IMTJ spoke to
Dr Mussaad Al-Rozouki, CEO of Kleos, a Kuwaiti based and Middle East focused healthcare development company
that connects high net worth and institutional investors with lucrative
healthcare assets and opportunities in the Middle East and North Africa. The
Kleos team has been involved in over one billion dollars of healthcare
investments and currently advises senior government and private stakeholder
investors in healthcare.
Who runs Kleos?
There are five
different principals, two in Kuwait, two in United Arab Emirates and one in the
US. We are all passionate about
healthcare and believe in the importance of developing high quality healthcare
for the region and in the long-term opportunity of the sector.
We also work
with a wide network of over fifty international healthcare experts that
contribute to the business, all involved in different aspects of healthcare
including technology, health economics, health finance and public policy.
Who do you work with?
We work with a range of sectors interested in investing in
healthcare. We advise Governments on
public/private partnerships. We also
work with healthcare operators and companies to grow their platform in the
region.
What are standards of medical care, services and facilities like in the
region?
Most of the Arab countries have a socialised system. Almost
80% of healthcare is provided by the government, but there is a perception by
the patients that level of services is not as good as in the West which is
something we need to address.
One of the biggest challenges is the lack of infrastructure,
most hospitals and clinics were set up in the 1970s and 1980s and this is a
problem throughout the region because standards are generally quite low. In the whole region we have only around 30
JCI accredited hospitals and Kuwait has only one JCI credited hospital out of about
70. The private sector is making changes because they want the public to have a
better perception of what is on offer and they are keen to keep patients in the
region but there is no government regulation to encourage any hospitals to get
accreditation.
The various governments know they could be doing a better
job, there’s a lack of high quality facilities and also of healthcare education
and the population suffers as result.
On the other hand here in Kuwait, we have best primary care
access in the world, there’s a strong density of primary healthcare with round
the clock access and you can get to see a GP within 5 minutes and all services
are free for locals. The problem is that
the system breaks down for secondary and tertiary care which is not as good.
Where do you fit in?
We are focused on assisting clients invest in healthcare assets
that are undervalued or finding healthcare companies looking for growth capital
and help them grow their platform in different geographies or grow their
current services.
Even though we work with investors and healthcare operators
our main mission is to improve the quality of care because we believe this is
the only way to improve the overall quality of healthcare services throughout
the region.
Are you venture capitalists?
No were financial management specialists that work with
investors. We work with large institutional investors who are looking for sustainable
long term projects and it doesn’t get more sustainable than a hospital. We also
work with private investment companies who are looking to diversify their
portfolio. We identify and source opportunities for our investors and do due
diligence and then also help them execute the mergers and acquisitions and
implementations or if existing project manage the entity and create enough
value.
How has the global recession affected your business?
It has actually been a positive vector for healthcare we
noticed that the recession has shifted a lot investment attention to our
sector. Before the recession it was hard to convince clients to invest in
something that would only provide a 10% return in three to five years, now
investors realise that the real estate boom is over they can see the advantages
of investing in a more stable product with a consistent return.
How do you create value for your clients once they have invested in a
hospital?
We get involved in the managerial and operational turnaround
and we provide new senior management which we generally recruit from
overseas.
Many of the hospitals in region and clinical systems are not
really designed for efficiency and the infrastructure usually needs to be
substantially altered. Most of our
hospitals in both the private and public system were built as a result of
social responsibility and are not focussed on treating patients as efficiently
as possible or with attention to patient care.
We also work with our investors to identify all the different
processes in hospital and work to implement changes, structurally, clinically
and administratively. One of our biggest
challenges and goals with all the hospitals our clients invest in is to change
the mentality of the institution and to focus more on outcome and delivery of
patient centric care.
How long does it take to turn around a hospital?
It typically takes from two to three years but all in all it
takes five to seven years to really feel the impact of any changes we
implement.
What are your biggest challenges and opportunities?
Greatest challenge in the region is basically the way we
finance healthcare today. At the moment Governments finance it directly from
the budget but they need to come up with new ways to fund healthcare. They talk
about private healthcare insurance and this is the likely way forward but there
also needs to be ways in which emergency services can still be funded by the
government. The secondary and tertiary
services could be funded by the private sectors, and to do this a payment
mechanism needs to be developed that helps refinance they system. Additionally the healthcare providers need to
take responsibility for healthcare in a way where the quality is measureable so
that investors and insurance companies can see where there money is going and
pay for performance.
What other challenges does the region face?
Probably the biggest issue that we are facing is lack of
qualified nursing staff and leaders, it is a global issues but particularly
problematic in this region. We need to
come up with better solutions. There’s been a sharp devaluation of the nursing
profession in the region. In Kuwait they relocated the nursing school from the Allied
Health University to the Vocational Training Institute; it has almost
downgraded the profession. We need to get nurses more involved not only in care
but in disease management, in the US there is a doctorate programme in nursing,
because they are trying to bring back prestige to the profession which is the
opposite of what is happening here. As a former doctor I understand the
importance of nurses in clinical infrastructure and as an industry we need to
figure how to keep this profession alive and well.
However, the most important thing for our country to address
concretely is healthcare education.
What are the main healthcare problems in the region?
Chronic diseases is growing rapidly because of the affluent,
sedentary lifestyle of most citizens, 20
to 30% of the population of Kuwait is obese and it is in the top five countries
for diabetes, the costs are very high, patients are more likely to be
hospitalised and we need to educate people better so that they understand the
consequences of their lifestyle choices and we want to promote preventative
health in the Middle East.
How else are you working with governments in the region?
We are working with government on trying to address how to
stop sending patients abroad. If we
improve the region’s healthcare infrastructure then it will be more efficient than
sending patients abroad. There’s an important balance that governments need to
strike so that citizens can get the best care possible in their own countries
so we need to develop home based services that are sustainable for the future.
Eighty to 90% of all patients we send overseas are fully funded
by the government, our constitution guarantees healthcare for all citizens and
in recent times that’s come to mean that the best healthcare is overseas and
patients know it will be funded by the government. We need to change that. The government pays not
only for their treatment costs, but also a daily stipend and almost all cases
get a family member to travel with them to keep them company. The average cost for sending patients abroad
for treatment is between $150-200,000 per patient. Patients can request to be
sent abroad for any type of treatment, including open-heart surgery and other
major operations. There are lots of
patients travelling for IVF treatment and it is not unusual for these patients
to be away for 3-9 months.
We cannot continue to send people to the best care in the
world, it is too expensive, not sustainable and we should be able to provide
top quality healthcare here but apart from the lack of infrastructure which we
are working on our other problem is that we don’t have good medical schools or
research centres which is another area that needs addressing.
Apart from working with investors and the governments of the
region to invest in the infrastructure what other opportunities are you
exploring?
We are very involved in setting up Islamic Healthcare
Insurance a “Takaful”, which is different from traditional healthcare
insurance. Takaful means cooperation and in Takaful companies the profit is
sometimes shared back with the enrolees to the companies. There are all sorts
of Takaful companies but we are developing a specialised healthcare Takaful in the
region. Traditionally in a Takaful company the healthy pay for the sick and the
young pay for the old. Communities used to pool their money together and pay
for the sick and the needy. This is what we’re developing now, a specialised
Takaful health insurance based on Islamic principals, it’s a project we are
very excited about.
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