Author:
Luke Richards
Measuring the impacts of healthcare on the economy is essential to provide decision-makers and stakeholders with critical information on the consequences of health inventions, policies, and projects, maximising value and increasing access and equity to healthcare.
With the GCC facing a high disease burden with growing incidences of communicable and non-communicable diseases and mental health issues, measuring the socioeconomic impacts of health transformation strategies is now more critical than ever.
Health transformation strategies are critical in improving patient outcomes, such as life expectancy, quality of life and well-being, and non-health outcomes, such as productivity and economic growth.
Monitoring these strategies in a region with high population growth rates and ageing communities helps determine their success. It ensures policymakers maximise outcomes across the care continuum by investing in the right programmes.
This article explores the importance of measuring the effects of healthcare interventions and the typical challenges that policymakers face in undertaking such assessments.
Current state of healthcare in the region
Healthcare in the GCC is transforming, moving from sick care to a precision, preventive and predictive model. Increased health awareness levels and high incidence of non-communicable diseases (NCD), have led governments to invest in innovative technologies that help in early disease detection. Governments in the GCC also recognize longevity as a national, strategic and economic opportunity, accelerating digital adoption to improve patient outcomes.
In the region, health outcomes have significantly improved over the last 10 years, with life expectancy in Saudi Arabia improving from 75.7 years in 2023 (from 72.5 in 2000), while in the UAE the current life expectancy in 2023 is 78.5 years (from 74.4 in 2000)1. Similarly, across the broader Middle East and North African region, the under-five mortality rate has declined by approximately 22% between 2010 and 20202.
Despite these advances, the region still lags compared to developed nations. Regional life expectancies remain below countries with similar GDP per capita (see figure 1) and premature deaths from chronic diseases remain high. The probability of an individual between 30-70 years old dying from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases in 2019 was 20.9% in Saudi Arabia and 18.5% in the UAE, compared to 10.3% in the United Kingdom.
Figure 1 - The life expectancy frontier curve: room for improvement for healthcare in the region
The life expectancy possibility frontier curve maps each country’s life expectancy and GDP per capita values. It represents the highest life expectancy that can be expected given income levels (as measured by GDP per capita). The distance to the frontier represents the gap from the “best in class” countries in life expectancy for a given standard of living represented by GDP per capita. Life expectancy values for the MENA region lag behind other countries with similar standards of living suggesting there is room to improve the quality and access of healthcare services.
Healthcare in the region also faces several challenges:
High population growth rates and aging populations will put pressure on healthcare services (see figure 2). Population in the Middle East and North Africa is expected to grow ~23% from ~500mn in 2023 to ~617mn by 2040 while the percentage of those aged over 65 is expected to increase from 5.6% in 2023 and increase to 9.9% in 2040. In Saudi Arabia the percentage of those aged over 65 is expected to increase from 3.1% in 2023 to 12.8% by 20403.
- Low healthcare service coverage with Saudi Arabia scoring 74 and the United Arab Emirates scoring 82 in the UHC Service Coverage Index compared to the UK, US, and Singapore at 88, 86 and 89, respectively in 20214.
- A shortage of healthcare professionals, with density rates of doctors in Bahrain as low as 9.3 per 10,000 people compared to the UK at 30.0. Similarly, the average Nursing and Midwifery density rates across GCC countries is less than 50% than that of the UK.
Stigma around mental health, with 15% of the GCC population suffering from mental health disorders in any given year. The region's shortage of mental health professionals and misinformation also means mental health problems remain widely untreated. In Saudi Arabia, for example, 80% with severe mental disorders do not seek treatment. The socio-economic impact of untreated mental health in the region costs the GCC $3.5 bn per year in lost productivity.5
- High prevalence of obesity leading to an increase in the number of contracted chronic diseases such as heart disease specifically in Kuwait, Qatar, and Saudi Arabia where 34%, 33%, and 32%, respectively, of the male population are considered to be obese.
Kuwait, Qatar, and Saudi Arabia have the 15th, 16th and 17th highest obesity prevalence rates in the world.6
Figure 2 - Standardised population growth forecasts: Growing regional populations are expected to drive future demand for healthcare services particularly for Sub-Saharan Africa, the Middle East and North Africa
The importance of measuring incremental impacts
Healthcare entities in the region have developed several health transformation strategies to close the gap in health outcomes. Notably, Saudi Arabia has introduced the Health Sector Transformation Program as part of Vision 2030, while the UAE has established a patient-centric approach with the UAE Centennial Plan 2071 that is aimed at providing high quality and efficient health services, whether curative, preventive or rehabilitative, with a focus on lifestyle diseases and mental health.
Such strategies are instrumental in improving healthcare quality when demand for healthcare services is rapidly increasing.
The WHO advocates the use of Health Impact Assessments (HIAs) to judge the potential health effects of a policy, programme or project, on a population to maximise the positive health effects and minimise the disease burden on an economy. It enables decision-makers to make informed choices and is based on stakeholder participation, health equity, sustainable development and the ethical use of evidence.
Measuring the impacts of these programmes is key and can achieve the following:
Enables stakeholders to make better informed decisions when designing and implementing healthcare interventions
Avoids any unintended consequences or minimise negative impacts
Enhances the business case for stakeholder support
Secures funding for initiatives, enabling informed decision-making on their disbursement
Strengthens positioning of health policies in local and national development plans as mechanisms driving sustainable economic growth and prosperity
Drives improved health outcomes by optimising policies or investments
However, current evaluation practices are inadequate. For example, evaluation techniques are confined to monitoring and assessing of key performance indicators (KPIs). While KPIs are essential for evaluating and monitoring the performance and operations of services, screening programs, and other public health activities, they are ineffective at measuring socioeconomic impacts. KPIs are also backward looking, with no indication of future impacts of interventions, initiatives, or projects in achieving strategic objectives.
Why is it difficult to measure health impacts?
Typical impact assessments highlight changes in well-understood areas, such as employment, income, and economic output (GDP). However, health impact assessments often estimate changes in these and specific indicators, which require a deeper understanding of individual and population health, including additional years lived and health utility.
Estimating the impact of health policies and investments requires knowledge of the type of health impacts that may occur and the distribution of those impacts in the affected community. While understanding these links is theoretically straightforward, in practice, it is challenging.
For example, measuring the impact of a policy on the health outcomes of individuals with chronic diseases is complex for several reasons:
- The change in quality of the treatment of these diseases may vary depending on the policy being introduced
Chronic diseases are rarely isolated and individuals may suffer from multiple diseases at once
Individuals in different age categories will have different health outcomes
The impacts may differ depending on if the policy is aimed at improving treatment or preventing individuals from contracting a disease
Quantifying the change in additional years lived and health utilities is not straightforward and may require triangulating primary data such as the Modified Rankin Scale for strokes, expert medical opinion and benchmarks on similar policies introduced overseas.
Calculating the impact of health indicators such as life expectancy are complex and require life tables to measure new life expectancies at birth
Establishing the counterfactual - what would have happened if the policy wasn't introduced may not be straightforward
we will explore in future articles methodologies PwC has developed to help policymakers address these challenges and robustly measure healthcare impacts.
What should you do?
Ministries of health and other policymakers should consider conducting socio-economic impact assessments on healthcare interventions to assess their potential impacts in relation to their overarching objectives. Conducting health impact assessment will help policymakers improve health outcomes for society, identify opportunities to minimise negative impacts, avoid unintended consequences and manage risks. Ultimately, socio-economic impact assessments help the region overcome challenges such as high population growth, ageing societies, and high chronic diseases prevalence rates through the implementation of effective and well managed healthcare policies.
The author would like to thank Jing Teow, Zuhdi Hashweh, Kofi Oteng, for their contributions and support.
Sources:
[1] World Bank - Life expectancy (years) - https://databank.worldbank.org/source/population-estimates-and-projections
[2] World Bank, Under-five mortality rate, https://data.worldbank.org/indicator/SH.DYN.MORT
[3] World Bank - Population (total) and percentage of population aged over 65 years (%) https://databank.worldbank.org/source/population-estimates-and-projections
[4] WHO - Healthcare Coverage Index
https://www.who.int/data/gho/data/indicators/indicator-details/GHO/uhc-index-of-service-coverage
[5] PwC, The Socio-economic Impact of Untreated Mental Health in the GCC
[6] Global Obesity Observatory - https://data.worldobesity.org
