  • This article contains a brief description and brief outline of the history of retail medicine as well as future trends of retail medicine in the US and the UK, including both recent success and failures.
  • The article then goes on to describe how the concept could be quite lucrative in the GCC and what are the milestones needed to bring retail medicine to the Gulf. 

There is an interesting new trend sweeping the western world; healthcare is moving away from hospitals and setting up shop in malls and other large retail outlets.

I was first introduced to the concept of retail medicine at the 2007 World Innovation Forum in New York City. Seen by many medical doctors as the scourge of traditional primary care, retail medicine has revolutionized the delivery of medicine through its own unique interpretation of disruptive innovation.

It all started on a wintry weekend in 1999, when American entrepreneur Rick Krieger took his sick son to an urgent care center in Minneapolis, Minnesota. Rick knew his son needed his throat tested and soon enough, after a two-hour wait, a strep throat test was finally done.

Like many parents before him, Rick believed that there had to be a quicker, more convenient way for experienced parents and patients to get quick healthcare diagnoses, so he teamed up with a physician and a nurse to put the limits of traditional medicine to the test.

Started as QuickMedx (and soon rebranded as the Minute Clinic), Krieger’s convenience care concept was simple – treat the 20% of disease that cause 80% of the visits to primary health centers (an essential extension of Paraeto’s 80/20 principle).

To keep costs down, Krieger and his team decided to staff these ‘mini clinics’ with resident nurses instead of physicians (pushing the boundaries of clinical practice) and locate the clinics within large retailers (thereby forgoing much of the costs such as building and servicing of restrooms).

Today, with over 500 clinics and close to 2 million mostly walk in, cash paying customers with a 99% satisfaction rate, the Minute Clinic (through its partnership with CVS Caremark Corporation) has opened up the US market to a whole new age of medicine. Even traditional medical power players such as the Mayo Clinic, have extended their brands into the retail medicine space, in this case via the Mayo Express Clinic.

More significant is box retailer Wal-Mart efforts, which started with a pilot program in 2005 for 75 clinics in 12 US states and and has since expanded to include plans for 6,600 medical clinics by 2012 through a partnership with various retail medicine companies such as RediClinic. Across the Atlantic, British supermarket giant J Sainsbury will also be adding government-paid doctors to some of its stores, where shopping patient will be alerted by a pager when their appointment arrives.

The ability now exists to put your next medical checkup on your grocery list.

The popularity of retail medicine lies in the trend of patient convenience. People want to have flexible visiting times. This is the millennium of multitasking and retail medicine is moving fast up the healthcare continuum as a complement to larger primary care clinics and hospitals.

In the UK, employees spend around 3.5 million working days a year traveling to and from doctors, costing the British economy close to $2 billion (estimated by the Confederation of British Industry). In the US, insurers have also advocated for increased healthcare options through retail medicine as evident by CIGNA Healthcare members in Dallas, Texas being offered convenience through the insurer’s addition of MedBasics Family Health Centers to its network.

However, the success of retail medicine is not without its share of skepticism. Many people and institutions (American Medical Association, American Academy of Pediatrics,) are concerned about quality of care, hygiene issues and the limited scope of the clinicians running these ad hoc facilities. These issues, coupled with an inability to maintain the salaries of healthcare professionals, have forced retail medicine corporations such as CheckUps and Take Care Health Systems to shut down multiple walk-in clinics in both Wal-Mart and RiteAid respectively.

Industry experts estimate that a company can consume $300,000 to $600,000 to finance and maintain a retail clinic, breaking-even at about 25 to 30 patients a day. This should be no problem for retailers within the GCC, where the desert heat pushes the average consumer to frequent the mall over 70 times per year (according to Dubai based market researcher GRMC).

The GCC retail industry is an extremely attractive sector globally, according to At Kearnery’s 10th annual Global Retail Development Index (GRDI) which ranks seven countries from the MENA region make it into the top 20 in the 2011 index of top ranked emerging markets for global retail expansion, including Kuwait (5th place internationally), Saudi Arabia (ranked 7th) and the UAE (ranked 9th).

With over five million square meters of retail space currently available in the GCC (worth over $100 billion and expected to treble in the next nine years according to Retail International), proprietors of retail medicine should have no problem carving out a niche for themselves with the right strategy and scope.

Developing a retail medicine concept specifically for the GCC would require significant investment and expertise. A number of detailed assessments need to be taken into account, starting with scope of service where the individual retail clinics must have a well-defined and limited scope of clinical services that falls within the local government regulations and is catered to local cultural norms. Also, an evidence-based medicine approach to clinical services and treatment must be implemented and quality improvement-oriented, in addition to the selection of the highly specialized staff.

Once the scope and staffing have been completed, an international partnership may be necessary to bring international best practices to the GCC.

The operations of the facility must be also carefully considered, with a team-based approach encouraged. Even retail walk in clinics should have a formal connection with physician practices in the local community, preferably with family physicians, to provide continuity of care. Other health professionals, such as nurse practitioners, should only operate in accordance with local regulations, as part of a team-based approach to health care and under responsible supervision of a practicing, licensed physician.

Most importantly, a steady referral stream also needs to be established where the clinic must have a referral system to physician practices or to other entities appropriate to the patient’s symptoms beyond the clinic’s scope of work. The clinic should encourage all patients to have a “medical home.”

Finally, it is also essential to have electronic health records set up to gather and communicate the patient’s information with the local healthcare providers.

The article is written by Dr. Mussaad Al Razouki for Arab Business Review

To read more thought-leadership stuff by leaders from Arab Region, please visit Arab Business Review

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Health Tourism in the UAE

Health Tourism in the UAE

  • Some Arab countries have all the factors required for a successful health tourism industry and Government support can help these countries become popular health tourism destinations
  • The U.A.E. is positioning itself to become a hub for global medical tourism and a preferred destination for domestic and foreign patients seeking high quality and cost effective procedures and treatment
  • While Dubai has many things going for it which make it an excellent health tourism destination, there are some challenges it faces such as competition from some South Asian countries and availability of affordable medicine

Health Tourism is increasingly becoming a successful investment strategy in the west and far-east countries. Governments have supported this sector primarily for its anticipated contribution to the development of the economy through generation of revenues and for its potential impact on improved quality of healthcare services. However, some of the Arab countries are also in a position to make this sector a very successful industry as they do have all the factors that can make it happen. Some of these factors are; natural hot spring and mineral waters and state of the art medical centers as well as the abundant resources for investing in cutting edge healthcare services. The GCC spends an approximately USD 30 billion on overseas treatment yearly. Therefore, there has to be some strategies to shift the burden from the Government, one way of doing that is by promoting health tourism in the GCC through developing this sector and support it with all required legislations and policies that are conducive to creating a favorable environment for its growth.

The U.A.E. is positioning itself to become a hub for global medical tourism and a preferred destination for domestic and foreign patients seeking high quality and cost effective procedures and treatment. The U.A.E. is already home to a number of high-profile partnerships which seek to bring Western technology, practices, and standards to the U.A.E. in an efficient and culturally relevant manner. The Cleveland Clinic Abu Dhabi and Mubadala—is scheduled to open its 360-bed multi-specialty tertiary care hospital in 2015 , The Johns Hopkins University Medical School works in partnership with Tawam Hospital, a 466-bed facility in Al Ain. The Dubai Healthcare City; consists of two free zones—a medical cluster and a wellness cluster—on a total of 23.2 million square feet of land and has attracted a number of top U.S companies and institutions as its key partners.

The U.A.E. has positioned itself as an attractive investment prospect for U.S. companies seeking to expand their footprint in the Gulf region. The country presents a substantial growth opportunity within the framework of strong regulatory oversight and ambitious plans to expand and improve healthcare coverage for its growing population. Through strong partnerships and direct investment opportunities. As per business monitor international report its expected that the health spending in the UAE will reach 11Billions US Dollars by 2015. Therefore, health tourism was consider as a sector which can contribute to the economic growth of the country.

Dubai has taken the initiative of promoting the city in the medical tourism hub in the 2012. Dubai is the most diversified economy in the GCC. Currently over 2 million residents from over 150 different nationalities lives in Dubai. It has its own Independent regulatory body established to ensure international standards in patient safety and quality of care. The health outcomes compare well to international benchmarks and clinical guidelines have been introduced. There are Over 4,750 doctors/ physicians speaking over 40 languages and centers of Excellence offering treatment for a wide range of specialties. This is to ensure that our community and our health tourism receive the best of care and feel safe. Geographically Dubai is only four hour flight from one third of the world’s population and within 12 hours for the remaining two thirds. As a health tourism it save on average between 30 to 60% on the cost of treatments when compared to the US. The high standard of living helps in attracting and retaining physicians and nursing staff compared to the other countries in the Middle East. And above all, the growing tourism sector and the expanding airlines networks (The Emirates and Al-Itihad airlines) make an excellent opportunity for promoting a travel driven medical tourism hub in the UAE.

Despite these forth mentioned favorable conditions, however looking at the market, there are challenges that Dubai will face and could be hard to change without a comprehensive plan, these include;

  • Competitive prices for treatment in the region; offered by India, Thailand and Singapore.
  • Nationals still seek health care in competitive countries.
  • Availability of world class, quality medicines at affordable prices.

The article is written by Laila Al Jassmi for Arab Business Review

To read more thought-leadership stuff by leaders from Arab Region, please visit Arab Business Review

Opening-up of Saudi Stock Exchange to Foreign Investors

Opening-up of Saudi Stock Exchange to Foreign Investors

  • The decision of the Saudi Capital Market Authority (CMA) to open the Saudi stock exchange to foreign investors has induced a lot of excitement and optimism in the market. In this article, we discuss what the change is all about, why it is important, how it is likely to be implemented, and what will be its impact on various stakeholders.

What? Why? How?

So what exactly is going to happen? On July 22, 2014, the Saudi government announced that the Tadawul All Shares Index (TASI) will be open to direct foreign institutional investment from the first half of 2015. This would mark a welcome departure from the current state of affairs, where foreigners can purchase Saudi stocks only via trades conducted through international banks and by making a small number of costly and time-consuming exchange-traded funds (ETFs). As a result of these restrictions, foreign investors currently own less than five percent of the Saudi market, and account for a meagre one percent of the volumes traded on the TASI, which is dominated completely by local retail investors. But once these restrictions are eased in 2015, foreign investors will be able to participate much more freely in the Saudi market, and own and trade stocks of public companies in the kingdom.

Why is the change important? With a capitalization of $530 billion, the Saudi capital market is much bigger than its regional peers (Dubai and Abu Dhabi combined have a market cap of about $235 billion, Qatari listed companies are worth $196 billion and Egypt’s market is about $69 billion), and also boasts of superior liquidity – the daily average turnover at TASI is $2 billion, which is once again much ahead of the trading volume in other Arab nations. And to add to these points is the fact that the Tadawul is home to the some of the largest companies & IPOs in the region, belonging to diverse sectors ranging from petrochemicals to banking to telecommunications to retail and real estate. Therefore, from an investor standpoint, the TASI is one the biggest market which is currently closed to foreign money; therefore, its proposed opening to foreign investors is perhaps the most significant investor-friendly step taken by a Middle East or GCC nation in many years.

However, the Saudi government is not taking this step simply to appease investors. Instead, this move is a part of the kingdom’s long-term strategy to reduce dependence on oil revenues, and strengthen the non-oil sector of the largest economy in the Middle East. The decision also comes close on the heels of Qatar and the UAE getting included in the MSCI emerging market index, and Saudi authorities surely don’t want to be left behind on this front, so an indirect aim would be to get the TASI listed on the MSCI frontier or emerging market index.

The importance attached by the market to this move can be gauged from the fact that the TASI jumped 2.8 percent to a six-year high on the day the announcement was made. Also, the IMF boosted its 2015 GDP growth forecast for KSA from 4.1% to 4.6%, based on expectations of strong private sector performance.

How will the change be implemented? The CMA is yet to come out with a definite plan, but it is obvious that the roll-out to foreign investors will a slow and gradual process to avoid volatility in the market, and also to test waters in a phased-out manner.

One of the reasons that this change has taken so long to come is that Saudi authorities have been very protective of the companies in the kingdom, and have been averse to foreign investors taking control of key listed companies. Therefore, we can expect the CMA to impose caps on the amount being invested. While official numbers are yet to be announced, the market expects that foreign institutions will not be allowed to own more than 10% of the Saudi market and more than 20% of a Saudi company.

Further, to start with, a limited number of investment licenses are likely to be granted to qualified investors only, in order to avoid a sudden influx of foreign money into the Saudi companies. Such investors likely to be chosen based on the size of their assets under management (AUM) and global investment management experience, with most expectations pointing to an AUM bar of at least $5 billion. Retail investors are unlikely to be given licenses for buying and trading in the first phase of the roll-out.

Finally, most experts believe that the KSA is likely to follow the route adopted by emerging markets like China and Taiwan, where a free and open market is regulated by government officials. Also, oil and gas companies may be kept out of the purview of the initial roll-out to ensure that the Saudi government retains control over firms currently generating majority of the national revenue.

What are the implications of opening-up of the market to foreign investors?

  • On the KSA economy: Saudi Arabia’s economy is likely to get a double boost from this move. First, the influx of foreign capital will boost the overall GDP, and push along the diversification to non-oil revenues that will ensure sustenance of growth. Secondly, a well-diversified and growing economy will help tackle the high level of unemployment, especially among the youth, in the country. As cited earlier, the IMF has already increased its 2015 growth forecast from 4.1% to 4.6%, expecting economic diversification to drive growth.
  • On the Tadawul Index (TASI) and the overall capital market in the kingdom: The index will become the gateway to foreign fund inflow worth ~$50 billion into the country, strengthening its case for inclusion into MSCI’s emerging market index. Even though such an inclusion unlikely to take place before 2016, the TASI will account for three to five percent of the index, when eventually included. The move will also boost trading and IPO activity on the TASI, and will also result in production of higher quality equity research in the region.
  • On Saudi Companies: Most large Saudi companies are cash rich, so obtaining additional funding will not be the biggest gain for them. Instead, such companies will benefit from shareholder activism and improved corporate governance and accounting standards that are likely to be implemented to meet the high standards expected by foreign investors. These companies will also benefit from receiving guidance and expertise from globally experienced investors, on operational as well as strategic issues. For medium-sized companies, influx of foreign capital will lead to lower financing costs and improved valuation. Further, working with global investors will allow companies in the KSA to think global, and will help them execute their international expansion plans (regional or global) in a better manner.
  • On Investors: The move will give investors much awaited access to the largest economy in the GCC and in the Middle East. Huge foreign reserves, a low-risk sovereign credit quality, and an emerging-market like growth potential make the KSA an especially attractive destination for foreign investors.  Additionally, through the TASI, it will give them access to leading firms across industries, such as Samba Bank, Saudi Basic Industries, Saudi Industrial Investment Group, and Yanbu National Petrochemical Company. Not only do these companies have a huge “upside” potential, most Saudi companies also have better corporate governance standards as compared their peers in the Middle East.
  • On Other Asset Classes: The current move is aimed at opening-up of the equity market. However, if the move is successful, it could prompt the government to open even the bond (or Sukuk) market to such investors. Even though such a follow-up move will take a long time before being implemented, the opening-up of the local Sukuk market would give foreign investors access to companies that sold 42 billion riyals ($11.2 billion) through a dozen sales in the past year, according to Bloomberg.

Overall, if implemented well, this move has huge positive implications not just for the KSA, but also for all other countries in the GCC and the Middle East, as discussed above. However, investors are keeping a close eye on the announcement since policymakers in the kingdom have put off such plans in the past. Therefore, it is important that the CMA comes out with a well-defined roll-out plan with actual dates and timelines to alleviate investor concerns, and implement what will be a landmark change in the way capital markets operate in the Arab World.

The article was originally published at: Arab Business Review

To read more thought-leadership stuff by leaders from Arab Region, please visit Arab Business Review

Overview of Banking System in Iraq

Overview of Banking System in Iraq

 

  • With 80% of population without a bank account, Iraq has one of the least developed banking sector in the MENA region.
  • The banking sector reform, which started in 2006, has provided solutions, in terms of new capital, but the implementation has been very slow.
  • Increasing the dialogue between the Iraqi authorities and the banking system, associated with the restructuring process, in terms of human resources, audit framework, accounting and performance is vital for the sustainability and solidity of this sector.
 

The reform of the Iraq banking system is a challenge, in the light of political and security environment issues, but the evidence from recent years has shown that the results are consistent and many of the solutions have already been implemented.

The banking sector of Iraq is the most underdeveloped banking system in the Middle East North Africa. According to the statistics, more than 80% of the population does not have a bank account (Sansar Capital, 2013).

Accounting for 75% of the financial system, in terms of assets and 77% of GDP, the Iraqi banking system is dominated by the state-owned banks (7) (IMF, 2013). The main issues of this segment are related to low capitalization, especially in the case of Rafidain Bank and Rasheed Bank. The banking sector reform, which started in 2006, has provided solutions, in terms of new capital, but the implementation has been very slow. The private banks (50) are small and their activities are short-term orientated to retail trade and wholesale. The professionalism of private banks is questioned by the Central Bank of Iraq officials, in regard to their real potential in supporting economic growth.

The regulation related to capital requirements, which must be met by the private banks favours public banks to monopolize the banking sector. The decision has the role to protect private banks funds but in the same time will slow down the activity. Also, forcing large banks to lend more and small banks to merge with other financial institutions is an attempt to implement central planning.

Additionally, the effectiveness of banking supervision is questioned and the audit standards are lax. The general mistrust of the banking system is driven by the lack of deposit insurance, the bankruptcy case of Warka bank and the losses registered by the two main banks in the system. There is a real need for transparency and reliable financial media.

 Other internal issues experienced by the Iraqi banking systems can be stated as follows:

  • Gaps in data collection on banking transactions in the northern region (Iraqi Kurdistan)
  • Party transactions role and actions – the majority shareholder family are using bank funds for projects of their own
  • Low financial infrastructure associated with shortages of skills and technology (The World Bank, 2012).

According to the Iraq Banking Reform Strategy – Action Plan (2008-2012), the actions designed to improve the overall situation are orientated to organizational structure, IT infrastructure, risk management and banking supervision. Increasing the dialogue between the Iraqi authorities and the banking system, associated with the restructuring process, in terms of human resources, audit framework, accounting and performance is vital for the sustainability and solidity of this sector.

We consider that the reform towards a modern banking system has to change the mentalities as well. The traditional way of holding cash at home becomes a real challenge for the banking development. The restrictions imposed on government agencies, state-owned companies and employees, to deal with private banking represent a drawback of growth.

However, we truly believe that the restructuring of the banking system of Iraq has determined positive results not only in terms of numbers, but also in the general perception over the role and potential of the banking activity on the economic growth. Many steps in overcoming the actual problems have been made. …Because adaptation to the internal and external conditions is crucial for the future.

 

The article is written by Falah Mousa for Arab Business Review

To read more thought-leadership stuff by leaders from Arab Region, please visit Arab Business Review

Not a Muslim? Not a problem!

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  • The holy month of Ramadan has arrived. It is happy occasion for Muslims around the world and a festive season in the Middle East. 
  • The article highlights some pointers to help non-Muslims understand the cultural (and/or legal) aspect of Ramadan in the region especially in the workplace. 
  • The Arab Business Review team wishes everyone a Ramadan Mubarak!
The holy month of Ramadan has arrived. It is the 9th month in the lunar Islamic calendar as well as a happy occasion for Muslims around the world. It is a period of prayer, fasting (from sunrise to sunset), charity giving and self-accountability. If you are visiting or have recently moved to the Middle East during this time you will notice a few things: the festive atmosphere associated with the month in most regions, the opening hours of businesses and organizations are altered to suit prayer times, and there will be high traffic around mosques—especially in the evenings. Here are some pointers to help non-Muslims understand the cultural (and/or legal) aspect of Ramadan:
Meet and Greet: As a friendly gesture acknowledge the arrival of the month by extending greetings to your Muslim friends and colleagues by saying “Ramadan Mubarak” or “Ramadan Kareem.”
The Headache Factor: Fasting is not easy. It means no water in the heat and no smoking or coffee—for those addicts among you. Around midday you will notice a drop in your colleagues’ energy levels, so to help them preserve their energy avoid extra lengthy discussions and do not take it personally if they are not in the mood to chat or socialize.
Slacking-off Attitude: Unfortunately many employees will use Ramadan as an excuse to slack off and be unproductive. If you are in a position of power do not accept this, fasting is not an excuse to be lazy. However, do not expect or ask your employees to work overtime during this month.
Lunch at the Office: While non-Muslims are NOT expected to fast during Ramadan, Muslim Middle Eastern countries (especially the Gulf region) forbid public eating and drinking. Cafes and restaurants will be closed during the fasting hours. Despite this law, it is a common practice within private companies and multinational firms for non-fasting employees to bring food from home and quietly eat in the kitchen, but this depends on the company’s culture.
Awkward Questions: Not all Muslims are practitioners, just like any other religion, so refrain from asking your colleagues if they are fasting or not—or why they aren’t fasting—if you happen to find them eating or drinking. Finally, keep the information to yourself and do not disclose it to others.
Time Management: If you are planning a project, please keep in mind that Ramadan working hours are shorter than normal working hours in most countries. Furthermore, if you have external meetings add at least an extra half hour to your usual commute time as roads are always congested during the month.
Safety on the Road: Accident rates tend to rise during Ramadan. This is sad, but true. Be safe on the road and avoid leaving the office or commuting around sunset as this is Iftar time (the meal that breaks the fast) and many people will rush to be home on time making it very risky to be on the road.
Many tourists and visitors enjoy their stay in the region during this holy month as they experience the full flavor of it. We hope that this article has brought you a step closer to understanding the Arabic and Muslim culture as our objective is to increase transparency and to disrupt what can and cannot be spoken of. If you like this article share it with others. The Arab Business Review team wishes everyone a Ramadan Mubarak!
 
The article was originally published at: Arab Business Review
To read more thought-leadership stuff by leaders from Arab Region, please visit Arab Business Review