Click image to view larger version

Private clinics are raising the bar to provide the best possible healthcare, giving consumers a range of options. Srinivasan Iyer reports

The last few years have seen a surge in the number of private clinics and hospitals, providing an alternative to primary healthcare. Two important reasons for their growing numbers are the long wait at the government hospitals and the lack of specialised healthcare providers. Patients prefer to pay more for specialised treatment and personalised service than wait in queues at the state-run institutions, even though the quality of healthcare and service is undoubtedly high.

Private clinics and hospitals are const-antly raising the bar with quality service and state-of-the-art equipment. The competition is intense with private players operating at different price levels and offering various services ranging from basic outpatient facilities to complex surgeries with quality post operative care.

Muscat Private Hospital (MPH) says it strives to provide high quality care through a phalanx of full time doctors as well as visiting and independent consultants. Says Gerard Strong, hospital director, MPH, "We provide comprehensive service, practically anything that is available in the state-run hospitals. These include complex procedures like joint replacements, neurosurgery, urology, ear, nose and throat surgery, cosmetic and plastic surgery and dental care. Our other departments include diagnostics, emergency, obstetrics and gynaecology, paediatrics as well as assisted conception. We cater predominantly to the upper middle class and Western expatriates."

MPH also brings in specialist visiting consultants on a regular basis, who are contracted to visit four times a year. “A foot and ankle consultant who had come recently is already booked for his next visit. Visiting doctors, as a rule, only work with hospitals that provide continuity of care. We are fully equipped in that respect and retain the responsibility of providing ongoing rehabilitation," adds Strong.

Due to the perceived lack of specialised hospitals, newer entrants see scope for growth. Welcare Diagnostic and Treatment Centre opened its first medical centre in Al Khuwayr. Welcare, a subsidiary of World Healthcare System of Dubai, has invested RO3mn in state-of-the-art equipment, like bone densometer, 4D ultrasound, and a full-fledged laboratory. The facility is linked with Dubai to allow the digital transfer of medical data for opinion from specialist doctors. Says Dr Pavan Kumar Shrivastava, medical director of Welcare, "Consultation is on appointment basis only to avoid a long wait. Each patient is taken care of by a dedicated nurse till he or she leaves the clinic premises."

Welcare has arrangements with Muscat Private Hospital and Al Shatti Hospital where it can make use of the operation theatre and post-operative care. The arrangements are only for the short-term as plans are on the anvil to offer in-patient facilities.

Standing out

Apollo Medical Centre, a unit of India's Apollo Hospitals Group, is differentiating itself from the pack by being the first in Oman to offer telemedicine services, besides the usual diagnostic services, general surgery and critical medical care. The telemedicine infrastructure at Hamriya has a dedicated high-speed ISDN line and patented software, providing 20-minute consultations with specialists in India. Says J Sandeep Kumar, COO, "There is no difference in direct consultation or telemedicine, because the specialists in India can simultaneously review investigations of patients in Oman, be it laboratory tests, X-rays, sonograms, CT scans and MRI, and give a comprehensive opinion. In fact, it is a cheaper option to travelling abroad for treatment. It is cost-effective and efficient healthcare." The brand equity has helped Apollo cement its reputation with corporates and the middle class.

At the other end of the spectrum, Badr al Samaa is popular with the middle class and expatriates for affordable, quality healthcare. Starting with just one clinic in Ruwi in 2002, Badr al Samaa now has clinics in Al Khuwayr, Sohar, Salalah and most recently in Al Khoud. There are plans to provide services in Nizwa and Sur. The group now employs 140 doctors and a several-hundred strong paramedic staff across its network.
The hospital recently started assisting in overseas shifting of critically ill patients in need of urgent surgery. The hospital has a full-fledged team in place and the necessary critical care infrastructure to safely transport patients to any hospital in India. Says Abdul Latheef, director of Badr al Samaa Group of Hospitals, "We are planning to set up a super speciality hospital in the near future. Our aim is to provide advanced treatment here at economical rates and prevent people from going abroad to seek treatment."

Others like Lama, Hatat and Al Hayat polyclinics have been around for some time and have established their credentials. Al Hayat, for instance, has built its reputation around Dr K P Raman, medical director and cardiologist who initially served with the Royal Hospital. Lama has maintained quality under general manager Philip Raju, who has several years of regional experience. "Lama has over 60,000 patient files. Many of our clients are regulars who have been coming to us for more than 15 years now," says Raju.

With new clinics rapidly appearing on the horizon, single-doctor clinics may find the going tough. Says Raman, "GPs (general practitioners) will disappear as more and more people prefer visiting well-equipped polyclinics that offer specialised services. This is why new entrants like Atlas Star Medical Centre, Apollo and Badr al Samaa are doing well. There is no doubt about the quality at government hospitals, but now people are not willing to wait. "

But the proliferation of private clinics can also lead to deterioration in the level of services as clinics try to cut corners or indulge in unhealthy practices to stay ahead of competition. Strong agrees. "Usually, competition is good for the customer. But healthcare is a capital-intensive business and competing clinics can stifle investment. In healthcare, technology keeps changing rapidly and equipment turns obsolete in no time."

Raju reiterates the point. "Running a hospital is no joke. There are a lot of costs involved – rents, equipment and salaries. Some of the newer entrants have cut consultation costs to lure customers. Some clinics give doctors a percentage of fees charged from medical tests and prescriptions. But there are instances when unnecessary tests are performed and eventually a patient ends up paying far more than he or she would in normal circumstances."

There are times when investments into a potential area might not even pay off. Dr Raman agrees that healthcare is capital-intensive and it is imperative to invest in a full-fledged set up. "A clinic or hospital is bound to lose money when a sufficient number of patients do not avail of services of a particular unit where huge investments have been made. We invested RO200,000 in an angiography set up, but it did not work. Had we invested in a full-fledged cardiac unit, which would have helped us deal with complications, things would have been different. Half measures don't pay dividends."
And not everyone is thriving. According to sources, Al Shatti Hospital is in financial trouble. International Medical Centre (IMC), which opened with so much fanfare barely six months ago, found the going tough and shut shop. Lama Polyclinic has taken over management and is revamping the clinic. Raju expects the equipment and staff to be in place by mid-November and fully operational in the first week of December. Says Raju, "The original promoters of IMC were not from this field and their business model failed. The returns from this business are not instant and it takes a few years before breaking even." Raju has sacked almost the entire staff. "I'm going to build IMC from scratch. We will be investing RO1mn in revamping the operations, which includes an MRI system, 4D ultrasound and echo cardio graph."

IMC has contracted Renaissance subsidiary IMTAC for automating and networking the clinic to improve performance, productivity and profitability and make it a paperless clinic. The MRI system's picture archiving and communication system (Pacs) will make IMC the only hospital in Oman to be connected with Khoula Hospital, allowing digital transfer of a patient's clinical and MRI data. "The Pacs system will allow us to stay in touch with any hospital around the world that is equipped likewise, " points out Raju.
Some of the better-run hospitals are seriously looking into expansion and introducing new services which will bring in steady revenue. Because additional medical services like cardiac related treatment are only available in the state-run hospitals, private clinics are zeroing in on providing the same.

MPH definitely sees a business need for such facilities here. Cardiac surgeries will be included as part of the services by the year-end or early 2008. "There is clearly a market as patients have to travel abroad now for treatment. There is definitely a business case that justifies our investment," says Strong. MPH also plans to strengthen its critical care, expand ER and man it with internationally qualified staff to provide a high level of care to trauma and emergency patients. Raman feels the needs of the people are underserved in cardiac-related treatment. "The cost of setting up a full-fledged cardiac unit is about US$2mn. A gestation period of three to four years must also be taken into account, following which returns will start accruing. However, not many private players have such resources at their disposal."

Al Hayat is bringing in the latest 64-slice CT scanner that can perform non-invasive angiograms, and an MRI scanner to assist in endoscopic and arthroscopic surgeries. "We will open a full-fledged maternity clinic in Al Khuwayr soon and plan to open clinics in Al Khoud and Salalah within a year," says Raman. But Srivastava says that cost-benefit scenario in the field does not lend itself to such investments. Raju agrees. "A super speciality hospital will not be successful here. The percentage of the population that would utilise the services would be minuscule. You may get one or two patients a week, but that is not enough. A heart specialist is used to doing between 10-12 surgeries a day. The numbers here will not keep him interested for long and he may get frustrated and leave after a few months. For the hospital to bring in a new doctor and rebuild that level of confidence may prove difficult."

With private medical centres constantly raising the bar, patients are choosing not to brave the tedious wait at government hospitals. Options in medical care are many, and discerning customers have unlimited access to quality health services. g