To Ensure Reliable Excellence in Healthcare to the Community. Annual report 2010

Transcription

1 Annual report

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3 To Ensure Reliable Excellence in Healthcare to the Community Annual report 2010

4 MISSION To Ensure Reliable Excellence in Healthcare VALUES VISION Everyone has access to healthcare Commitment to the Community we Serve World-class quality care and outcomes Pursuit of Excellence & Continuous Improvement Full spectrum of health services Quality regularly monitored and published Predominantly independent and private providers Mandatory health insurance Flexible & efficient financial system Integrity Respect & Accountability Collective Wisdom Compassion of Teamwork & Collaboration BALANCED SCORECARD Internal Outcomes Customers Improve Health Financial Control Abu Dhabi Cost Processes Establish Quality Processes Employees Develop Quality Workforce Satisfy Residents Provide Affordable Access Increase Private Investments Deliver Results Plan Succession STRATEGIC PLAN : OUR PRIORITIES 1. Fill critical gaps in capacity and insurance coverage 2. Improve medical outcomes 3. Inspect and control quality 4. Improve health professional education 5. Increase emiratization of health sector 6. Improve public health 7. Create customer transparency 8. Pay-for-quality 9. Increase private sector investment 10. Be prepared for emergencies 11. Automate internal processes 12. Develop quality workforce and plan succession

5 H.H. Sheikh Khalifa Bin Zayed Al Nahyan President of the United Arab Emirates and Ruler of Abu Dhabi Sheikh Zayed Bin Sultan Al Nahyan Founder of the United Arab Emirates H.H. General Sheikh Mohammed Bin Zayed Al Nahyan Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces

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7 HAAD Annual report 2010 Contents E Chairman s letter 7 CEO letter 11 Strategic Highlights 14 Financials 26 Reliable xcellence in healthcare by expanding access to healthcare services 36 Insurance Access (DRG system) 39 Enhance Quality of Care 43 Web-based Access 49 Partnerships 53 Excellence in Customer Service 59 Corporate Social Responsibility 62 Health Statistics Capacity Master Plan 130 CEO Closing Statement 160

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9 HAAD Annual report 2010 Chairman s Letter 7 Welcome to the 2010 HAAD annual report. The Health Authority - Abu Dhabi has continued to strengthen its role as regulator and custodian of the health system as defined and inspired by the wise vision of the late Sheikh Zayed bin Sultan Al Nahyan (God bless him) and greatly supported by our president, H.H. Sheikh Khalifa bin Zayed Al Nahyan and Crown Prince H.H. Sheikh Mohammed bin Zayed Al Nahyan. Through its role, the Health Authority - Abu Dhabi sets out to provide clear and simple outcomes, namely to (1) improve health, (2) provide affordable access, and (3) satisfy residents. In order to achieve these outcomes, HAAD has set up a framework of strategic priorities based on a common vision shared with its stakeholders. HAAD is responsible for setting the strategic blueprint for the overall development of the healthcare system, and to monitor and evaluate performance while ensuring compliance with regulations. Our activities do not exist in a vacuum: most of our key performance indicators, priorities, and initiatives are established in cooperation with stakeholder consultation.

10 To Ensure Reliable Excellence in healthcare to the community Chairman s Letter The Health Authority - Abu Dhabi has continued to strengthen its role as regulator and custodian of the health system as defined and inspired by the wise vision of the late Sheikh Zayed bin Sultan Al Nahyan (God bless him) and greatly supported by our president, H.H. Sheikh Khalifa bin Zayed Al Nahyan and Crown Prince H.H. Sheikh Mohammed bin Zayed Al Nahyan. Through its role, the Health Authority - Abu Dhabi sets out to provide clear and simple outcomes, namely to (1) improve health, (2) provide affordable access, and (3) satisfy residents. In order to achieve these outcomes, HAAD has set up a framework of strategic priorities based on a common vision shared with its stakeholders. HAAD is responsible for setting the strategic blueprint for the overall development of the healthcare system, and to monitor and evaluate performance while ensuring compliance with regulations. Our activities do not exist in a vacuum: most of our key performance indicators, priorities, and initiatives are established in cooperation with stakeholder consultation. HAAD s strategy revolves around a future in terms of offering a world class system of healthcare to Abu Dhabi s population. We measure our progress towards this ideal based on key customer-centric results that we evaluate regularly. Improve health: The Authority understands that improvements to patient outcomes can only be facilitated by having quality healthcare facilities; having these facilities operated by a sustainable and skilled healthcare workforce; and making sure the two together provide high quality of care to patients. HAAD has licensed new facilities to accommodate population increases and growing needs in specialty areas. Five new private hospitals have opened in the last five years, in addition to 105 clinics. There is also a focus on facilitating the investment in specialty healthcare areas, which are particularly important to the demographic makeup and chronic disease burden within the Emirate. HAAD is absolutely committed to creating and training a sustainable workforce of skilled Emirati healthcare professionals to ensure smooth succession. The Authority has embarked on a variety of initiatives that encourages UAE nationals to choose a career in healthcare. A residency matching process has been set up so that new medical graduates can get appropriate practical learning through training programs at hospitals and facilities across Abu Dhabi. Notably, through the program, we have had the largest number of medical graduates ever distributed into post graduate training posts with 81% occupancy of training posts compared to 54% average occupancy in the last 5 years. Our focus on healthcare goes beyond simply responding to illnesses; the Authority also follows prevention strategies through screening and targeted health promotion campaigns. We have launched health campaigns with internationally renowned partners in the public and private sector. Through campaigns like Drive Safe, Save Lives and Healthy Lifestyle, we ensure that specific groups of people are targeted with the right messages at the right time. The Weqaya screening program for UAE nationals scans for possible health issues and estimates risks of cancer, diabetes, obesity and other chronic ailments. Over 96 percent of UAE nationals over the age of 18 in the Emirate have been scanned by Weqaya, and they can access their reports online. The results of the screening are being used to lead interventions at the individual patient level, as well as for public health measures addressing major areas of concern, such as diabetes. Moreover, through the School Health program, students across the Emirate are provided a comprehensive screening that includes a physical examination, hearing test, anemia screening, and oral health exam.

11 HAAD Annual report 2010 Chairman s Letter 9 To promote effective steering of patients through the health system leading to excellent clinical care outcomes, HAAD has introduced clinical care pathways, which define who does what at each stage of a best-practice patient journey through the system. Provide Affordable Healthcare: To make sure that everyone has access to affordable healthcare they could afford, HAAD mandated compulsory insurance for all expatriates in Abu Dhabi in We followed this in 2008 with the Thiqa program of universal healthcare coverage for UAE nationals. As a result, 98 percent of all residents and nationals living in Abu Dhabi are covered by insurance. Healthcare is also being made affordable for all through a flexible and efficient financial system with standardized payments. In 2010, the Authority changed the way healthcare is paid for by introducing a DRG-based payment system. We are also determined to keep lines of communication open to our stakeholders, partners, customers and the wider community. We continue to share quality data and key information with interested parties through various forums such as the World Health Congress and the Abu Dhabi Diabetes Congress. Additionally, the Health Authority has sponsored several public interest shows through varied media channels, including the Studio 1 radio show and sponsorship of the Green Apple show on MBC. In closing, HAAD is committed to ensuring reliable Excellence in healthcare and making sure we pass on the gift of good health and quality of life to generations to come. In this endeavor, we are very thankful for the support of our partners and stakeholders, and the vision and collaborative efforts of the Government of Abu Dhabi. Chairman Health Authority Abu Dhabi Satisfy Residents: Our efforts to provide access and improve health mean nothing if our patients are unhappy. The Health Authority is vigilant about regularly assessing patient perception, and annually commissions satisfaction surveys across all hospitals in the Emirate. The results of this year s survey, the largest health satisfaction campaign conducted to date, indicate that levels of satisfaction with healthcare are at their highest ever at 84.7 percent. Overall trust is also on the rise, with 95.8 percent of patients saying they would recommend Abu Dhabi s hospitals to family and friends based on their positive experiences the highest endorsement of satisfaction and trust.

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13 HAAD Annual report 2010 CEO Letter 11 The Health Authority Abu Dhabi (HAAD) has had a notable 2010 where it addressed strategic priorities to ensure an excellent system of healthcare regulation and service delivery. HAAD s strategic priorities for 2010 were based on the theme of ensuring access to healthcare in order to improve quality of care for Abu Dhabi s population. This Access theme included initiatives to continue high rates of insurance coverage, maximize e-service availability, increase transparency and improve healthcare through prevention and screening.

14 To Ensure Reliable Excellence in healthcare to the community CEO Letter The Health Authority Abu Dhabi (HAAD) has had a notable 2010 where it addressed strategic priorities to ensure an excellent system of healthcare regulation and service delivery. HAAD s strategic priorities for 2010 were based on the theme of ensuring access to healthcare in order to improve quality of care for Abu Dhabi s population. This Access theme included initiatives to continue high rates of insurance coverage, maximize e-service availability, increase transparency and improve healthcare through prevention and screening. One such achievement was our progress with the Weqaya disease management program that targets the Emirate s biggest killer: cardiovascular disease. Notably, HAAD established the Innovators Forum to apply a more holistic, evidence-based approach to combating chronic illnesses. Through this forum, the Health Authority is able to harness the expertise of subject matter experts to find innovative ways to improve prevention and treatment efforts and overall quality of care outcomes. HAAD has also been working extensively with public and private sector partners to further the cause of public health through campaigns, screenings and other health promotion activities. The Authority entered into formal partnership with the Susan G. Komen Foundation to raise public health awareness about the importance of screening and also signed an agreement with the Red Crescent to establish a donation network for cancer treatment. The Authority collaborated with the Ministry of Labor for its Safety in Heat program, aimed at employer s safety officers and laborers in Abu Dhabi. In addition, HAAD endorsed BMW and GMC Chevrolet in their advertising campaigns promoting and encouraging the proper use of child safety seats. In order to promote transparency, HAAD has set up a hospital quality rating system, which incorporates and analyzes a number of criteria, including patient satisfaction and treatment quality indicators. This is expected to yield published results by 2011 and will offer an incentive to healthcare providers to maintain constant patients. Excellence in quality for their HAAD has also established an advanced data infrastructure that enables mandatory e-claim processing. Not only does this reduce overhead, but also means that costs and revenues are fully traceable, and the quality of care offered to patients fully monitored. In addition, the Authority s data infrastructure captures content from healthcare providers, which allows it to monitor health trends and address capacity shortages, both current and projected, in manpower and specialists. HAAD has taken numerous steps to ensure improvements in core facilities and overall human capital. The Authority is taking steps to ensure a sustainable workforce to meet Abu Dhabi s current and future health needs. Initiatives include the Tanseeq residency program, which is the first medical residency match program in Abu Dhabi. The program has led to the largest number of medical graduates given postgraduate training posts. HAAD has also partnered with the United States National Residency Match Program International - the largest residency match organization in the world. These residency programs establish sustainability and succession planning in the medical workforce, allowing for consistency in quality of care over time. In order to make sure professionals can be qualified and tested quickly, the Authority has expanded its testing capacity to 17 international test centers in addition to the main HAAD center. This ensures that health

15 HAAD Annual report 2010 CEO Letter 13 professionals find licensing and recruitment to be quick and easily accessible, while hospitals find the testing centers a cost saving alternative to paying for recruits to take licensing exams locally. The availability of qualified doctors is a necessary step in expanding access to healthcare and ensuring quality of care. The theme of offering easy access to healthcare services runs throughout the strategic structure of the Authority and its initiatives. In line with this overall ambition, HAAD has ensured most of its services are easily accessible and automated, including birth and death notifications, visa screening, and infectious disease notifications. In fact, up to 83 percent of all HAAD processes are now automated, and most are available online. A cornerstone of ensuring access is the successful implementation of mandatory health insurance across the Emirate. UAE nationals are covered under the Thiqa scheme that provides comprehensive access to healthcare treatment. Expatriate residents are covered under employer-sponsored private sector partnership schemes. Currently, 98 percent of all UAE nationals and residents living and working in Abu Dhabi are covered by health insurance, a feat unparalleled in the GCC region. Insurance allows residents of Abu Dhabi to get the right care at the right time, thereby improving access, convenience and overall care quality. The health system financing mechanism has made significant advances. For one, contracts have been standardized between payers and providers so that prices relate to quality of care and not volume. Secondly, the Authority has ensured transparency by fully implementing HAAD DRGs (diagnosis-related groups) a well-established international system for inpatient services payment to ensure patients get the care they really need, at costs that are standardized based on the patient s condition. The implementation of DRGs has led to a reformed payment system that is easy to understand and simple to administer. It helps hospitals gain revenue predictability and offers incentives such as easier reporting, which in turn assures patients of access to quality care. HAAD facilitates open stakeholder communication at all times, and is encouraging strategic goals established through consultation. The Authority has also established channels of communication with the community, such as the Studio 1 radio show that puts senior stakeholders in contact with patients and the general population, and the Green Apple TV show on MBC that offers health and well-being tips to the community. Additionally, HAAD extended its Ta wun program of community outreach to include insurance providers, healthcare facilities and other government entities. Each week, two senior officials from the Authority visit these stakeholders to open dialogue between organizations. The results of these discussions are incorporated into HAAD s plans to improve services. We look forward to continuing with these changes in the coming year, ensuring that HAAD creates a regulatory environment guaranteeing world-class healthcare to all. As always, I am grateful for the support and contribution of our customers, partners, and employees who make our achievements possible, and help us live up to our mission of ensuring reliable E xcellence in healthcare. Chief Executive Officer Health Authority Abu Dhabi

16 Strategic Highlights

17 Priority 1: Fill critical gaps in capacity and insurance coverage 18 Priority 2: Improve medical outcomes 18 Priority 3: Inspect and control for quality 18 Priority 4: Improve health professional education 19 Priority 5: Increase nationalisation of health sector 20 Priority 6: Improve public health 20 Priority 7: Create customer transparency 22 Priority 8: Pay-for-quality 22 Priority 9: Increase private sector investment 23 Priority 10: Be prepared for emergencies 23 Priority 11: Automate internal processes 24 Priority 12: Develop quality workforce and plan succession 24

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19 HAAD Annual report Strategic Achievements 17 The Health Authority s strategy to build a sustainable, world-class system of healthcare and regulation revolves around twelve priorities for HAAD measures the success of its strategies based on key achievements and performance within these twelve areas.

20 To Ensure Reliable Excellence in healthcare to the community 2010 Strategic Achievements Priority 1: Fill critical gaps in capacity and insurance coverage To ensure that healthcare services are accessible to everyone, HAAD has implemented a system of mandatory, universal insurance coverage. With 98 percent of UAE nationals and expatriates in Abu Dhabi covered through Thiqa and employer-sponsored private sector partnership schemes, HAAD is making sure that everyone has access to affordable healthcare. Key achievements 98 percent of population (expatriates and UAE nationals) covered by insurance through private sector providers, resulting in the fastest and most comprehensive coverage in GCC region The introduction of Thiqa to offer UAE nationals full access to public and private sector providers in the emirate of Abu Dhabi as well as abroad 100 percent migration to e-claims to reduce data processing overheads while letting the Authority analyze trends and plan capacity Insurance Enrolles 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 0 Implementation of Mandatory Health Insurance Enhanced 210, , , ,744 1,044,734 Basic 133, , , ,207 1,204,418 Thiqa 383, , ,239 Source Health System Financing Division, Health Authority - Abu Dhabi. Introduction of Diagnostic Related Groups (DRGs), a bundled payment system that allows comparison of similar conditions and removes incentives for providers to deliver unnecessary services a first in the GCC region A NICU taskforce established to address capacity planning for future health needs Funded mandates defined and addition of worker s accident insurance coverage to fill coverage gaps Priority 2: Improve medical outcomes HAAD is working on a comprehensive strategy to improve medical outcomes for the patients of Abu Dhabi. These range from a greater emphasis on auditing healthcare providers to safeguard consistent Excellence to developing and sharing clinical quality indicators in association with key stakeholders. HAAD s medical outcome improvement strategy is based on faster, more efficient regulation, monitoring clinical outcomes, and targeted, evidence-based approach to preventive care and treatment services. Key achievements 17.4 percent decrease in road traffic fatalities in 2010 through extensive stakeholder collaboration with Department of Transport and Abu Dhabi Police Abu Dhabi Health Research Council created to better regulate and promote biomedical research within the Emirate Weqaya II: Extended screening includes mammography and follow-up on diabetes. Weqaya. ae launched with 8,000 unique visitors to website Pathways for diabetes: A call center with booking system established for those screening positive for diabetes Developed and published first series of clinical quality indicators that were shared at the World Health Congress Inclusion of essential preventive services in the Thiqa insurance plan Development of version 1.0 of the HAAD Policy Manuals (Health Insurance, Health Facilities, Health Professionals, Health Regulator) in collaboration with the Joint Commission International and with extensive internal and external stakeholder involvement Priority 3: Inspect and control for quality Through a process of key stakeholder consultation, policies and standards are developed for the health system of the Emirate, which are in alignment with HAAD s auditing and licensing functions. Externally, healthcare professionals, facilities, and insurers are regularly audited to ensure consistent Excellence and compliance with relevant published policies and standards. Workshops are continually held so that professionals and other customers are fully aware and educated regarding timely issues, and new policies and standards. Internally, HAAD generates monthly reports on key project and performance variables and quarterly external performance reports to the Abu Dhabi General Secretariat of the Executive Council (ADGSEC). Quarterly CEO meetings involving all department heads are held, where quick action is taken on any points of concern. Key achievements 2,614 audits conducted in 2010 (1,457 healthcare facilities and 1,157 pharmacies) Set HAAD standards for vaccine cold chain Upgraded the functionality of the infectious disease notification system

21 HAAD Annual report Strategic Achievements 19 Provided training workshops to healthcare professionals on standards for premarital screening, visa screening, HIV, malaria control, infectious disease notification and TB control Criteria set for prioritizing clinical review and investigation disciplinary cases in order to allow for quick intervention for more serious offences Released comprehensive school screening program standards for implementation in all public schools Assessed mental health services in Abu Dhabi Emirate using the WHO-Assessment Instrument for Mental Health System Introduction of JAWDA, a quality rating system for pharmaceutical facilities Key achievements Region s leading program of Continuing Professional Development (CPD) with mandatory education requirements linked to license renewals Attracted over 9,000 health professionals to HAAD organized and sponsored CPD events Opened new international test centers to bring the total to 17, in order to increase number of qualified applicants to HAAD Hosted Abu Dhabi International Nursing Conference, World Health Congress, Abu Dhabi Diabetes Congress and Arab Health to facilitate knowledge and expertise exchange Total Number of Audits and New Licenses, Total number of Audits New Licenses Healthcare Pharmacy Healthcare Pharmacy ,193 1, (9%) 112 (11) ,310 1, (11%) 63 (6%) ,457 1, (11%) 81 (8%) Number of violations reported by Licensing/Disciplinary Committees Healthcare Pharmacy Source Health System Compliance Division, Health Authority - Abu Dhabi. Priority 4: Improve health professional education The Authority continues to focus on its Continuing Professional Development (CPD) education program, which is linked to medical professionals obtaining their licenses renewals. Additionally, to ensure that professionals can be qualified and tested quickly, HAAD has opened 17 international testing centres. The aim is to ensure a regular stream of skilled professionals entering the Abu Dhabi health market. Accredited Hours Total Accredited Continuing Medical Education (CME) Hours, , , , , , Source Health Regulation Division, Health Authority - Abu Dhabi , , ,

22 To Ensure Reliable Excellence in healthcare to the community 2010 Strategic Achievements Priority 5: Increase nationalisation of health sector A truly sustainable healthcare system needs the participation and involvement of UAE nationals. On this front, the Health Authority has partnered with the renowned John Hopkins University to offer Emiratis opportunities in postgraduate education, namely a dual MPH-PhD degree program. HAAD has a system of public-private partnerships where global expertise is channelled under Emirati leadership. At the same time, the Authority is taking steps to develop and train Emirati leaders through relevant courses and workshops. The Authority has recognized the need to encourage UAE Nationals to become clinical experts and hosts a number of seminars and promotional campaigns to recruit talented Emiratis and make them part of a vibrant healthcare system for future generations. Key achievements Sponsored postgraduate education and healthcare leadership study at DrPh and MPH level for UAE nationals (MPH-PhD) in partnership with Johns Hopkins School of Public Health Implemented first centralized application and residency matching process for medical graduates seeking training in Abu Dhabi through the Tanseeq project. The outcome has been the largest number of medical graduates ever distributed into post graduate training posts with 81 percent post occupancy compared to a 54 percent average occupancy in the last 5 years. This involved partnering with the United States National Residency Match Program International, marking the first international collaboration with the largest residency match organization in the world Published first study on the need for Emirati health professionals in the healthcare system Ongoing promotion campaigns to recruit talented UAE nationals Priority 6: Improve public health HAAD is improving public health through a number of initiatives launched in collaboration with public and private sector partners. For instance, HAAD s partnership with SEHA - the Abu Dhabi Health Services Company, and Daman initiated the Weqaya disease management program that targets the emirate s biggest killer: cardiovascular disease, so that preventive action can be taken. The Road Safety campaign, launched in partnership with BMW, was aimed at reducing accidents and minimizing loss of life while driving. The Authority has also launched an awareness campaign for working in the heat of summer in collaboration with the Ministry of Labour. The campaign offers laborers suggestions for preventing dehydration and maintaining fluid intake. Apart from its many campaigns, HAAD also monitors public health through high quality data analysis, which enables rapid response to disease outbreaks and health trends. Key achievements Cardiovascular disease and risk factors: Weqaya I & II: Link of Thiqa to mandatory screening confirmed public health threats; namely diabetes and cardiovascular disease. Weqaya.ae launched with 8,000 unique visitors to website. 96 percent of UAE Nationals over 18 are covered by the Weqaya screening program Weqaya Advisory Task Force established, consisting of members from HAAD, Abu Dhabi civil sector (termed Health Guardians ), key Abu Dhabi government entities, leading academic institutions and non-governmental organizations - to act as an independent source of expertise, advising on research and policy interventions for effective control of chronic illnesses and disease outbreaks Launched Healthy Lifestyle promotional campaigns on radio and TV before and during Ramadan and in Majed cartoon publications. Health Promotion: Awareness raising campaigns with BMW and Chevrolet for child seat car safety. Launched Road Safety campaign, which won recognition at Gulf Traffic Awards for Changing Driver Behavior Occupational & Environmental Health: Cooperation with Ministry of Labor for Safety in Heat campaign targeted at laborers. Developed electronic injury and poisoning notification system

23 HAAD Annual report Strategic Achievements 21 in line with and reviewed by WHO Surveillance: 100 percent implementation of e-notifications (including birth, death, and infectious disease) Cancer: Breast cancer awareness and screening collaboration with the Susan G. Komen Foundation. Campaign has included hosting of 5 major events, 70 seminars, and more than 45 Pink corners/stalls Collaboration with SEHA to launch Weqaya II with extended screening that includes mammography and follow-up on diabetes. 13,266 Mammogram were conducted by end of 2010 (43 percent uptake). 10,834 booking for mammograms through a dedicated call center & website Over 30,000 unique visitors to Simply Check website with approximately 60 cancer cases detected through further screening. Simply Check website received the Best Pan Arab Breast Cancer Website award Signing MOU with Red Crescent to establish donation account to support breast cancer patients and community initiatives to combat breast cancer Maternal & Infant Health: Launched newborn screening program Family & School Health: Launched Eat Right and Get Active Campaign at 28 pilot schools. Developed HAAD standard on first aid training including guidelines for schools. Implemented school screening program and electronic reporting system. Revised school canteen guidelines in collaboration with Abu Dhabi Education Council and Abu Dhabi Food Control Authority Infectious Disease: Set HAAD standards for vaccine cold chain. Added Varicella and Hexa vaccines to Immunization Schedule. Implemented premarital screening program 2010 Overall Inpatient Satisfaction Indicators: Emirate of Abu Dhabi Overall Physicians 92.9% Nurses 91.5% Medical Service Provision 90.0% Cleanliness 89.7% Healthcare Environment 88.6% Allied Healthcare Professionals 88.4% Discharge Process 88.3% Overall 86.3% Convenience or Location & Parking 84.7% 80.0% 82.0% 84.0% 86.0% 88.0% 90.0% 92.0% 94.0% 2010 Overall Outpatient Satisfaction Indicators: Emirate of Abu Dhabi Overall Nurses 91.3% 25,000 20,000 15,000 10,000 5,000 0 Total Number of Mammograms, ,130 13,266 4,415 5, Physicians 90.1% Cleanliness 88.4% Healthcare Environment 87.8% Overall 83.2% Convenience of Parking & Location 81.8% Medical Service Provision 78.1% Waiting Time 75.7% 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0% Source Public Health Policy Division, Health Authority - Abu Dhabi. Source GRMC Advisory Services, 2010

24 To Ensure Reliable Excellence in healthcare to the community 2010 Strategic Achievements Priority 7: Create customer transparency HAAD wants to be completely transparent in its strategy, goals and actions. To this end, it has taken a number of steps to ensure customers and stakeholder participation. HAAD relies on a consultative approach for defining its strategy, and involves stakeholders in framing important areas of improvement and growth. In addition, the Authority has improved its transparency and approachability by streamlining customer service and quickly resolving customer complaints. In order to obtain an idea of issues that customers consider important, HAAD launched the Studio One weekly radio program to create a forum for people to access decision-makers within the authority, and express their concerns. The feedback received from the show led HAAD to make adjustments to insurance claim regulations, for example. Key achievements Largest health satisfaction campaign conducted within the Emirate of Abu of Dhabi showing high overall satisfaction with health system (83.2 percent overall outpatient satisfaction & 86.3 percent overall inpatient satisfaction) Initiation of Hospital Quality Rating System project, in association with renowned global information company, Thomson Reuters, to provide data-driven, intelligence-led monitoring assessment of the quality and safety of all hospitals in the Emirate of Abu Dhabi. First results to be published in 2011 Launched the Green Apple show, with 39 episodes in 1st season. Airing on MBC, the show revolves around public health issues and community health behaviors Launched the Studio One weekly radio show (52 episodes) addressing public complaints and concerns Expanded capacity of HAAD offices in other regions of the Emirate, such as Al Ain, for improved public access to licensing, inspection and public health services. Additional customer outreach through opening of offices at Chamber of Commerce and Marina Mall Priority 8: Pay-for-quality The Authority is working hard to make sure that patients receive quality care. As a regulator, this operationally translates to building in financial incentives based on quality not quantity into insurance reimbursement rates. Standard contracts have been mandated between payers and providers to safeguard against abuse of the billing system and ensure that medical procedures are billed at prices related to quality of care received by the patient. Simultaneously, HAAD has fully implemented e-claims to enable the monitoring of the kind of treatment patients receive. DRGs have been introduced so patients get the care they really need. All of these steps protect Abu Dhabi s population and ensure reliable E xcellence in healthcare, at reasonable cost, without uncertainty or hassle. Key achievements Standard coding for all clinical encounters (diagnosis & procedure) fully implemented to ensure customer transparency 100 percent e-claim system to track healthcare provision and health trends Introduction of DRGs (diagnostic related groups) so healthcare providers are paid based on nature and seriousness of illness, not on time spent in hospital or numbers of procedures Mandated standard contract between provider and payer so prices relate to quality of care Mandated E&M coding for doctor consultations Daman implementing pay-for-quality based on HAAD e-claims data

25 HAAD Annual report Strategic Achievements 23 Priority 9: Increase private sector investment HAAD believes in a system of private and public partnership. It is already working in collaboration with international leaders in their respective fields, to attract more local, regional, and international investment to healthcare from the private sector. The Authority is developing a transparent environment to encourage investment, where costs and potential revenues can be calculated, resulting in more accurate calculations of return on investment (ROI). Additionally, a transparent and efficient system of regulation allows for reduction in start up times and costs. Key achievements Created a payment structure to allow for investment in specialized home care services Standardized financial system and insurance structure to improve transparency and revenue predictability Addition of two types of health care activities: provision of health services and home care - to allow for expanded opportunities for investors Established customer service booths in Abu Dhabi Chamber of Commerce and Marina Mall to facilitate services to investors and other customers Development of health care building guidelines in conjunction with external stakeholder involvement first of its kind in the GCC region. The new standards set the requirements for health facility design and construction as well as the prequalification of healthcare design consultants. Purpose is to improve medical outcomes and minimize errors caused by inappropriate healthcare facility design Priority 10: Be prepared for emergencies In order to continue strong on its preparedness efforts, HAAD has a 24/ 7 operations centre, which is in regular contact with hospitals and monitors the status of healthcare resources. As the lead in coordinating emergency and disaster healthcare response for the Emirate, HAAD also has an integrated incident command system, comprising of policies, procedures, staff, and equipment that are aligned with lead government agencies such as NCEMA, the National Emergency and Crisis Management Authority. Key achievements Full establishment of 24/ 7 operations center on site Management of 7 drills, 36 major incidents (and preparation exercises), and 8 mass gatherings (including FIFA World Cup and Red Bull Air Race) Formation of HAAD incident command system and major incident plan Health Information System (HIS) linked to operations centre providing live patient information Geographic Information System (GIS) linked with Abu Dhabi Systems & Information Centre (ADSIC)

26 To Ensure Reliable Excellence in healthcare to the community 2010 Strategic Achievements Priority 11: Automate internal processes HAAD has invested heavily in information technology business process redesign (automation) adopting international best practices that are wholly-customer focused. Automation efforts have helped to reduce unnecessary steps for common transactions from customer service queries to renewing licences which means every request is recorded and followed through. This initiative has resulted in an increased number of requests being resolved daily, but has also allowed HAAD to monitor processing times and demand, and respond swiftly. These automated internal processes also feed a business intelligence system that analyses data and pushes it to an Oracle dashboard so that performance can be regularly monitored and improved. Key achievements Automation of approximately 300 external and internal business processes Automation and online availability of visa screening system and Weqaya screening reports 100 percent automation of births, deaths, infectious diseases, injury & school health notification systems, which are available online Electronic online system for healthcare providers to report instances of injury and safety and poisoning concerns on premises Insurance provider authorization and insurance product approvals process automated Operations Center critical capacity reporting brought online Back office automation includes HR, procurement and finance Priority 12: Develop quality workforce and plan succession A good healthcare system can only rest on skilled employees who are motivated to deliver results and provide quality, ever-improving work products that directly or indirectly improve patient care. HAAD believes in the power of human capital and encourages employees to perform and persist in the pursuit of Excellence and continuous improvement. All employees are regularly evaluated on skills and results which are tied into their promotions and salary increases. The Authority has also initiated succession planning efforts, making sure that a new generation of young, national employees is being trained and ready to take on more senior responsibilities. Key achievements Conducted first full successful cycle of performance appraisals Appraisals linked to salary increases and promotions Conducted employee satisfaction surveys Launched formal succession planning efforts

27 HAAD Annual report Strategic Achievements 25

28 Financials

29 Independent auditor s report to the Chairman of the Health Authority Abu Dhabi 30 Notes to the statement of cash receipts and disbursements for the year ended 31 December

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31 HAAD Annual report 2010 A transparent view to financial performance 29 The Health Authority continually strives to provide a true, fair, and transparent view into its financial performance. In order to do so, HAAD upholds a rigorous auditing process on a yearly basis, enlisting the services of PricewaterhouseCoopers (PwC), a third party auditing firm. Currently, financial reporting is conducted on cash basis, with a transition to an accrual-based system by 2012.

32 To Ensure Reliable Excellence in healthcare to the community Independent auditor s report to the Chairman of the Health Authority Abu Dhabi

33 HAAD Annual report 2010 Statement of cash receipts and disbursements 31

34 To Ensure Reliable Excellence in healthcare to the community Notes to the statement of cash receipts and disbursements for the year ended 31 December General information The Health Authority Abu Dhabi ( the Authority or HAAD ) (previously known as General Authority for Health Services) was established on 6 February 2007 in accordance with Abu Dhabi Law No. (1) of 2007 issued by the President, His Highness Sheikh Khalifa Bin Zayed Al Nahyan. Under this law, HAAD was established as a corporate body under the Executive Council of the Emirate of Abu Dhabi with financial and administrative independence to act only as the regulator of all public and private healthcare providers in the Emirate. This law repealed Law No. (8) of 2001 (which was issued by HH Sheikh Khalifa Bin Zayed Al Nahyan), under which the General Authority for Health Services for the Emirate of Abu Dhabi (GAHS) was established on 27 October 2001, thereby replacing it with HAAD from the date the new law came into effect. The registered address of the Authority is P.O. Box 5674, Abu Dhabi, United Arab Emirates. Since its inception on 27 October 2001, the Authority maintained its financial records on an accruals basis. With effect from 1 January 2006, the Authority opted for a cash basis of accounting. Although records of receivables, fixed assets and payables are also maintained for control purposes. The statement of cash receipts and disbursements is related to the years presented and cash and bank balances position as at the end of the year. Accordingly, the statement of cash receipts and disbursements does not purport to present the net income or loss for the year as would a statement of income for a business enterprise. The main activities of the Authority include: Defining the strategy for the health system; Monitoring and analyzing the health status of the population and performance of the system; Shaping regulatory framework for the health system; Inspecting against regulations and enforcing standards; Planning capacities and service levels; Driving programmes to improve societal health; Defining minimum standards for health service providers and health professionals; and Regulating scope of services and premiums and reimbursement rates of providers and payors. Managing Preventive Medical Centres. The Authority receives funds from the Government of the Emirate of Abu Dhabi ( the Government ) through Department of Finance ( DoF ) to run its day to day operations. Any fees earned from the operations (provision of health services) are remitted back to the Government through DoF.

35 HAAD Annual report 2010 Notes to the statement of cash receipts and disbursements for the year ended 31 December Summary of significant accounting policies The principal accounting policies applied in the preparation of the statement of cash receipts and disbursements are set out below. These policies have been consistently applied to all the years presented, unless otherwise stated. 2.1 Basis of preparation The Authority s policy is to prepare the Statement on the cash receipts and disbursements basis. On this basis, receipts are recognised when cash is received and expenses are recognised when cash is paid. Expenses are considered paid by issuing the cheque and approving the payment by management of the Authority. 2.2 Cash and bank balances Cash and bank balances include cash on hand, at bank, with third parties and deposits held at call with banks, net of overdrafts, if any. 2.3 Receipts (a) Receipts from the Government (Department of Finance) Cash funding from the Government of the Emirate of Abu Dhabi through the Department of Finance is accounted for in the period in which it is received by the Authority. (b) Healthcare services fees Fees for healthcare services including preventive medicine, health cards etc. are accounted for in the period in which it is collected by the Authority. (c) Interest income Interest income is recognised when credited to the Authority s bank accounts by the Banks. 2.4 Expenditure All operating and capital expenditure, including fund transfers to the Government through the DoF, are recognised in the statement of cash receipts and disbursements when paid. Capital expenditures represent amounts paid towards the acquisition of property and equipment, split into recurring and initiative category, with useful life above one year; however any amount paid is accounted for as expenditure in the Statement of receipts and disbursements for the year in which it is paid. Operating expenditures mainly represent general and administrative expenditures split into recurring and initiative category. 2.5 Translation of foreign currency (a) Functional and presentation currency Items included in the Statement of the Authority are measured and presented using the currency of the primary economic environment in which it operates (UAE Dirhams). (b) Transactions and balances Foreign currency transactions are translated into the functional currency using the exchange rates prevailing at the dates of the transactions.

36 To Ensure Reliable Excellence in healthcare to the community Notes to the statement of cash receipts and disbursements for the year ended 31 December AED 000 AED Staff costs Salaries and wages 137, ,538 Accommodation and other benefits 32,324 26,951 Post-employment benefits 9,937 6, , ,415 4 Capital expenditure Initiative capital expenditures (see below) 14,371 12,866 Computer hardware and software 2,634 2,795 Furniture and office equipment 924 3,207 Building improvements 413 4,595 18,342 23,463 5 General and administrative expenditure Medicine and vaccine 50,825 - Initiative operating expenditures (see below) 44,819 86,370 Advertisement expenditures 17,831 9,247 Consultancy fees 17,745 13,489 Communication and utilities 4,361 1,194 Recruitment and training expenditures 4,219 2,570 Technical training expenditures 3,254 2,665 Catering expenditures 743 1,365 Others 27,861 12, , ,212

37 HAAD Annual report 2010 Notes to the statement of cash receipts and disbursements for the year ended 31 December The expenditures for the Authority are split into Recurring and Initiative expenditures. Recurring expenditures cover the regular expenditures while Initiative expenditures cover the specific project related expenditures of the Authority. This division of expenditures is organised by DoF into the Authority s system. During the year ended 31 December 2010 the Initiative operating expenditures were mainly incurred on H1N1 program, screening program (Weqaya) etcetera, while Initiative capital expenditures were incurred on the establishment of quality control laboratory. 6 Cash and bank balances AED 000 AED 000 Cash on hand and at bank 4,071 41,930 Cash at bank includes AED 19.3 million in the clearing account which represents checks and transfer letters prepared and approved by the management before 31 December 2010 supported by contracts and invoices against the goods and services availed by the Authority during the year ended 31 December Commitments AED 000 AED 000 Capital expenditures commitments 11,130 25,300 Capital expenditure contracted for at the end of the year 2010 but not yet incurred amounted to AED million. This mainly relates to quality control laboratory. 8 Other legal and regulatory requirements In accordance with article 11 of the Financial Law No.18 of 2006 and its executive regulations issued in September 2008, Abu Dhabi Government entities are prohibited to spend funds in excess of the amount budgeted and allocated to them by the DoF. Any surplus should be paid back to DoF unless approved otherwise. Further, in accordance with article 12 of the same law, Abu Dhabi Government entities are prohibited from transferring any surplus in the budget to the next year, or to any other project, unless it is approved by the DoF. During the year ended 31 December 2010, HAAD used surplus budget from Preventive Medicine Department Project to pay AED 11.2 million related to Aonak Project. As of the date of issuance of this Statement, the Authority was in the process of obtaining the DOF approval over these expenditures and the use of this surplus.

38 Reliable Excellence in healthcare by expanding access to healthcare services

39 Insurance Access (DRG system) 39 Enhance Quality of Care 43 Web-based Access 49 Partnerships 53 Excellence in Customer Service 59

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41 HAAD Annual report 2010 Insurance Access (DRG System) 39 Health insurance provides for the right incentives and improves transparency as it produces a wealth of data that can be used to improve medical quality. HAAD has therefore followed up on its vision of a health system that finances itself through mandatory health insurance for all Abu Dhabi residents to ensure that over 98 percent of the entire population in Abu Dhabi, expatriates and UAE Nationals, are covered by health insurance.

42 To Ensure Reliable Excellence in healthcare to the community Insurance Access (DRG System) Health insurance provides for the right incentives and improves transparency as it produces a wealth of data that can be used to improve medical quality. HAAD has therefore followed up on its vision of a health system that finances itself through mandatory health insurance for all Abu Dhabi residents to ensure that over 98 percent of the entire population in Abu Dhabi, expatriates and UAE Nationals, are covered by health insurance. HAAD has also streamlined the system of payments and reimbursements for patients treatment. In 2010, HAAD introduced a system of DRGs (diagnosis related groups) to regulate payments between insurers and healthcare providers. The basic concept of DRGs is based on averages. Even though individual patients are unique, there are similarities among groups. DRGs provide a method for classifying patients both in terms of clinical similarity, and the cost and effort associated with treatment. The average cost of treating patients with similar characteristics and clinical profiles is defined, and the healthcare provider is paid this average amount per patient. The DRG payment method is effective in driving efficiency in inpatient care. DRGs achieve two goals at the same time. First, the method groups things that belong together, so that similar DRG encounters can be compared. DRGs are a language that makes sense to clinicians and allows for comparison of quality along groupings. Second, bundled payment removes the incentive for providers to deliver additional und unneeded services just to receive compensation for them. Abu Dhabi s health financing system reflects the demographics of the Emirate s population. While HAAD has tailored the financing system to Abu Dhabi, the payment system (how providers are paid by insurers) is highly standardized and derived from international best practice. DRG implementation requires a large data set from all hospitals, putting increased emphasis on accurate and consistent medical record documentation and coding. HAAD s DRG approach has been implemented in phases. In 2010, HAAD introduced mandatory DRGs for the government-sponsored program for lowearning individuals. SEHA, the Health Services Company managing Abu Dhabi s hospitals, also adopted DRG based payments on a voluntary basis for all Thiqa claims. DRG based payments will become mandatory for all inpatient encounters (inpatient visits) independent of type of insurance coverage starting in Given the completion of significant work required ahead of the implementation of DRGs in establishing standard clinical coding and e-claims, the introduction of DRGs to Abu Dhabi s healthcare system has been rapid and smooth. The Emirate has once again demonstrated its leadership position in regional health by successfully introducing a DRG based payment mechanism. HAAD has also enacted a consistent set of regulations around the application of DRGs and focused on ensuring capacity and reimbursement of step-down and homecare services to ensure the healthcare net is extended to beyond the patient s discharge from hospital. As DRG implementation enters its final stages, the Authority looks forward to deriving further cost, efficiency, performance and data gathering advantages from the system in order to enhance the quality of care in the Emirate. Financial Risk Sharing the Risk to Drive Efficiencies Fee for service Per diem DRG Episode Capitation Payment Source Health System Financing Division, Health Authority - Abu Dhabi Explanation of chart: DRGs give some risk to providers as they are paid only what it should cost, not what it actually costs a hospital to treat a patient. They therefore drive efficiency in healthcare delivery.

43 HAAD Annual report 2010 Insurance Access (DRG System) 41

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45 HAAD Annual report 2010 Enhance Quality of Care 43 The Health Authority Abu Dhabi realizes that a world-class system of healthcare can only be guaranteed by a world-class system of regulation and outcomes. This insight, aligned with Abu Dhabi Government s 2030 Vision, provides a clear approach for the Authority to ensure high quality of care.

46 To Ensure Reliable Excellence in healthcare to the community Enhance Quality of Care Policies & Standards, Compliance, and Facilities Licensing: HAAD has simplified health regulations for the emirate into two levels: Policies and Standards. A full review of the relevant international, UAE federal and Abu Dhabi laws, regulations and decrees related to the health system was completed, which led to the development of the HAAD Policy Manuals. The HAAD Policy Manuals bring together the existing HAAD policies and standards into four booklets, consolidating health regulations for healthcare facilities, healthcare professionals, health insurance and the healthcare regulator (HAAD). Collectively, they translate federal UAE and Abu Dhabi laws into a simple, practical set of tools to help drive compliance and improved quality and cost-effectiveness across the system. HAAD has also introduced 27 policies and standards covering all aspects of processes deployed in healthcare facilities, the requirements for staff, the health and safety of the facility s environment; quality standards for medical equipment, the building and safety standards applicable to the amenities, clinical care standards, and the rights and responsibilities of the customers and the protection of the privacy and confidentiality of their health data. These policies and standards ensure that the people utilizing the health system of the Emirate can entrust their health and well-being and that of their families to the healthcare service providers operating within the health system. All healthcare facilities (hospitals, clinics, pharmacies, etc.) are regularly audited using these policies and standards. During routine visits, the audit teams check that mandatory minimum requirements are rigorously adhered to. In 2010, 2,614 audits were conducted (1,457 healthcare facilities audits and 1,157 pharmacies audits), both announced and ad hoc. Facilities that failed the first audit go through additional audit exercises to ensure that corrective action has taken place. The compliance team takes great pride in the consultative role it seeks to play as it strives to assist facilities in achieving the highest standards possible. The auditing process is linked to health facility licensing and renewal with only facilities complying with HAAD standards given permission to operate. In 2010, there were 1,211 facilities licensed to operate in Abu Dhabi, including 33 hospitals, 674 health centers and clinics, and 468 pharmacies and drug stores. In order to streamline the facility licensing process, as well as provide a much more customer-focused application process, HAAD has developed an automated application process to simplify and speed licensing transactions. Additionally, HAAD has launched the new healthcare facility design standards, which set the requirements for health facility design and construction, as well as the HAAD prequalification of healthcare design consultants. The standards aim at improving medical outcomes and minimizing errors caused by inappropriate healthcare facility design, and is a step towards improving awareness and knowledge of the HAAD regulatory requirements for the healthcare industry. Health Professionals: The Health Authority is ensuring the rapid licensing of qualified professionals in healthcare, with a focus on developing a sustainable expert workforce. This ensures the population s health needs are met not just at present, but also in the future as the population grows and healthcare needs change.

47 HAAD Annual report 2010 Enhance Quality of Care 45

48 To Ensure Reliable Excellence in healthcare to the community Enhance Quality of Care Health Professional Licensing: All world class health systems have clearly defined licensing criteria and procedures for healthcare professionals. HAAD has established clearly defined licensing criteria and procedures for all HAAD-regulated healthcare professionals, based on training background, practical experience, and continuous medical education, as part its Professional Qualification Requirements (PQR) for the Emirate of Abu Dhabi. In 2010, a total of 19,103 health professionals (including physicians, dentists, nurses, and allied health professionals) were licensed and working within the Emirate of Abu Dhabi. Continuing Professional Development: In line with its strategy to secure reliably high standards of healthcare services through a quality workforce, the HAAD links the renewal of licenses for all healthcare professionals to prove that they have been attending Continuous Professional Development (CPD) events. For physicians and dentists, this means that they are required to participate in 50 hours of Continuing Medical Education (CME) per year; for nurses and pharmacists, 20 hours are mandated. In 2010, HAAD attracted over 9,000 healthcare professionals to HAAD organized and sponsored CPD events and accredited 2,500 hours worth of CME offerings, a testament to the Authority s commitment to offering a wide array of educational opportunities considered relevant by healthcare professionals in the Emirate. Tanseeq Residency Matching: The rapidly expanding health system of the Emirate requires a constant, sustainable supply of well-trained healthcare professionals to deliver world-class services. Thus, one of HAAD s priorities is to increase the capacity of the health system for post-graduate education programs (internships and residencies) together with various international partner organisations. In 2010, HAAD partnered with the United States National Residency Match Program International to implement the first centralized application and residency matching process for medical graduates seeking training in Abu Dhabi. This milestone marks the first international collaboration with the largest residency match organization in the world, with the outcome being the largest number of medical graduates ever distributed into post graduate training posts. This has led to notable improvements in residency occupancy: 81 percent of residency posts were occupied in 2010, compared to an average occupancy of 54 percent over the last 5 years. Clinical Reviews: The HAAD has established a professional system dealing with customer complaints in order to identify and analyse root causes of arising issues with the help of independent clinical experts, and initiate improvements across the healthcare sector. To complement the complaints process, HAAD has a disciplinary committee that has well-established governance and rules of procedure. The Disciplinary Committee is comprised of HAAD members representing legal, administrators of health regulations, compliance and quality auditors and clinical advisors. The Committee has the powers to invite external experts from the clinical and healthcare professionals to assist in its business. The Committee deals with medical errors caused by ignorance of technical matter, or due to negligence or lack of due care on the part of healthcare professionals. This mechanism has resulted in two significant improvements. First, it is easier for customers to lodge service or clinical complaints. Second, complaint resolution has become more effective and transparent. In 2010, a total of 170 violations were reported to the Licensing and Disciplinary committees for further review

49 HAAD Annual report 2010 Enhance Quality of Care 47 and action. For us, a first step was to review policy and standards, and overall strategy. Then, we developed our performance indicators and priorities. We also put a lot of thought into having procedures for investigating issues and complaints, and monitoring healthcare facilities, said Dr. Mohammed Bader Al Seiari, Director of Health System Compliance. We ve set up a Clinical Reviews and Investigation Section to audit healthcare providers and follow up on customer issues in an integrated, confidential, and evidence-based manner. Data Flow, Patient Satisfaction and Quality Rating System: Patient choice is a very important element in the strategy to improve the quality of healthcare. As patients have more choice and freedom to select providers, providers are forced to focus on the needs of their customers. The more transparency that is provided regarding quality of care, outcomes, and patient satisfaction, the easier it is for customers to choose healthcare providers based on performance. HAAD has meticulously defined the data standards for all relevant quality data and created the processes and incentives for a continuous reliable data flow. Very few countries have achieved this so far. These data allow quality of service & outcomes comparisons between healthcare providers, as well as give users of the health system the chance to make informed choices as to which service provider to entrust with their well-being and that of their families. In this regard, regular mandatory patient satisfaction surveys increase transparency for users of the health system and help to highlight areas for improvement to providers. Therefore, HAAD regularly assesses patient perception and shares the results with the public, as well as hospitals and insurers. In 2010, the Health Authority conducted the largest health satisfaction campaign within the Emirate of Abu of Dhabi, indicating high overall satisfaction with health system, with 83.2 percent overall outpatient satisfaction and 86.3 percent overall inpatient satisfaction. To build on standardized data flow and patient satisfaction results, the Health Authority has established a health quality provider rating system to enable improved patient choice of healthcare provider. The rating system takes into account various metrics, including patient satisfaction, key clinical quality indicators, as well as structural components such as physician and nurse staffing. The first ratings report will be compiled by Thomson Reuters and published by HAAD in Public Health: For HAAD, improvement in public health outcomes is closely linked to quality of care. The Authority has identified 10 priority health areas, which are addressed through targeted activities, including health awareness campaigns, screening measures, health education activities, and early treatment or prevention approaches. HAAD has partnered with some of the best health organizations in the world, such as Johns Hopkins Bloomberg School of Public Health and Cleveland Clinic to devise measures that have the maximum positive impact on public health. The Authority also works with private and non-governmental partners to benefit from their experience; e.g. Susan G. Komen Foundation for breast cancer, Children s National Medical Center for pediatric medicine, and Astra Zeneca for cardiovascular disease. HAAD s major achievements in public health have included a 17.4 percent decrease in road deaths in collaboration with the Abu Dhabi Police, GCC-wide recognition for best road safety campaign, and a fourfold increase in mammograms since Overall, HAAD s goal is to ensure an environment where excellent healthcare can be delivered to the largest number of people. The authority has created a regulatory framework that listens and responds to stakeholders, uses data to plan capacity and human capital, ensures fast and transparent licensing, tracks performance indicators constantly, zeroes in on areas of concern quickly, and audits healthcare providers regularly.

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51 HAAD Annual report 2010 Web Based Access 49 In line with the overall strategy of the Government of the Emirate of Abu Dhabi, the Health Authority Abu Dhabi has made it a priority to focus on customer accessibility by enhancing speed of services, increasing service reliability and improving the efficiency of both customer-facing services as well as the back-office business processes that support them.

52 To Ensure Reliable Excellence in healthcare to the community Web Based Access The Authority has been working to improve customer accessibility and efficiency of services through largescale automation of business processes. Key external and internal business processes within HAAD have been assessed, reengineered, and automated with the help of external consultants. Many business processes and services have been brought online, supported by various call-centre systems for the customers and stakeholders, to increase customer access and improve processing time. Bringing services online has also allowed better monitoring of response times, which has helped the Authority deliver performance-oriented public and health services. HAAD customers now utilize the Internet to register and apply for a range of services. During 2010, over 300 of HAAD s services were automated to allow full online access, including health insurance product validations, birth and death notifications, infectious disease, injury, and poisoning reporting, as well as professional licensing and continuing education activities. School health screening programmes that include BMI (Body Mass Index), vision and vaccination, are already available online for school nurses to facilitate better health for children in the Emirate. Customers can also request services and make appointments online. HAAD is expanding its e-services continually to enable better access to healthcare, and better health for Abu Dhabi s population. HAAD has automated its Medical Fitness Screening program for expatriates in Abu Dhabi. This has resulted in improved efficiencies, better quality control and faster processing. Screening centers (Disease Prevention Screening Center - SEHA) have also introduced fast track services for their customers. The new electronic system has closed the gaps that existed in the manual and semi-electronic systems of old. The new system captures all the information needed to accurately diagnose identified infectious diseases, and allows for data analysis to identify trends and generate reports. The next step is to integrate this paperless system with the Ministry of Immigration Integration for seamless end-to-end e-government services that ensure a paperless process for customers. HAAD s web access and e-government initiatives involve and benefit many of its stakeholders. Pharmacists, for instance, can submit drug coding requests online. Health professionals can apply for licenses and renew existing ones, while patients will be able to apply for birth certificates in the near future. For healthcare facilities, it is easier than ever to apply for or renew licenses, or inform the Authority of cases of poisoning, and any injuries or health and safety issues occurring on premises. Not just that, but insurance companies have the ability to gain authorization of services online and even register new products and services with the Authority. In making these services fully accessible through automation efforts and expanding services online, the Authority has gained many benefits for itself and its stakeholders, including quick notification and processing, better customer services, improved data quality, real time data availability for monitoring, analysis and capacity planning, and reduced data entry efforts that allow professionals, healthcare institutions and insurance providers to more efficiently serve their customers. In one example, process re-engineering efforts have led to an elimination of six manual steps, more than 50 percent improvement in process efficiency, and an increase in capacity to handle more than 300 percent growth in insurance products submissions. Online service provision is just the first step in business process optimization at HAAD. The back-end infrastructure has been revamped using ERP (Enterprise Resource Planning) technology, which allows for a high degree of business process automation. This leads to better efficiency and throughput, yielding advantages that are directly passed on to the customer through better and faster service. Over 120 e-services are available now, with 64 customer-facing processes, all of which have improved processing speed and efficiency. For example, time

53 HAAD Annual report 2010 Web Based Access 51 to process insurance product requests has reduced drastically, from 48 hours on average to less than E-services are also proving increasingly popular in 2010 the system handled over 1.5 million transactions. Another advantage of the e-services model is accessibility anywhere and at anytime. Healthcare providers can, for example, check online the status of any license request they ve submitted. A highly important element in HAAD s e-services strategy is ensuring that the online system is continuously evaluated and monitored to ensure acceptability and usage. The last survey, conducted via e-notification, indicated that 81 percent of respondents have not had any technical issues accessing the e-services capabilities at HAAD Do you currently face any technical or connection problems? The distributed nature of the online system allows data monitoring and validation from remote locations. At the same time, HAAD has invested in real-time monitoring and analytical support through business intelligence software that creates interactive dashboards to monitor key variables. This allows the authority to keep track of key health trends and create proactive health strategies to cope with possible disease trends or outbreaks. The data is also categorized geographically, allowing the Authority to instantly identify hotspots of infectious disease. A data standards panel, comprising of a cross-section of relevant internal and external stakeholders, reviews and recommends changes and additions to electronic data exchange standards, such as transactions, codes and business rules. In this way, the panel contributes to data strategy and advises on stakeholder communications. 81% 19% No Yes Source Information Technology Department, Health Authority - Abu Dhabi Apart from the obvious customer benefits, HAAD s automation system has resulted in several improvements that allow the Authority to better perform its role of regulator. Data entry overheads, including required manpower, document transfer and printing forms, have been reduced, and the Authority has also created a data quality protocol to ensure error elimination. HAAD s overall approach to its electronic systems and web access is to create an integrated ecosystem that allows access and sharing between and departments internally, and allows partners and patients to request services and monitor their status externally. The goal is to facilitate end-to-end electronic integration that reduces processing time, improves transparency, and gives the Authority valuable data to plan capacity and strategy for the healthcare needs of the future.

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55 HAAD Annual report 2010 Partnerships 53 The Health Authority Abu Dhabi (HAAD) actively seeks partners that can help fulfil its mission of Reliable Excellence in Healthcare for Abu Dhabi. HAAD prioritises partnerships that deliver value to all parties concerned, helping ensure buy-in and long-term sustainability.

56 To Ensure Reliable Excellence in healthcare to the community Partnerships SELECT DEVELOP AND BUILD UNDERSTAND HAAD PARTNERS SUPPLIERS HAAD s partnerships come from understanding areas where incentives may be aligned across public, private and civil sector organizations. Many of HAAD s strongest partnerships are created in response to specific healthcare issues. One example of this is in the field of breast cancer: when HAAD s data analysis showed that breast cancer was one of the main causes of cancer deaths in women in the Emirate, it entered a formal partnership with the Susan G. Komen foundation the world s largest breast cancer awareness organization, to raise public health awareness about the importance of screening for early detection. HAAD also signed an agreement with the Red Crescent foundation to establish donation support for breast cancer patients, and community initiatives to combat the disease. Other partners in the breast cancer campaign included the Abu Dhabi Media Company, Etisalat, Ghantout Polo Club, Radisson Blu and Park Inn at the Yas Island, and Tawam Hospital, with another 40 organizations also supporting the campaign in different ways. This broad-based collaboration helped drive impressive results 13,266 mammograms were conducted by end of 2010, with over ten thousand bookings for mammograms made through the dedicated call centre and the campaign website, Through its Schools for Health program, HAAD works with the Abu Dhabi Education Council (ADEC), Abu Dhabi Food Control Authority (ADFCA), Zayed Higher Organization for Humanitarian Services, and School Health Department (Ambulatory Health Services-SEHA) to ensure that students receive quality healthcare while at school and also develop healthy behaviors that will last a lifetime. One example of HAAD s commitment to children s health is the active role it played in developing the School Canteen Standard with ADEC and ADFCA. For its Safety in Heat programme, aimed at employer s safety officers and blue-collar workers in Abu Dhabi, HAAD partnered with the Ministry of Labour to create awareness of the issue and distribute multilingual (in 8 languages), multimedia educational and awareness materials to employers across all economic sectors. Other examples of specific collaborations include HAAD s cooperation with the Ministry of Interior (Department of Immigration) and SEHA on visa screening, and a strong and evolving partnership with Abu Dhabi Food Control Authority (ADFCA) on implementing e-notification services for infectious diseases, injuries and poisoning. The Health Authority has also entered broader partnerships, for example with Johns Hopkins Bloomberg School, the world s largest and most active school of Public Health. The current focus of the HAAD John Hopkins partnership is training a cohort of 23 Emirati students who will become the next generation of leaders in healthcare within Abu Dhabi. The partnership also includes collaboration on data analysis, and research on policy and implementation focused on specific disease priorities. Both HAAD and Johns Hopkins have greatly benefitted from a strong and dynamic partnership. The Authority s positive market image has made it easier to enter favourable partnerships. For instance, HAAD was approached by the UAE Football Association (UAEFA) to help promote active and healthy lifestyles. This was a point of innovation for the Health Authority, and a departure from the norm for UAEFA, which moved from marketing products and services to promoting health. In providing affordable access to healthcare through implementation of mandatory health insurance, HAAD has worked with insurance companies, government agencies, hospitals and employers. Through these efforts, and in particular collaboration with Daman, UAE nationals are covered under the Thiqa insurance scheme, allowing access to free preventive and treatment services provided by public and private health care providers. Expatriate residents in the Emirate have access to healthcare through mandatory employer-sponsored insurance. Additionally, expatriate residents have free access to essential preventive services through the government funded free insurance program. As a result, over 98 percent of the Abu Dhabi population has affordable access to health services: a feat unparalleled in the GCC region.

57 HAAD Annual report 2010 Partnerships 55 HAAD s partnership with SEHA - the Abu Dhabi Health Services Company - and Daman initiated the Weqaya disease management program that targets cardiovascular disease and diabetes; the emirate s top threats to health. A Weqaya Advisory Task Force has been established, consisting of members from HAAD, Health Guardians from Abu Dhabi s civil sector, key Abu Dhabi government entities, leading academic institutions and non-governmental organisations. The task force acts as an independent source of expertise, advising on research and policy interventions for effective control of chronic illnesses and disease outbreaks. In addition, HAAD recognises that effective intervention in chronic disease requires a holistic approach. The roots of the most common chronic diseases lie in behavior: for example unhealthy diets, lack of physical exercise, tobacco smoking and the use of alcohol. In tackling these issues, HAAD works closely with a range of private companies in the Innovators Forum the Authority has created. To date, HAAD is working through this Forum with two international partners, Eli Lilly and AstraZeneca, to analyse its extensive health data on chronic diseases (particularly diabetes and cardiovascular disease) and to find innovative ways to improve both prevention and clinical treatment. HAAD is also now working with Etisalat, the UAE government-owned telecommunications provider on data management (ehealth) and mobile devices (mhealth), two big growth areas in global healthcare that offer significant potential in improving the health of Abu Dhabi residents. HAAD has a history of encouraging and endorsing public health initiatives by private-sector organisations. For instance, HAAD endorsed BMW and GMC Chevrolet in their advertising campaigns promoting and encouraging the proper use of child safety seats. GMC Chevrolet donated 500 infant car seats to parents of newborns through Al Rahba Hospital. The hospital also sponsored training sessions conducted by Safe Kids USA for the nurses to aid parents in the facilitation of proper use. While coordinating road safety marketing initiatives, HAAD worked in close partnership with Abu Dhabi Media Company. The Authority evaluated its Drive Safe, Save Lives campaign using renowned research company YouGov.com. The postcampaign assessment indicated that over two-thirds of the target audience were aware of the campaign messages, with a 10 percent positive shift in practice/behavior with regard to wearing of seat belts (70 percent pre-campaign, 80 percent post-campaign), along with a similar increase in the belief that speeding kills. In 2009, the international H1N1 pandemic served as a reminder that new health challenges will continue to emerge. HAAD s swift response and integrated response to this virus illustrated our increasing maturity as an Authority as well as our level of preparedness and flexibility. To build upon this success, HAAD has continued to work with key partners, including the National Crisis and Emergency Management Authority (NCEMA), Abu Dhabi Police, Emergency & Public Safety Department, and other health and emergencyrelated institutions to carry out necessary emergency preparedness planning efforts and major incident management activities. Notable achievements have included the establishment of an integrated incident management system and Operations Center backed by enforced policies and round-the-clock capacity monitoring, with successful Geographical Information System (GIS) mapping of health facilities.

58 To Ensure Reliable Excellence in healthcare to the community Partnerships HAAD has also developed and implemented a standard to optimize responses to poison and drug cases in collaboration with SEHA and other hospitals as part of a unified poison control management system across the Emirate. This has led to the reporting rate for poison cases rising from less than 10 percent to 100 percent across the Emirate. Overall, HAAD s partnerships are constructed to serve core regulatory and public health functions, and focus on long-term, sustainable collaboration that can be measured, evaluated and improved to the benefit of both parties, and that serve Abu Dhabi s population in receiving excellent, reliable, and accessible healthcare. The authority s Public-Private Partnership approach is allowing it to build sustainable outcomes with Emirati leaders, whilst improving internal capabilities to deal with future changes in a rapidly developing population. Summary: Public Health Campaign Targeted Marketing and Promotional Strategies BMW GROUP MIDDLE EAST. STAY ALERT. STAY ALIVE SAFETY IN HEAT CAMPAIGN WEQAYA SCREENING All national newspapers covered articles on the campaign launch; The campaign made the front page of the largest read English newspaper in UAE; Over 39 media clippings generated to date with an advertising value of US$112,000. Result: Positive Public Response: approx. 5,000 people turned up to Awareness Days in Abu Dhabi and Dubai Arabic and English Websites developed; Training Manual (Arabic and English); Online Thermal Work limit Calculator; Posters, Pamphlets, Charts, Direct Mail Campaigns, CD/DVD Sets, Online Resources, Publications; Television coverage x 6 (4 x news interviews and 2 x current affairs programmes); Newspaper article x 13; UAE website coverage x 2 articles (UAE interact); Other articles x 1 Abu Dhabi Weekly. Result: Self registration of companies target was 250 and achieved 465 companies. Distribute over 77,000 materials. Two large companies reported a 79.5% decrease in heat related treatment and emergency cases Phase 1: Education and awareness brochures, newspaper ads, TV, radio. Phase 2: Use of technology Weqaya website includes awareness and educational information to the public about CVD risk factors and means of prevention, a clinical appointment booking system which also seeks feedback on visits, SMS messaging for reminders for appointments. Community events such as workplace workshops, majlis events, booths at malls and health facilities. Branding of Weqaya to include all healthy behavior, e.g. Weqaya logo used by UAE Football Association, large stakeholder involvement. Result: Around 183,000 (~97% of the population) screened for cardiovascular risk factors and are now able to access their personal health report online, 92,000 Weqaya reports distributed (as of mid-october 2010); Early diagnosis of risk factors of diabetes (35% were newly diagnosed); Weqaya web portal attracted thousands of visitors (8,529 came from 84 countries); and an increase in uptake of Weqaya screening since April 2008 BREAST CANCER Encourage-Enable-Enforce Marketing Campaign: Healing & Hope documentary made using local survivors telling their own stories launched at the Middle Eastern International Film Festival; Newsletters; Interactive website was developed by the team with an online appointment booking system which also hosts videos for survivors, self-examination,

59 HAAD Annual report 2010 Partnerships 57 stories and the facility to contact the breast cancer team directly by ; Marketing and promotion via Susan G. Komen foundation, via documentation, media advertising, promotional and awareness global events. Result: Breast Journal Award H1N1 ROAD TRAFFIC AWARENESS SCHOOLS FOR HEALTH Award Winner, Comprehensive media and communications campaign which showed that the HAAD swine flu advertising on radio and TV were the most motivating. Pamphlets, factsheets, posters, 24/7 hotline, marketing at international conferences (Disaster Management 2009) Comprehensive media plan including mass media; targeted media channels, TV & radio channels, online media, newspapers and magazines, cinema and outdoor media, printed materials in Arabic and English, cinema, and radio spots, a website ( ae), website banners, messages, outdoor advertisements, e.g. road side banners, lampposts, bridge banners. School Health Educational materials to be used by school nurses and school teachers-phase 1 of health promotion - Eat right and get active, Majid Your health, your choice ; say yes to healthy teeth promotion via pamphlets, workshops, videos, fact sheets, and educational materials. Phase 2- Capacity Building - Ongoing Continuous Medical Education training for school nurses and continuing campaigns.

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61 HAAD Annual report 2010 Excellence in Customer Service 59 Excellent customer service requires constant planning and evaluation. But ultimately, exceeding customer requirements requires direct customer contact and convenience. Hence, excellent customer service at multiple access points across Abu Dhabi is a key part of HAAD s strategy to improve access to healthcare.

62 To Ensure Reliable Excellence in healthcare to the community Excellence in Customer Service On the one hand, HAAD has improved customer access through more points of contact, including online services, for greater customer convenience. On the other, HAAD has centralized all services under a single roof and cross-trained the customer service team so that customers don t have to queue at multiple locations to receive required assistance. HAAD has opened up service centres in Marina Mall and the Abu Dhabi Chamber of Commerce, as well as expanded offices in Al Ain and the Western Region to supplement the main HAAD Customer Service Centre. These contact points offer the full spectrum of HAAD services, from birth and medical board certificate applications to healthcare professional licensing. Focus groups conducted by HAAD have registered customer approval for the ability to interact through these access points. For round-the-clock enquiries, suggestions and complaints, the Health Authority also maintains and encourages use of the 24-7, toll free number. Posters with the number are made available at all hospitals and clinics so patients are fully aware of their rights, and the channels of communication open to them. Feedback can also be relayed by ing Healthcare@haad.ae. HAAD is also maximizing access to healthcare related services through an online portal that gives customers a range of fully Internet-based services, including healthcare professional licensing applications, continuing professional development education programs, and birth and death notifications, to name but a few. HAAD is expanding its e-services continually, which not only increases customer convenience, but also frees up physical infrastructure for walk-in customers. Overall, the new customer service strategy has allowed for rapid service, higher traffic, and faster resolution of issues, thereby creating a highly efficient system. The number of people served per day has risen from 1500 to over Time to process customer data has also reduced drastically, from 48 hours on average to under two. The majority of customers are still handled by the HAAD head office, with over 12,000 passing through the doors of the Customer Service office every month. Here, service Excellence stems from hiring employees with the determination to learn and exceed their customers requirements. UAE nationals account for 95 percent of the Customer Service workforce, and are chosen for their dedication and desire to provide healthcare. Excellence in The Customer Service Centre employees are appraised, and trained accordingly, on a regular basis. At the outset, their qualifications are considered, and possible gaps identified. Their on-the-job performance is also taken into account, and a rigorous cross-training programme is then designed based on all these factors. It is these employees, says Jaber Saeed Al Lamki, Section Head of Customer Services, who are responsible for the department s customer service improvements. They are skilled and dedicated, and have a willingness to communicate that goes above and beyond standard job descriptions. Apart from being fluent in Arabic and English, some are also conversant in other languages used commonly in the UAE, such as Hindi, Urdu and even Farsi. Customer service is all about being hands-on, says Al Lamki, and it is this attitude of proactive problem solving he tries imparting to all his employees. He can often be seen on the front lines, standing at the customer service stations and dispensing advice. Understanding customer requirements and soliciting feedback are essential principles of HAAD s customer service E xcellence program: to the extent that HAAD sponsored the Green Apple Show with Howaida and Dr. Jamal on MBC television, as well as a Studio 1 radio show. Both shows reach out to stakeholders and the community, impart information and obtain feedback for healthcare. Excellence in

63 HAAD Annual report 2010 Excellence in Customer Service 61 The aim of these initiatives is to address key public health concerns, and create forums for open debate that allow customers to reach key people at HAAD and freely discuss their healthcare issues. The key message these programs deliver is that HAAD strives for transparency and wants to communicate with people directly over mass media to address their concerns. The Studio 1 program was a very important channel for an honest exchange with our stakeholders. It helped us explain HAAD s role in healthcare regulation, and started a forum for candid feedback and the pinpointing of issues affecting healthcare delivery, said Dr. Jamal Al Kaabi, Director of the Customer Services and Communication division at the Health Authority. For instance, it was the Studio 1 program that helped put the spotlight on health insurers who were categorizing leprosy as a cosmetic condition and refusing to cover it. Once this was pointed out to HAAD, steps were taken to ensure coverage. The Authority constantly evaluates the results of its customer service strategies through stakeholder surveys. In 2010, a survey was conducted to assess customer perceptions, targeted at government entities whose employees had dealings and common projects with HAAD. The findings were used to measure the perception stakeholders had of HAAD and to understand how to improve the Authority s relationship with its customers. The overwhelming majority of respondents were satisfied with HAAD service delivery, with only 6 percent expressing dissatisfaction: this result proves HAAD s efforts to maintain customer service E xcellence through people development, efficient procedures and technology are succeeding. HAAD is working to further improve these numbers on a daily basis through direct customer feedback channels. Overall, the Authority is constantly trying to improve customer service, not just by increasing points of contact and making services available online, but also by ensuring ease, efficiency and quality in each customer transaction.

64 Corporate Social Responsibility

65 Corporate Social Responsibility 65

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67 HAAD Annual report 2010 Corporate Social Responsibility 65 Health Authority Abu Dhabi s vision for CSR is to provide Reliable Excellence in Health Care, contributing to the social, economic, cultural and environmental development of Abu Dhabi in a sustainable manner. HAAD involves its community in order to have a positive contribution towards the development of the Emirate in alignment with the 2030 Vision. HAAD s CSR approach is integrated, from having incorporated CSR into its strategic initiatives alongside a formal committee to embed CSR across the organization. As healthcare touches the lives of every individual, corporate social responsibility is a priority for HAAD to ensure that its operations are continuously monitored and improved; whilst safeguarding that any positive or negative impacts are managed to best meet the needs of all its stakeholders as the regulator of healthcare services in the Emirate.

68 To Ensure Reliable Excellence in healthcare to the community Corporate Social Responsibility An environmentally sustainable approach is at the foundation of the Authority s mission. The organization strives for environmental sustainability through adherence to the principles of Reduce, Reuse and Recycle, with the objective of saving resources and reducing waste. In addition, the Authority also complies with all relevant health, safety and environmental legislation and codes of practice to provide a green environment for staff to work in. In 2009, HAAD reviewed its existing corporate social responsibility (CSR) practices via a self assessment and formalized them through the establishment of a CSR committee. Initiatives based on these findings were executed in 2010, with a positive trend clearly visible. The CSR committee is a multi-disciplinary team that ensures full CSR integration within HAAD. Under the PERFORMANCE MANAGEMENT (QUARTERLY/ANNUAL) ENVIRONMENT RESPONSIBILITY SUSTAINABILITY REPORTING (ANNUAL) ECONOMIC RESPONSIBILITY ALIGNMENT WITH ABU DHABI GOVERNMENT STRATEGY STAKEHOLDER ENGAGEMENT (CONTINUOUS) SOCIAL RESPONSIBILITY HAAD s CSR Model committee s leadership, the Authority ensures minimal negative impact of its operations on society and the environment while maximizing benefits, creating policies and initiatives in a way that reflects the interests of all stakeholders. HAAD has carried out CSR initiatives down to the section and departmental level through integration of social responsibility into strategic and departmental planning. The Authority s CSR initiatives have been extended to the community via leading edge initiatives such as the Weqaya program for disease management, breast cancer awareness and donational support, the Safety in Heat program for laborers, the Road Safety campaign, and the Tanseeq program to match graduating physicians into residency programs based on community needs. HAAD s CSR initiatives have received international recognition, and the Authority has also received the annual Red Crescent Giving Award on many occasions. HAAD s Public Health Department works on multiple outreach initiatives that impact all aspects of the community. Some examples include the Eat Right, Get Active campaign; the Immunization Program; the Anti -Tobacco Campaign; the Colon and Cervical Cancer awareness campaign; Schools for Health; Tuberculosis DOTs; various pharmaceutical monitoring programs; and a Poison Control hotline. Additionally, HAAD creates environmentally friendly policies and standards for the healthcare system and actively engages with the community, e.g. visits to orphanages, work camps, and charity fundraising. HAAD s CSR strategy calls for initiatives that Support the Local Community, and engage it through volunteer and CSR awareness programs a recent example being the HAAD activity of planting trees and plants to support environmental protection within the Emirate; and the Voting for Buttinah Island campaign supporting the UAE in a worldwide competition to be one of the new seven wonders of nature. HAAD has specific community commitments implemented via MOUs with partners such as the Environment Agency of Abu Dhabi, Ministry of Labour, The Emirates Environmental Group and ADMA-OPCO. Community goals are also defined via documented stakeholder meetings that take place across the organization.

69 HAAD Annual report 2010 Corporate Social Responsibility 67 The table below highlights HAAD s initiatives as a socially responsible organization committed to its wider community: SOCIAL INITIATIVE (INTERNATIONAL) Green Apple Health Series on MBC, 2010 The program provided an interactive platform where the studio audience and at home viewers were able to share personal experiences, problems and enquiries through interviews, video clips and ed enquiries Donation to Charity for the Emergency and Disaster Support to the victims of the floods in Pakistan Floods in Pakistan, HAAD announced joining the campaign Your help is our duty» Donation: 52,600 AED. SOCIAL INITIATIVE (NATIONAL/REGIONAL) Women s Union Activity, 2010 Celebration of Emirati Women s Day (giving presentations & increasing HAAD s profile) Orphan Charity Centre Visit, 2010 To share in daily activities, supporting HAAD s image in caring for its people Internally, HAAD has a full HR policy and an Employee Code of Conduct document for the rights, responsibility and accountability of all employees including policies for those with special needs and strategies to promote Emiratization. Externally, HAAD implements human rights policies and standards that include full access to healthcare, sick leave, handicap access and work guidelines in addition to safety in heat procedures to promote safe and healthy working environments. In addition, HAAD has been an active member of the Abu Dhabi Sustainability Group since 2009, contributing to knowledge sharing in adopting sustainable methods and complying with global benchmarks in sustainability reporting. It has also adopted an environmentally sustainable approach relying on the principles of Reduce, Reuse and Recycle with the objective of saving resources and reducing waste. Such green initiatives are aligned with the Environment Agency Abu Dhabi s mandates. GCC Gulf Women s Sport Event, 2010 Collaboration to Support National Team for UAE Football, 2010 Studio 1 Receiving and Responding to Health Concerns on the Live Public Radio, 2010 Promotion of women s health on a GCC scale Partnership to promote sports, health, and wellbeing of the public in UAE Live interactive radio discussion on health services Since 2009, in line with the Abu Dhabi Environment, Health and Safety Management System (EHSMS) Framework introduced by Decree No (42) of 2009 by H.H The Crown Prince, Chairman of the Executive Council, HAAD has been developing a Health Sector EHSMS for initial implementation in 33 Government and Private Hospitals across the Emirate of Abu Dhabi. HAAD has developed and implemented a consumption and utilities monitoring and management system to track usage. The Authority is showing continuous improvement in resources management since the implementation of the system and is also presenting quarterly performance reports on sustainability KPIs (key performance indicators).

70 To Ensure Reliable Excellence in healthcare to the community Corporate Social Responsibility HAAD s strategy of environmental awareness rests on the following four pillars: Minimize energy consumption Minimize water consumption Minimize paper consumption Recycle/reuse waste Minimize fuel consumption Internally, HAAD encourages all its employees to be vigilant in energy consumption by reminding them via notices and stickers to switch off unnecessary lighting and conserve energy in daily operations by switching workstations off as opposed to leaving them on standby. In addition, all facade lights in the main HAAD building are switched off at night, while security staff also ensures internal lights and office equipment are switched off after hours. These policies saw a 9.6 percent reduction in energy consumption between 2009 and HAAD also encourages employees to use water sparingly, and turn off faucets when not in use. Regular maintenance minimizes water wastage through leaks. These measures have lead to a 20.5 percent reduction in water usage between 2009 and HAAD is very conscious of the importance of reducing paper usage, and recycling wherever possible. HAAD s premises have been provided with paper recycling containers, particularly in areas that generate paper waste, such as near the photocopy machines and printers. In 2010, the Authority recycled over 6.6 metric tonnes of paper. In addition, the Authority only uses recycled paper for all new stationery requirements. Employees are reminded to only print where necessary and minimize paper use wherever possible. The Authority is also very conscientious about the use of fuel. It offers drivers waiting room in the main building to avoid having to wait inside their cars with the engine turned on. The consumption of fuel is carefully monitored by registering trip mileage and obtaining passenger signature verification to ensure cars are not being misused. Drivers are constantly reminded to switch their engines off while waiting. All HAAD vehicles are kept in optimal condition to ensure the most efficient use of fuel. Car-pooling is encouraged wherever possible, and single passenger trips are avoided wherever applicable. The Authority also expects its contractors to share its ethos of social responsibility and environmental sustainability. Bidders are required to meet certain environmental requirements and credits are given to those meeting environmental standards (e.g. ISO 14000), or possessing certificates on environmental protection. Finally, HAAD is including sustainability as a core of its building design philosophy. Several projects were launched in 2010 to reduce resource consumption and improve building design: Introduction of energy saving T5 lamps for HAAD s International Patient Care (IPC) Site Installation of an AC split unit for the Operation Center and IT server room to better control airconditioning and energy usage Faucet filters and water sensors installed to reduce water waste Waiting rooms built for the public in Al Ain, Delma, and WR Mortuaries; and an extra HAAD branch opened in Madinat Zayed to serve the community of Western Region (WR). Replacement of all locks for the Al Ain and WR Office with a master key system for improved security efficiency. Overall, the Authority is looking to set benchmarks in environmental sustainability social responsibility to ensure a sustainable future for generations to come while delivering a regulatory system that facilitates the provision of world class healthcare to the population of Abu Dhabi.

71 HAAD Annual report 2010 Corporate Social Responsibility 69 Electricity Consumption per employee Consumption per employee (KW) Target Achievement Actual Achievement 2008 KW 27,589 N/A N/A 2009 KW 18,064 10% reduction 34.5% reduction 2010 KW 16,319 5% reduction 9.6% reduction HAAD continues to implement its vision for sustainability to minimize the negative impact of its operations on the environment, and to have a positive effect on society, whilst seeking to work with other organizations who embrace these objectives. HAAD aims to use natural resources responsibly, to work with community projects, and to encourage and educate its employees on CSR, in addition to providing full access to healthcare within Abu Dhabi, and ensuring the minimization of medical waste for healthcare providers. Water Consumption per employee Consumption per employee (gallons) Target Achievement % reduction 16% reduction % reduction 20.5% reduction Paper Consumption per employee & Paper Recycling Efforts Actual Achievement Consumption per employee (sheets) Recycled Paper (kg) ,146 sheets 6,655 kg

72 Health Statistics 2010

73 Overview Introduction 73 Stable Vision 74 Achieving our vision 75 Statistical highlights 76 Public Health highlights 77 Investor highlights 78 Benchmarks 79 various breakdowns 81 Births and Deaths 84 Leading causes of death 87 Injury deaths 89 Communicable diseases 91 Health status 92 Diabetes Mellitus 94 Cancer 96 Encounters and activities Encounters various analyses 100 Activities by type 103 Procedures 105 Drugs 106 Providers Provider overview 108 Clinical performance 109 Labour productivity 110 Hospital patient satisfaction 111 Hospitals 113 Hospital inpatient profile 114 Centers and Clinics 115 Beds including critical care 116 Blood bank 118 Market structure 119 Claims Claims 122 Claims by provider 123 Payers Payer members 125 Payer claims 126 Financing Enhanced plans premiums 128 Enhanced plans benefits 129

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75 HAAD Annual report 2010 Introduction to Statistics 73 Abu Dhabi s ambitious reform program requires co-ordination with all stakeholders. The jointly developed vision aligns stakeholders on the healthcare system s strategic direction, while statistics offer feedback on progress. Knowing the present, and understanding the future, facilitates effective reforms. Key information needs to be provided to all stakeholders, while respecting important patient and commercial confidentiality. The Annual Health Statistics provide a succinct, quantitative, publicly available summary of the present. Published annually since 2007, the statistics describe the healthcare trends of the population including health status, service consumption, as well as utilization of services of the Providers, Payers and health system financing. Capacity planning through business intelligence and data analysis lies at the core of HAAD s healthcare strategy. The data generated via the e-claim health insurance system helps HAAD understand how healthcare services are currently utilized. This insight, coupled with a vision of future healthcare services, provides the basis upon which HAAD issues the Capacity Master Plan. HAAD identifies potential gaps and plans accordingly by considering healthcare demand and supply for the current population, and making informed projections about the healthcare service needs of the future population. HAAD has invested great effort into making its analytics available to all, to further increase transparency. The source code for KEH Knowledge Engine for Health, HAAD s analytical system is now available through an open-source license. This enables stakeholders to analyze their own data in ways similar to HAAD, thereby supporting enhanced dialogue and alignment.

76 To Ensure Reliable Excellence in healthcare to the community Stable vision In the Emirate of Abu Dhabi, everyone has access to healthcare and freedom to choose their provider. A system encompassing the full spectrum of health - protecting, promoting, sustaining and restoring services across the territory of the Emirate. Quality driven by ambitious improvement targets set by the regulatory authority of the Emirate and reflected in the regularly monitored and published key performance indicators of the system. Payers Providers The health system finances itself through a mandatory health insurance for all AD residents. The financial system should be flexible in order to manage for change over time and the degree of subsidy should be managed as efficiently as possible. Providers are independent and predominantly private. An open system for all certified providers of health services delivers World-class quality care and outcomes in compliance with the highest international standards.

77 HAAD Annual report 2010 Achieving our vision 75 In 2006 we defined a vision for Abu Dhabi s health system with the mission of being reliably excellent in healthcare. This vision has guided major reforms and continues to inform daily decisions in healthcare. The Health Authority Abu Dhabi (HAAD) was created to track and steer progress towards realizing the vision and to measure returns on investments for a healthy society. HAAD regulates all healthcare entities public or private, provider or payer by licensing them, setting clear and simple rules, e.g. minimum standards for facilities, and ensuring everyone complies. HAAD doesn t own or build facilities, treat patients, pay for treatment (insurers and other payers do), or pay the private sector to partner. SEHA (Arabic for Health ) is the public provider: it owns and develops existing public healthcare facilities, treats patients, and partners with Johns Hopkins, the Cleveland Clinic, University of Vienna, VAMed and Bumrungrad to manage its facilities. Everyone has access to healthcare via mandatory health insurance. In 2006, we began giving all expatriates health insurance and, by linking it to resident permits, guaranteeing access to healthcare a first for many like labourers. In 2008 Nationals received Thiqa cards and with them, free access to care in both the private and public sectors and the freedom to choose their provider. World-class quality care and outcomes with Quality regularly monitored and published. We have invested heavily in a common, routine and confidential way to share information about the conditions patients have and the treatments they receive. We are also working with local doctors and international experts to develop measures that tell us if patients are getting the right treatments and outcomes, e.g., is a patient s diabetes well-controlled after receiving treatment? Full spectrum of health services. Our model of care sets out services should be appropriate, convenient and well co-ordinated around patient needs. Prevention. We want to try to prevent diseases from occurring in the first place so we are working with: schools to get children to eat healthily and exercise regularly; the police to get people to drive safely and wear seatbelts; and the construction industry, so workers don t dehydrate in the heat. Screening for health risks. When Nationals were screened for various health risk factors in a programme called Weqaya it showed that many were obese and had diabetes. Worse, almost half of the diabetics didn t know they had the condition, and risk factors are projected to increase. Community-based services help patients manage their chronic conditions, like diabetes, on a daily basis. For instance, the Imperial College London Diabetes Centre offers integrated consultation, diagnostic and pharmacy services to diabetics. Another creative solution is to treat patients, particularly those who are frail, in their homes as the Sama Abu Dhabi Home Health Care group is now doing. Specialty care. Competition for patients created new services, increased convenience and efficiency for existing services, and generally reduced waiting times. Examples include: international experts flying in to provide services otherwise not available; SKMC s pediatric kidney transplantation service; Tawam and Lifeline providing mobile breast cancer screening services; and the Corniche Hospital opening a conveniently located Women s Health Centre. Patients also have greater choice as private facilities offer services previously only available at SEHA, such as Al Noor Hospital s dialysis service and cancer treatments at the Gulf International Cancer Centre. Hospital care. We want to treat patients outside hospitals wherever possible. But, to account for population increase, 5 new private facilities have opened in the last 5 years Lifeline hospital, Al Noor Hospital in both Al Ain and the Capital, NMC Specialty hospital, the Gulf Diagnostic Center. In addition, 93 private clinics and 12 SEHA clinics have opened. Ambulance services. Good hospitals are worthless, if patients can t get there. The Police provides emergency Ambulance services and are looking to privatize them. We are working with them to develop a more integrated service that responds to a wider range of health emergencies by road or air. Predominantly private providers. Based on positive experience in the region and here, we want private operators to provide most healthcare and add any required new capacity. Private facilities generally build and operate more efficiently than SEHA, and are also generally more responsive to HAAD quality audits. Patients feel at least equally satisfied in private facilities and, we will be monitoring how they perform on robust clinical indicators. A Flexible and efficient financial system. We want to pay providers for the patients they actually treat and the quality of that treatment and to limit direct subsidies to SEHA. The DRG system introduced in 2010 rewards quality: it pays hospitals on the basis of how sick patients are, not how long they stay or how many doctors they see. Insurers are also set to pay a bonus for high quality care.

78 To Ensure Reliable Excellence in healthcare to the community Statistical highlights m residents, 19% Nationals Median age 18 for Nationals and 31 for Expatriates 29,366 births and 2,879 deaths There are more insurance contracts (2.7m) than residents Financing 13.5 million encounters 1.3% inpatient ( ) 45% by Nationals 43% by hospitals Encounters Payers Providers Claims 35 licensed insurers compete for members 13.1 Million claims processed physicians, nurses and % of claims for outpatients allied health professionals in licensed facilities: 33 hospitals (3 579 beds) 674 centers and clinics 468 pharmacies and stores

79 HAAD Annual report 2010 Public health highlights 77 One in five residents are Nationals of whom two thirds are under 30 and half under 19 81, 82. Expatriates are overwhelmingly male and of Asian origin and predominantly aged between 20 and 40 81, 82. A significant share are employed in construction and accommodated in labour camps. The introduction of mandatory health insurance in 2007 provided all residents in Abu Dhabi access to high quality care. Residence status is generally contingent on being employed, so there are very few retirement age or unemployed expatriates. The population has been growing rapidly in previous years, with likely temporary decline in Birth Fertility rates the main driver of growth for Nationals have declined for over 30 years 84, 85. The UAE s Total Fertility Rate has declined from 4.4 to 2.3 per woman between 1990 and Declining birth rates are attributed to urbanisation, delayed marriage, changing attitudes about family size, and increased education and work opportunities for women. Death Mortality rates have also declined steadily 86 over the past years. Infant mortality is now comparable with other developed countries 7 and the WHO has reported a decrease in the under 5 mortality rate from 15 to 8 per live births between 1990 and 2007 across the UAE. In 2010, the diseases of the circulatory system caused the highest number of deaths, accounting for 27% of all death cases registered in the Abu Dhabi Emirate. External causes of morbidity and mortality and neoplasms are the second and third highest causes of death 87, 88. Injuries Abu Dhabi has one of the highest rates of injuries resulting from Road traffic accidents. They account for 12% of all deaths and are the leading cause of death amongst young males Speeding fines, free provision of child seats, and traffic safety education programs are some of the actions being taken by government agencies. Occupational injuries are now covered by health insurance. Communicable diseases Rates of childhood communicable diseases are very low, due to immunization programs targeting children aged <5 years 91. Expatriates are screened for communicable diseases before acquiring residence status 91. Non-Communicable diseases The Emirate has high rates of chronic diseases related to life style such as obesity, diabetes, and cardiovascular diseases. Cardiovascular diseases accounted for over a quarter of deaths in Adult Nationals were screened for cardiovascular risk factors in 2008 as a condition for enrollment in Thiqa insurance. Early analysis of results of this screening showed obesity rates of 33% for males and 38% for females and high proportions of people at risk of diabetes and hypertension among UAE nationals over Without major changes, these rates are set to increase further as the young population ages. Individuals thought to be at high risk of cardiovascular disease are being followed up. Cancer Cancer caused 15% of all deaths in the Emirate in Lymphoid, Haematopoietic and related tissue cancers are the dominant cancers in Abu Dhabi 97. Late detection of breast cancer leads to significant increases in mortality. Female adult Nationals aged are being screened for breast cancer as part of their Thiqa insurance renewal. Education and awareness campaigns have increased screening rates for all nationalities. Respiratory infections Respiratory infections are the second most common non-life threatening condition in the Emirate after nondisease conditions, accounting for almost 15% of all encounters across all healthcare facilities 101. Respiratory infections impact workforce productivity and quality of life.

80 To Ensure Reliable Excellence in healthcare to the community Investor highlights The population is concentrated on or nearby Abu Dhabi island 147. Areas of growth in the short to medium term are expected to be just off the island (Khalifa City A, Mohammed Bin Zayed City, the islands adjacent to Abu Dhabi island) and Al Ain city. At the end of 2010 there were 0.42m National Thiqa members, 1.2m Basic members and 1.0m Enhanced members 125. Demand Demand for health services grew at a higher rate in 2010 following little growth during This was driven by a significant increase in outpatient encounters inpatient and ER encounters both decreased slightly 100. Aggressive growth in demand is expected for services relating to lifestyle related diseases, e.g. diabetes and cardiovascular disease, and cancer with larger volume increases in outpatient settings 148. Supply There has been significant growth in the number of physicians 139 and facilities 108. By 2020, it is estimated that up to 3,100 additional doctors and 5,800 nurses will be required. If churn remains at the 2010 level, this requires annual recruitment of some 1,400 doctors and 1,600 nurses 148. Physician productivity indicates however there are reserves within existing facilities 110. High demand projections also indicate that in 2020 demand for inpatient services may require up to 2,600 additional beds beyond the current 3,600 beds 149. However, investors hold 63 Preliminary hospital licenses which signals significant future capacity to meet this demand 146. Capacity gaps Waiting times have been reduced across most specialties. There is a critical capacity gap in Intensive & Critical Care medicine and overall gaps remain in Emergency medicine, Neonatology, Cardiology, Psychiatry, Pediatrics, Oncology and Obstetrics & Gynaecology 144. Significant new capacity is however anticipated in pediatrics and obstetrics/gynaecology 146. Overall bed occupancy rates vary by facility, but have not increased in aggregate 113. Bed occupancy in ICU, NICU, PICU, CICU, CCU and Isolation was consistently over the optimal 75% during Reimbursement HAAD sets prices for the Basic product uniformly. Providers negotiate prices with Payers for Enhanced plans, generally as a multiple of Basic product rates. Thiqa rates are equivalent to Daman s most generous Enhanced plan. Prices have been weighted towards outpatient care. Accordingly, growth in demand has largely been in outpatient services 100. Inpatient services represent a small and reducing proportion of all encounters 1.9%- 1.3% from DRGs were introduced for the Basic product in 2010 and will apply for Enhanced and Thiqa during will see outpatient payments based on Evaluation and Management codes, thereby changed to reflect the severity the patient s condition not the grade of doctor seen. Provider market Government-subsidised SEHA facilities treated 60% of all inpatients (2% gain from 2009) and 32% of all outpatients (4% loss from 2009) 100, 113. The largest independent groups are Al Noor (who now hold 25% of the hospital outpatient market) and NMC 113. Off the island, health services are concentrated in larger facilities 113,115. International providers have come to Abu Dhabi, generally on the basis of a management service agreement, such as the Cleveland Clinic for SKMC and Johns Hopkins for Tawam. Payer market Overall, the competitive Enhanced health insurance market has increased to over 1.0m members. Almost 60% of this market is held by three payers Daman (28.6%), Oman Insurance (16.4%) and ADNIC (14.5%) 125. Daman also administers Thiqa and Basic product. Claims per member have been stable at 4.5 from 2009 and On average payers take 55 days to remit AED1 claimed, AXA and Dubai Ins. Co. are the lowest taking 21 and 24 days respectively and RAK and Al Khazna the highest at 158 and 151 days respectively. 126

81 HAAD Annual report 2010 Benchmarks 79 growth, Life expectancy at birth (years), 2008 Males Females Germany UK USA GCC Abu Dhabi Under - 5 mortality rate / live birth Infant mortality rate / live birth Beds / population Physicians /1,000 population Nurses / 1,000 population USA UK UAE Saudi Arabia Qatar Oman Kuwait Germany Bahrain Abu Dhabi Notes assumptions were adjusted from the Department of Planning, based on health insurance data; Physicians, nurses and beds statistics in WHO and other reports are reported for different years ; Bed ratio calculations were adjusted, as the population in Abu Dhabi is young and is not expected to need to go to hospital as frequently as other, older population. To enable a fair comparison the bed ratio was adjusted by mapping the population age structure of Abu Dhabi to that of Germany, using German resource consumption profiles Source WHO Statistical Information System/World Health Statistics 2009, Public health department, SCAD, and health facility submissions.

82 To Ensure Reliable Excellence in healthcare to the community Financing Encounters Payers Providers Claims

83 HAAD Annual report Financing Payers Claims Encounters Providers by age, gender and nationality Female Male 110,000 10,000 90, , ,000 National Expatriate

84 To Ensure Reliable Excellence in healthcare to the community by age, gender and nationality 2010, continued As at 31 December 2010 Age band National Expatriate All Male Female Total Male Female Total '165 37'049 32'812 69'861 41'260 38'044 79' '517 32'081 28'763 60'844 33'825 31'848 65' '655 26'377 23'345 49'722 26'033 24'900 50' '907 24'149 21'723 45'872 22'617 20'418 43' '512 20'383 20'465 40' '205 40' ' '422 19'534 21'131 40' '700 74' ' '554 16'244 18'470 34' '627 65' ' '604 10'634 12'961 23' '381 47' ' '347 7'613 9'496 17' '924 34' ' '646 5'416 6'876 12'292 98'645 23' ' '034 4'356 6'047 10'403 71'292 17'339 88' '988 3'724 4'421 8'145 39'679 11'164 50' '428 3'291 3'261 6'552 12'653 5'223 17' '063 2'457 2'052 4'509 3'238 2'316 5' '446 2'023 1'737 3' ' '428 1' ' ' ' ' ' Total 2'321' ' ' '769 1'447' '754 1'887'234 Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here differ and are for internal HAAD use only Source SCAD population estimates for Nationals, additional HAAD assumptions and analysis based on raw insurance data

85 HAAD Annual report Financing Payers Claims Encounters Providers by region and nationality 2010 As at 31 December 2010 Region National Expatriate Total National Expatriate Abu Dhabi Al Ain Western % 86.4% 36.1% 63.9% 18.7% 81.3% Total % 40.8% 6.6% 16.6% 52.6% 76.8% National Expatriate Abu Dhabi Al Ain Western

86 To Ensure Reliable Excellence in healthcare to the community Births and deaths 2010 Note Rates = crude birth and death rates based on internal HAAD population estimates (per 1000)other rates based on crude births (per 1000); HAAD and SCAD are collaborating to align with official SCAD data, still births 2009 data, 2009 data had been revised by the Public Health Source Birth and Death notification data-emirate of Abu Dhabi, 2010; provided by HAAD-Public Health and Policy Department; Health Statistics Analysis

87 HAAD Annual report Financing Payers Encounters Providers Claims Births and deaths time series Births National Expatriate Aggregate Year Total National Rate Expatriate Rate % Nationals Note Rates based on internal HAAD population estimates; HAAD and SCAD are collaborating to align with official SCAD data; Presented data excludes cases where nationality is not available, 2009 data had been revised by the Public Health Source MOH statistical books, Preventive Medicine Department annual reports, Public Health and Policy; Health Statistics analysis

88 To Ensure Reliable Excellence in healthcare to the community Births and deaths time series, continued Deaths Year Total National Rate Expatriate Rate % Nationals ' % ' % ' % ' % ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % ' ' % Note Rates based on internal HAAD population estimates; HAAD and SCAD are collaborating to align with official SCAD data; Presented data excludes cases where nationality is not available, 2009 data had been revised by the Public Health Source MOH statistical books, Preventive Medicine Department annual reports, Public Health and Policy; Health Statistics analysis

89 HAAD Annual report Financing Payers Encounters Providers Claims Leading causes of death 2010 Injury, poisoning and certain other consequences of external causes 1% Congenital malformations, deformations and chromosomal abnormalities 5% Diseases of the circulatory system 27% Endocrine, nutritional and metabolic diseases 7% External causes of morbidity and mortality 19% Other causes 25% Neoplasms 16% Causes Diseases of the circulatory system External causes of morbidity and mortality Injury, poisoning and certain other consequences of external causes Neoplasms Endocrine, nutritional and metabolic diseases Congenital malformations, deformations and chromosomal abnormalities Other Total Note Causes of death classified according to WHO ICD-10, 2009 data had been revised by the Public Health Source Death notification data - Emirate of Abu Dhabi, 2010, HAAD-Public Health and Policy

90 To Ensure Reliable Excellence in healthcare to the community Leading causes of death 2010, continued National Expatriate NA By gender By age group By gender By age group By gender By age group Causes of death Cases NA NA Total Death 2' Diseases of the circulatory system External causes of morbidity and mortality Neoplasms Endocrine, nutritional and metabolic diseases Diseases of the respiratory system Congenital malformations, deformations and chromosomal abnormalities Certain conditions originating in the perinatal period Diseases of the digestive system Certain infectious and parasitic diseases Diseases of the genitourinary system Injury, poisoning and certain other consequences of external causes Diseases of the nervous system Diseases of the blood and blood-forming organs and certain disorders involving the immune Diseases of the musculoskeletal system and connective tissue Factors influencing health status and contact with health services Mental and behavioural disorders Diseases of the skin and subcutaneous tissue Pregnancy, childbirth and the puerperium Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Causes of death not defined Note Classification according to ICD 10; 51.9% of infant deaths (122 cases) are due to congenital malformations, deformations and chromosomal abnormalities Source HAAD Death notification data complemented by investigation of causes of injury using medical records and police reports - Public Health and Policy; Health Statistics Analysis

91 HAAD Annual report Financing Payers Encounters Providers Claims Injury deaths 2010 Occupational Injury 14% Suicide 8% Occupational RTI 5% Road Traffic Injury 63% Other injuries 4% Home injuries 4% Drowning 2% % Change Cases % National Total -19% Road Traffic Injury -19% % 27% 28% 28% Occupational Injury -9% % 4% 3% 5% Occupational RTI 0% % 0% 13% 6% Suicide -18% % 0% 2% 3% Home -63% % 23% 24% 20% Drowning 8% % 31% 38% 36% Other 10% % 24% 25% 39% Source HAAD Death notification data complemented by investigation of causes of injury using medical records and police reports - Public Health and Policy; Health Statistics Analysis

92 To Ensure Reliable Excellence in healthcare to the community Injury deaths 2010, continued Male 1.40 Female Rate per CASES AGE Source HAAD Death notification data complemented by investigation into the causes of injury using medical records and police reports - Public Health and Policy; Health Statistics Analysis

93 HAAD Annual report Financing Payers Claims Encounters Providers Communicable diseases 2010 Preventable Screened Total National Expatriate NA Disease Chickenpox Malaria Viral Hepatitis B Viral Hepatitis C Scabies Other Food Poisoning Pulmonary Tuberculosis Typhoid Fever Other STD Seasonal Influenza Mumps Viral Hepatitis A Extra Pulmonary Tuberculosis Scarlet Fever Salmonella Whooping Cough Gonorrhoea Syphilis Giardia Lambia Brucellosis Bacillary Dysentery Measles Viral Meningitis Other Viral Hepatitis Rubella Paratyphoid Fever Acute Flaccid Paralysis Acute Encephalitis Schistosomiasis 1 1 Tetanus 1 1 Other Note Preventable: Diseases preventable by vaccination, Screened: Adult expatriates are screened on application or renewal of residence visa Source HAAD infectious diseases notification data - Public Health and Policy; Health Statistics Analysis

94 To Ensure Reliable Excellence in healthcare to the community Selected cardiovascular indicators overview National 1 Correlation 2 Expatriate 3 Total Male Female Obesity Hypertension Diabetes High lipids Smoking Total Male Female Obesity 36% 33% 38% 20% 17% 32% Hypertension 17% 24% 12% 35% 33% 41% Diabetes 21% 22% 20% 18% 18% 18% High lipids 36% 50% 26% 18% 19% 15% Smoking 11% 24% 0.8% 25% 29% 6.6% Less More likely likely Source 1Preliminary analysis of Weqaya sample of UAE Nationals in the Emirate screened in , Public Health and Policy; Definitions: Obesity: body-mass index 30; Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; High lipids: LDL >4.1 mmol/l or HDL <1 mmol/l; Diabetes: HbA1c 6.1%; Smoking: at least one cigarette per day, 1 cigar/pipe per week or one shisha per month 2Preliminary analysis of Weqaya sample1, Public Health and Policy; Indicators used in correlation analysis: Obesity: body-mass index; Hypertension: systolic blood pressure; High lipids: LDL; Diabetes: HbA1c; Smoking: self-reported consumption 3Extrapolation based on a survey of 76,070 residents in the Emirate in 2005; Definitions: High lipids: self-reported history of high cholesterol and/or total serum cholesterol >200 mg/dl; Hypertension: self-reported history of hypertension, and/or systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; Obesity: body-mass index > 30; Diabetes: self-reported diabetes or fasting glucose over 126 mg/dl; where only random glucose was available, diabetes status was imputed using a logistic model; Smoking: self-reported smoking; UAE University and Health Statistics analysis

95 HAAD Annual report Financing Payers Claims Encounters Providers Selected cardiovascular indcators by age group and gender Preliminary Female Male Nationality Indicator National Obesity 25% 41% 57% 65% 55% 45% 37% 29% 37% 37% 36% 30% 25% 23% High lipids 20% 26% 34% 37% 38% 36% 35% 44% 56% 57% 55% 49% 51% 50% Hypertension 5% 8% 18% 34% 44% 50% 47% 18% 20% 28% 42% 47% 49% 46% Diabetes 8% 14% 34% 57% 61% 59% 57% 8% 17% 34% 55% 64% 62% 50% Smoking 1% 1% 1% 1% 1% 0% 0% 27% 27% 22% 17% 10% 7% 7% Heart disease 0% 1% 3% 8% 11% 14% 13% 1% 1% 3% 7% 12% 14% 14% Stroke 0% 1% 2% 4% 5% 6% 6% 1% 1% 1% 3% 5% 6% 6% 1 Physical exercise 25% 27% 25% 20% 13% 5% 6% 43% 40% 35% 33% 27% 19% 24% Expatriate Obesity 21% 32% 42% 51% 49% 30% 67% 12% 18% 21% 23% 30% 21% 18% High lipids 29% 37% 61% 66% 60% N/A N/A 16% 37% 48% 52% 52% 51% 50% Hypertension 3% 9% 28% 45% 65% 61% 58% 9% 16% 30% 46% 58% 53% 33% 2 Diabetes 5% 13% 32% 46% 61% 44% 33% 5% 15% 35% 46% 53% 47% 33% Smoking 6% 7% 9% 6% 5% 10% 0% 33% 29% 25% 21% 21% 14% 21% Physical exercise 21% 23% 27% 29% 23% 9% 8% 32% 31% 34% 37% 36% 24% 36% Source 1Preliminary analysis of Weqaya sample of UAE Nationals in the Emirate screened in , Public Health and Policy; Definitions: Obesity: body-mass index 30; Hypertension: systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; High lipids: LDL >4.1 mmol/l or HDL <1 mmol/l; Diabetes: HbA1c 6.1%; Smoking: at least one cigarette per day, 1 cigar/pipe per week or one shisha per month 2Extrapolation based on a survey of 76,070 residents in the Emirate in 2005; Definitions: High lipids: self-reported history of high cholesterol and/or total serum cholesterol >200 mg/dl; Hypertension: self-reported history of hypertension, and/or systolic blood pressure 140 mm Hg or diastolic blood pressure > 90 mm Hg; Obesity: body-mass index > 30; Diabetes: self-reported diabetes or fasting glucose over 126 mg/dl; where only random glucose was available, diabetes status was imputed using a logistic model; Smoking: self-reported smoking; Physical exercise: self-reported physical exercise; UAE University and Health Statistics analysis

96 To Ensure Reliable Excellence in healthcare to the community Prevalence of Diabetes Mellitus by age group 70 % 80, 000 % At risk of diabetes 60 % 70, 000 Average 50 % 60, % 50, , % 30, % 21 % 20, % 10, % Note Risk of diabetes is defined as HbA1c 6.1% Source Preliminary analysis of Weqaya sample of UAE Nationals in the Emirate screened in , Health Statistics

97 HAAD Annual report Financing Payers Encounters Providers Claims Diabetes performance Related care indicators Total Male Female Thiqa Enhanced Basic Diabetics 140,822 93,268 47,554 1,300 2,111 32,212 82,424 22,775 36,339 53,240 51,397 Well controlled diabetics 20 % 18 % 25 % 4 % 9 % 16 % 21 % 24 % 27 % 20 % 15 % Moderate & well controlled diabetics 26 % 23 % 31 % 5 % 12 % 20 % 27 % 32 % 35 % 25 % 19 % Annual HbA1c test 62 % 59 % 68 % 20 % 46 % 47 % 65 % 76 % 78 % 58 % 55 % Annual lipid profile test 58 % 57 % 62 % 10 % 30 % 48 % 62 % 66 % 69 % 53 % 57 % Annual renal test 63 % 60 % 68 % 25 % 47 % 51 % 65 % 74 % 75 % 60 % 57 % Annual eye exam 68 % 66 % 72 % 70 % 65 % 67 % 67 % 72 % 78 % 57 % 73 % latest LDL:HDL < % 8 % 14 % 5 % 12 % 7 % 10 % 15 % 24 % 6 % 4 % latest LDL:HDL > 3.5 w/o treatment 47 % 49 % 42 % 80 % 90 % 63 % 45 % 27 % 39 % 52 % 64 % Note Diabetics is number of members who had an encounter with diagnosis of diabetes. Well controlled diabetes is a measure of diabetics whose latest HbA1c<7%, whilst moderately controlled diabetics those whose latest HbA1c<7.5%. Related care indicators apply to diabetics only and indicate 1 test per member per annum. Rates shown are rates within breakdown category. Indicator definitions are available at Source KEH Encounters with start date 1 January 31 December 2010 as at 07 June 2011.

98 To Ensure Reliable Excellence in healthcare to the community Cancer 2009 By Nationality NA 1% By Gender NA 0% Expatriate 67% National 32% Female 47% Male 53% Cases 2009 Rate per 100'000 population Total Male Female NA Male Female Total 1,981 1, National Expatriate 1, NA Note Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator) Source Facility submissions, Public Health and Policies, Health Statistics Analysis

99 HAAD Annual report Financing Payers Claims Encounters Providers Cancer by site 2009 Total Female Male 40% % % % 351 Breast 8% % 235 Breast 8% 36% Organs 11% 41% % 33% % % % 73 Skin 33% 11% 36% 33% 20% 43% 63 21% 39 0% Skin 43% 54 34% 44 45% 40 15% 26 0% 25 44% 25 25% 12 Skin 21% 66 31% 51 56% 39 47% 34 19% 27 50% 14 0% 14 46% 26 35% Breast 12 2 National Expatriate NA Note Total includes seven cases with patient s gender not available Source Facility submissions, Public Health and Policies, Health Statistics Analysis

100 To Ensure Reliable Excellence in healthcare to the community Cancer by age group Cases incidence rate per 1000 population Age National Female % 45% % 44% % 38% % 55% % 61% % 51% % 52% % 62% % 57% % 62% % 48% % 39% % 32% % 40% % 33% % 36% % 46% NA 14% 29% Note Data need to be interpreted with caution, due to undercounting and ambiguity about the overall population (denominator) Source Facility submissions, Public Health and Policies, Health Statistics Analysis

101 HAAD Annual report 2010 Encounters 99 Financing Encounters Payers Providers Claims

102 To Ensure Reliable Excellence in healthcare to the community Encounters Encounters by type, setting and nationality 2010 Total Inpatient ER Outpatient Hospital SEHA Hospital SEHA Hospital SEHA Center SEHA Clinic SEHA '475' '349 59% 829'911 68% 4'870'917 28% 6'882'886 38% 712'132 1% National 6'036'649 67'275 73% 426'344 81% 1'384'015 57% 3'988'347 51% 170'669 1% Expatriate 7'438' '074 50% 403'567 55% 3'486'902 17% 2'894'539 20% 541'464 1% '468' '428 58% 829'533 71% 4'839'867 27% 5'049'410 48% 571'842 1% National 4'794'421 67'529 71% 428'651 82% 1'347'497 50% 3'029'646 62% 137'242 1% Expatriate 6'673' '899 51% 400'882 58% 3'492'370 19% 2'019'764 28% 434'600 1% Inpatient ER Clinic Center National '201' ' '598 4'999'387 4'026'446 1'288'484 National 4'489'972 66' '440 1'393'544 2'340' '236 Expatriate 6'711' ' '158 3'605'843 1'685' '248 Growth % 1% 0% 1% 36% 25% National 26% 0% -1% 3% 32% 24% Expatriate 11% 2% 1% 0% 43% 25% % 1% 12% 22% 28% 16% National 13% -3% 3% -2% 27% 16% Expatriate 29% 3% 24% 34% 29% 16% Outpatient Hospital Expatriate Setting Provider Nationality Total Inpatient ER Outpatient Hospital Hospital Hospital Center Clinic SEHA 4'654' ' '415 1'386'688 2'589'151 6'765 National 3'202'277 48' ' '716 2'023'910 1'381 Expatriate 1'451'987 56' ' ' '241 5'384 Other 8'890'793 83' '209 3'557'283 4'293' '367 National 2'921'983 25'329 80' '921 1'964' '288 Expatriate 5'968'810 57' '202 2'874'362 2'329' '079 Note 2010 data used, where available; otherwise 2009 data or extrapolations, estimates used; for Al Salama hospital 2008 used, growth rates indicative only Source Health Facility submissions ; Health Statistics Analysis

103 HAAD Annual report 2010 Encounters 101 Financing Payers Encounters Providers Claims Encounters by diagnosis group, % of volume Total Outpatient ER Inpatient % of Total Encounters Non-disease conditions Respiratory infections Musculoskeletal diseases Digestive diseases Endocrine disorders Cardiovascular diseases Respiratory diseases Skin diseases Genitourinary diseases Diabetes mellitus Sense organ diseases Oral conditions Infectious and parasitic diseases Neuropsychiatric conditions Nutritional deficiencies Maternal and Perinatal conditions Cancer Injuries Congenital anomalies RTA Note Non-disease conditions include Injuries (ICD-9 codes ) Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

104 To Ensure Reliable Excellence in healthcare to the community Encounters Encounters by diagnosis group, % of value Total Outpatient Inpatient 77.7% 22.3% Break down Break down Services Procedures Drugs Supplies Services Procedures Drugs Supplies % of Total value Non-disease conditions Cardiovascular diseases Respiratory infections Endocrine disorders Musculoskeletal diseases Digestive diseases Maternal and Perinatal conditions Oral conditions Genitourinary diseases Diabetes mellitus Respiratory diseases Infectious and parasitic diseases Skin diseases Sense organ diseases Neuropsychiatric conditions Cancer Nutritional deficiencies Injuries Congenital anomalies RTA Note Procedures: CPT + Dental codes, Supplies: HCPCS codes Source Health Statistics analysis based on A sample of 3,971,975 encounters from data submissions in 2009; categorization based on WHO classification of ICD diagnosis

105 HAAD Annual report 2010 Encounters 103 Financing Payers Claims Encounters Providers Activities by type, % of value Drug 12% Dental 6% Service 26% DRG 1% HCPCS 5% CPT 50% CPT 100% Service 100% Pathology & Laboratory 54.3% Consultation Specialist 23% Diagnostic Ultrasound 8.1% Generic code for yet undefined services 21% Radiology 8.0% Consultation Consultant 14% Maternity Care & Delivery 5.7% Consultation GP 13% Digestive System 4.2% Room and Board: Per Diem - First Class Room 10% Musculoskeletal 3.6% Room and Board: Per Diem Semi -Private (Shared Room) 3.0% Integumentary 2.6% Per diem Intensive - Care Unit (ICU) and Cardiac Care Unit 2.9% Cardiovascular System 2.6% Per diem N-ICU 2.2% Eye & Ocular Adnexa 1.8% Room and Board: Per diem -Observation <6 hours 2.1% Respiratory System 1.8% Room and Board: Per Diem - Ward 1.1% Evaluation & Management 1.6% Room and Board: Long-term Stay (Intermediate) 1.0% Urinary System 1.6% Per diem Inpatient 1.0% Female Genital System 0.9% Room and Board: Private Room Deluxe or better 1.0% Nuclear Medicine 0.7% Per diem -Observation <6 hours 0.6% Auditory System 0.6% Room and Board: Long-term Stay (Intensive) 0.6% Nervous System 0.5% Room and Board: Per Diem - Long stay (simple cases) 0.5% Male Genital System 0.5% Per diem - Special-Care Baby Unit (SCBU) 0.4% Other CPT 0.4% Room and Board: Per Diem - Pediatric Intensive-Care Unit (PICU) 0.4% Radiation Oncology 0.3% Room and Board: Escorts 0.4% Breast Mammography 0.1% Room and Board: Per Diem- Day care < 12 hours 0.3% Operating Room 0.2% Per diem - Special-Care Unit (SCU) or Adult Special-Care Unit (ASCU) 0.2% Room and Board: Per Diem -Newborn Nursery 0.2% Room and Board: Per Diem - Isolation Room or Negative pressure room 0.1% Per Diem- Day care < 12 hours 0.1% Home Visit 0.1% Note Not all drugs have been mapped to the appropriate ATC code ; HCPCS CMS Hospital Outpatient Payment system includes 90% unclassified drugs. Source Health statistics analysis; Cube 2010

106 To Ensure Reliable Excellence in healthcare to the community Encounters Activities by type, % of value, continued Drug 12% Dental 6% Service 26% DRG 1% HCPCS 5% CPT 50% Drug 100% Dental 100% Antiinfectives for systemic use 26% Restoration 34% Alimentary tract and metabolism 11% Adjunctivegeneral 12% Cardiovascular system 11% Diagnostic 12% Blood and blood forming organs 11% Oralmaxillo 10% Antineoplastic and immunomodulating agents 9% Endodontics 10% Musculo-skeletal system 8% Orthodontics 9% Respiratory system 7% Prevention 6% Dermatologicals 2.3% Periodontics 3.1% Nervous system 2.1% Fixedprostho 2.8% Genito-urinary system and sex hormones 2.0% Removableprostho 1.1% Various 1.3% Sensory organs 1.2% Systemic hormonal preparations, excluding sex hormones and insulins 0.7% Antiparasitic products, insecticides and repellents 0.0% Note Not all drugs have been mapped to the appropriate ATC code ; HCPCS CMS Hospital Outpatient Payment system includes 90% unclassified drugs. Source Health statistics analysis; Cube 2010

107 HAAD Annual report 2010 Encounters 105 Financing Payers Encounters Providers Claims Procedures by diagnosis group, % of value Diagnosis group Overall Top 5* 1st 2nd 3rd 4th 5th Non-disease conditions 23.0 Complete CBC W/Auto Diff Wbc Ob US >/= 14 Weeks, Single Fetus Therapeutic Exercises OB US, Detailed, Single Fetus US Exam, Abdom, Complete Oral conditions 11.3 Instalment for Treatment In Progress One Surface Two Surfaces Class I Malocclusion + L Crown, Porcelain/Ceramic/Polymer Glass + L Maternal and Perinatal conditions 8.2 Obstetrical Care Cesarean Delivery Only OB US >/= 14 Weeks, Single Fetus Fetal Non-Stress Test OB US < 14 Weeks, Single Fetus Musculoskeletal diseases 7.5 Knee Arthroscopy/Surgery MRI Lumbar Spine W/O Dye Therapeutic Exercises MRI Joint of Lower Extre W/O Dye MRI Neck Spine W/O Dye Genitourinary diseases 6.9 Hemodialysis, One Evaluation US Exam, Pelvic, Complete Transvaginal US, Non-OB Fragmenting of Kidney Stone US Exam Abdo Back Wall, Comp Diabetes mellitus 6.8 Lipid Panel Assay of Parathormone Glycosylated Hemoglobin Test Assay of Vitamin D Assay of Ck (cpk) Cardiovascular diseases 5.8 Echo Exam of Heart Left Heart Catheterization Cath Placement, Angiography Insert Intracoronary Stent Lipid Panel Digestive diseases 5.4 Laparoscopic Cholecystectomy Upper GI Endoscopy, Biopsy US Exam, Abdom, Complete Laparoscopy, Appendectomy Complete CBC W/Auto Diff WBC Endocrine disorders 3.8 Lipid Panel Assay Thyroid Stim Hormone Assay of Vitamin D Assay of Free Thyroxine Free Assay (Ft-3) Respiratory infections 3.5 Ther/Proph/Diag Inj, Sc/Im Airway Inhalation Treatment Complete CBC W/Auto Diff WBC Nasal Endoscopy, Dx Ther/Proph/Diag Inj, Iv Push Respiratory diseases 3.3 Nasal Endoscopy, Dx Repair of Nasal Septum Remove Tonsils and Adenoids Airway Inhalation Treatment CT Maxillofacial W/O Dye Sense organ diseases 3.0 Cataract Surg W/Iol, 1 Stage Treatment of Retinal Lesion Remove Impacted Ear Wax Remove Foreign Body From Eye Eye Service or Procedure Neuropsychiatric conditions 2.5 Psytx, Off, Min W/E&M Medication Management Psy Dx Interview Motor Nerve Conduction Test Psytx, Off, Min Cancer 2.4 Pet Image W/CT, Full Body Chemo, IV Infusion, 1 Hr Radiation Treatment Delivery CT Abdomen W/Dye Tissue Exam By Pathologist Skin diseases 2.3 Drainage of Skin Abscess Complete CBC W/Auto Diff WBC Ther/Proph/Diag Inj, Sc/Im Active Wound Care/20 Cm Or < Laser Tx, Skin < 250 Sq Cm Infectious and parasitic diseases 2.3 Destruct B9 Lesion, 1-14 Transvaginal US, Non-OB Complete CBC W/Auto Diff Wbc US Exam, Pelvic, Complete Destruct Lesion, 15 Or More Nutritional deficiencies 1.1 Assay of Vitamin D Assay of Parathormone Assay of Ferritin Complete CBC W/Auto Diff WBC Assay Thyroid Stim Hormone Congenital anomalies 0.9 Echo Transthoracic Echo Exam of Heart Blood Gases W/O2 Saturation Suspension of Testis Reconstruction of Urethra Injuries 0.0 Insertion of Cannula(S) Lower Jaw Bone Graft Blood Gases W/O2 Saturation Resect/Excise Lesion, Skull Shoulder Arthroscopy/Surgery RTA 0.0 Insertion of Cannula(S) Skin Splt Grft, Trnk/Arm/Leg Mri Lumbar Spine W/O Dye Wnd Prep, Ch/Inf, Trk/Arm/Lg CT Head/Brain W/O Dye 100 * Share of top 5 procedures within diagnosis group Note Procedures: CPT + Dental codes, Supplies: HCPCS codes; Non-disease conditions include Injuries (ICD-9 codes ) Data should be interpreted with caution, particularly for categories with low counts Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

108 To Ensure Reliable Excellence in healthcare to the community Encounters Drugs by diagnosis group, % of value Diagnosis group Overall Top 5 1st 2nd 3rd 4th 5th Diabetes mellitus 19.9 Lipitor Januvia Janumet Lantus Solostar Crestor Non-disease conditions 11.3 Herceptin Augmentin Lipitor Pantozol Avastin Respiratory infections 10.9 Augmentin Zinnat Rocephin Omnicef Klacid Cardiovascular diseases 10.0 Lipitor Plavix Norvasc Crestor Pantozol Musculoskeletal diseases 7.4 Humira Celebrex Arcoxia Lyrica Voltaren Endocrine disorders 6.1 Lipitor Kogenate Fs Exjade Crestor Naglazyme Respiratory diseases 5.7 Singulair Seretide Diskus Symbicort Turbuhler Singulair Paediatric Pulmicort Digestive diseases 5.4 Nexium Humira Pantozol Pariet Omiz Skin diseases 4.6 Humira Enbrel Remicade Roaccutane Augmentin Infectious and parasitic diseases 3.6 Pegasys Baraclude Lamisil Zovirax Ciprobay Genitourinary diseases 3.5 Ciprobay Omnic Arnasep Tavanic Xatral Xl Neuropsychiatric conditions 3.4 Avonex Keppra Rebif Seroquel Topamax Cancer 3.3 Glivec Herceptin Avastin Neulastim Revlimid Sense organ diseases 2.0 Lucentis Cosopt Artelac Advanced Zaditen Travatan Maternal and Perinatal conditions 1.2 Clexane Duphaston Synagis Augmentin Rocephin Nutritional deficiencies 1.0 Humira Lipitor D-Forte Enbrel One-Alpha Oral conditions 0.6 Augmentin Brufen Amoxil Zinnat Cataflam Congenital anomalies 0.2 Tracleer Norditropin Synagis Genotropin Viagra Injuries 0.0 Augmentin Meiact Tazocin Meronem Brufen RTA 0.0 Lipitor Augmentin Clexane Plavix Pantozol 100 * Share of top 5 procedures within diagnosis group Note Data should be interpreted with caution, particularly for categories with low counts; Non-disease conditions include Injuries (ICD-9 codes ) Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

109 HAAD Annual report 2010 Providers 107 Financing Payers Claims Encounters Providers Financing Encounters Payers Providers Claims

110 To Ensure Reliable Excellence in healthcare to the community Providers Providers 2010 Facilities Clinicians Store 5% Other 3% Hospital 3% Total SEHA Abu Dhabi Eastern Western Total Total % '103 Hospital 33 36% '588 Centers (various) % '173 Center % '068 Physicians 4'757 3' SEHA 56% 31% Dentists SEHA 11% 26% Nurses 8'221 6'887 1' SEHA 76% 46% AHPs* 5'246 2' SEHA 84% 59% Diagnostic 16 31% Rehabilitation 101 1% Polyclinic 197 0% Clinic 20 % Centers (various) 35% Clinic 239 2% Pharmacy % '558 Store 60 2% Other 36 22% ' Clinicians Breakdown by Nationality & Gender Pharmacy 34% Growth rate (CAGR ) CAGR Hospital Centers (various) Clinic Pharmacy National Male Female 4% 7% Expatriate Male 62% Female 27% Clinicians Breakdown by Region Abu Dhabi 65% Al Ain 29% Western 5% 2% 7% 57% 34% 68% 29% 3% 0% 1% 16% 83% 63% 31% 6% 1% 6% 41% 52% 67% 28% 5% Store Notes Definitions of categories as per Health Facilities Licensing criteria, see Seven Day Surgery Hospitals considered as Centers as per Health Facilities Licensing Criteria changes, One hospital was licensed by December 30,2010. Behavioral Science and Rehabilitation considered as part of SKMC as they are under SKMC management Liwa licensed as a hospital but doesn t have inpatients, therefore classified as a Center Al Ain Military Hospital added to the Eastern region Non-SEHA hospitals, not licensed by HAAD, but they do operate in Eastern region with about 130 bed capacity Source Facility licensing database as of 27th January, 2011

111 HAAD Annual report 2010 Providers 109 Financing Payers Encounters Providers Claims Clinical performance Consultant Specialist GP Hospital Center Polyclinic Clinic Public Private Episodes w Common Cold w Antibiotics 34 % 35 % 34 % 34 % 36 % 24 % 50 % 28 % 22 % 39 % Routine dental extraction w complication 1 % 0 % 1 % 1 % 1 % 1 % 1 % 1 % 1 % 1 % Episodes Obese w Lifestyle or Drugs 5 % 22 % 3 % 2 % 5 % 12 % 8 % 10 % 1 % Episodes [GR]/Encounters [DM] w potentially severe or life threatening drug-drug interactions GR DM 0.42% 0.17% 1.44% 0.17% Encounters w absolute drug-disease DM 0.73 % 1.00% 0.74% 0.55% 0.84% 0.51% 1.20% 1.61% 0.46% 0.91% Episodes w duplicate generic drug prescribed GR 16 % 27% 14% 19% 22% 20% 0.20% 0.17% 19% 17% Encounters w diagnosis error alerts DM 1.52 % 1.16% 1.87% 1.08% 1.78% % 0.65% 0.54% 2.50% Encounters w inappropriate CPT alerts DM 51 % 63% 51% 41% 66% 30% 21% 47% 44% 49% 0.61% 0.18% 0.19% 0.11% 0.60% 0.20% % % 0.15% 0.00% 0.80% 0.82% 0.08% 0.34% 0.23% Notes Performance is not shown for all categories of healthcare professionals or healthcare facilities. Rates shown are rates within breakdown category. DM Clinician Category encounter numbers based on activity count ratios during sample period. Indicator definitions are available at Source KEH Episodes with Encounter start date 1 January 31 December 2010 as at 10 May Drug/Diagnosis/CPT alerts: KEH, Greenrain (Sample of 3,057,800 encounters with transaction dates 1-30 September 2010), Dimensions Healthcare (Ingenix and CMP Medica) sample of 6,778,887 encounters with activity start dates 1 March - 10 September 2010.

112 To Ensure Reliable Excellence in healthcare to the community Providers Labour productivity Indicative Productivity Episodes (000) Episodes per doctor per day 6.4 Al Ahalia Al Wagan Oasis Al Noor - Airport Road Al Noor Al Salama Al Noor - Al Ain Al Ain Dar Al Shifaa Specialized Medical Care SKMC National Emirates International Al Rahba Ghayathi Life Line N M C Specialty - Al Ain Delma Gulf Diagnostic Center N M C Specialty Al Corniche Al Silla Tawam Al Mafraq Al Raha Al Mirfa Madinat Zayed Emirates French Al Reef Internaional Al Rewaise Seha Other 2.9 Episodes per nurse per day Hospital Doctor Nurse Inpatient Outpatient Total, Weighted Al Ahalia Al Wagan Oasis Al Noor Al Salama Al Noor - Airport Road Al Noor - Al Ain Specialized Medical Care Dar Al Shifaa Al Ain SKMC ,021.3 National Emirates International Life Line Ghayathi N M C Specialty - Al Ain Al Rahba Gulf Diagnostic Center Delma N M C Specialty Tawam Al Corniche Al Raha Al Silla Al Mafraq Al Mirfa Madinat Zayed Emirates French Al Reef Internaional Al Rewaise Total/Average , ,366.3 Note Productivity is defined as adjusted episodes per clinician per day. An Episode is any encounter with a consultation. To account for the higher resource need of inpatients, inpatient episodes are multiplied by ratio of the average value (ClaimNet) of an Inpatient Episode versus an Outpatient episode. To reflect clinical complexity inpatient episodes are then adjusted by the difference of case mix index of each individual hospital from Abu Dhabi average. Seha hospitals episodes are underestimated due to certain Seha clinical obligations such as public events medical preparation. Tawam hospital provides rotating staff to Al Wagan which effects both hospitals productivity. Source Cube 2010; HAAD licensing database; Operations Center data for 2009; Health Statistics analysis, Medical Group Management Association Survey

113 HAAD Annual report 2010 Providers 111 Financing Payers Encounters Providers Claims Hospital patient satisfaction, inpatient indicators Criteria Medical Staff Allied Healthcare Professionals Discharge Process Inpatient Care Tangibles Non Tangibles Hospital Name City / Area No. Of Beds Overall Rating of Healthcare Facility Overall Courteousness & Friendliness Proper Communication Response Time Overall Courteousness & Friendliness Proper Communication Time Spent Overall Timely & Smooth Discharge Process Instructions Provided for Care at Home Medication & Provision for Follow up Care Overall Pain Management Medication Overall Accomodation Facility Food & Beverage Visual Appeal Parking Facility Overall Convenience of Location Convenience of Visiting Overall Cleanliness Resolution of Medical Problem Paperwork at Reception Noise Level Al Noor Hospital (Airport Road) Abu Dhabi % NMC Hospital (Abu Dhabi) Abu Dhabi % Al Noor Hospital (Khalifa Street) Abu Dhabi % Al Reef International Hospital Abu Dhabi % SKMC Hospital [SEHA] Abu Dhabi % Al Corniche Hospital [SEHA] Abu Dhabi % Al Rahba Hospital [SEHA] Abu Dhabi % National Hospital Abu Dhabi % Al Raha Hospital Abu Dhabi % Al Mafraq Hospital [SEHA] Abu Dhabi % Dar Al Shifa Hospital Abu Dhabi % Magrabi Hospital Abu Dhabi % Gulf Diagnostic Center Hospital Abu Dhabi % Al Salama Hospital Abu Dhabi % CosmeSurge & Emirates Hospital Abu Dhabi % Lifeline Hospital Abu Dhabi % Emirates French Hospital Abu Dhabi % Ahalia Hospital Abu Dhabi % Al Samaya Specialized Hospital Abu Dhabi % Lifeline Day Care Hospital Abu Dhabi % SKMC (Psychiatrics) [SEHA] Abu Dhabi % Al Noor Hospital (Al Ain) Eastern Region % Emirates International Hospital Eastern Region % NMC Hospital (Al Ain) Eastern Region % Al Ain Hospital [SEHA] Eastern Region % Specialized Medical Centre Hospital Eastern Region % Oasis Hospital Eastern Region % Al Tawam Hospital [SEHA] Eastern Region % Madinat Zayed Hospital Western Region % Wagan Hospital [SEHA] Western Region % Ruwais Hospital Western Region % Al Ghayathy Hospital Western Region % Al Mirfa Hospital [SEHA] Western Region % Delma Hospital [SEHA] Western Region % Sila Hospital [SEHA] Western Region % Note Overall facility rating is based on a single question in the patient satisfaction questionnaire; Source: GRMC Advisory Services, 2010

114 To Ensure Reliable Excellence in healthcare to the community Providers Hospital patient satisfaction, outpatient indicators Medical Staff Tangibles Non Tangibles Hospital Name City / Area Overall Rating of Healthcare Facility Overall & Friendliness Proper Communication Time Spent Explanation of Test and Treatment Explanation of Medical Condition Overall Facility & Equipments Parking Facility Comfort of Waiting Area Clarity of Healthcare Facility Internal Signs Visual Appeal Overall Location Overall Cleanliness Privacy Waiting Time Paperwork Involved Al Samaya Specialized Hospital Abu Dhabi 86.8% Lifeline Hospital Abu Dhabi 86.7% Al Corniche Hospital [SEHA] Abu Dhabi 85.5% Al Noor Hospital (Khalifa Street) Abu Dhabi 86.4% Al Mazroui Hospital Abu Dhabi 86.3% Al Rahba Hospital [SEHA] Abu Dhabi 85.1% Al Noor Hospital (Airport Road) Abu Dhabi 85.1% SKMC Hospital [SEHA] Abu Dhabi 84.9% National Hospital Abu Dhabi 84.9% Magrabi Hospital Abu Dhabi 84.8% Dar Al Shifa Hospital Abu Dhabi 84.7% Al Raha Hospital Abu Dhabi 84.7% Emirates French Hospital Abu Dhabi 84.6% NMC Hospital (Abu Dhabi) Abu Dhabi 84.5% CosmeSurge & Emirates Hospital Abu Dhabi 84.5% Al Salama Hospital Abu Dhabi 84.0% Al Mafraq Hospital [SEHA] Abu Dhabi 83.1% Gulf Diagnostic Center Hospital Abu Dhabi 81.3% Al Reef International Hospital Abu Dhabi 80.7% SKMC (Psychiatrics) [SEHA] Abu Dhabi 78.6% Lifeline Day Care Hospital Abu Dhabi 78.6% Ahalia Hospital Abu Dhabi 75.6% NMC Hospital (Al Ain) Eastern Region 86.8% Specialized Medical Centre Hospital Eastern Region 86.7% Emirates International Hospital Eastern Region 84.9% Al Noor Hospital (Al Ain) Eastern Region 84.7% Al Tawam Hospital [SEHA] Eastern Region 83.3% Al Ain Hospital [SEHA] Eastern Region 83.1% Oasis Hospital Eastern Region 82.0% Liwa Hospital [SEHA] Western Region 85.9% Al Ghayathy Hospital [SEHA] Western Region 84.7% Madinat Zayed Hospital [SEHA] Western Region 83.3% Wagan Hospital [SEHA] Western Region 80.3% Al Mirfa Hospital [SEHA] Western Region 79.9% Ruwais Hospital Western Region 79.8% Delma Hospital [SEHA] Western Region 79.6% Sila Hospital [SEHA] Western Region 78.0% Note Overall facility rating is based on a single question in the patient satisfaction questionnaire; Source: GRMC Advisory Services, 2010

115 HAAD Annual report 2010 Providers 113 Financing Payers Claims Encounters Providers Hospitals RegionHospital Inpatients ER Outpatients Total Dentists Physicians % Consultants % Specialist % GP Nurses Paramedics Administrators Bed capacity Critical VIP Royal Bed Occupancy ALOS Notes * Total Operational beds include 88 and 125 beds for SKMC Rehabilitation Center and Behavioral Science Pavilion as of 31st December 10; Staff as of December 10; Activities: Al Salama 08, no data available for Al Hayat, Al Rewaise, Zayed Military Hospital Source Hospital submissions, Operation Center, Clinician Licensing Database

116 To Ensure Reliable Excellence in healthcare to the community Providers Hospital inpatient profile by value Hospital Name Overall Top 5* 1st 2nd 3rd 4th 5th Tawam 24 Maternal and Perinatal conditions (24%) Non-disease conditions (24%) Cardiovascular diseases (9%) Cancer (9%) Endocrine disorders (5%) SKMC 9 Cardiovascular diseases (16%) Non-disease conditions (16%) Congenital anomalies (12%) Musculoskeletal diseases (9%) Neuropsychiatric conditions (7%) Al Noor - Airport Road 8 Cardiovascular diseases (26%) Maternal and Perinatal conditions (21%) Digestive diseases (11%) Respiratory diseases (9%) Non-disease conditions (7%) Al Corniche 7 Maternal and Perinatal conditions (82%) Non-disease conditions (15%) Genitourinary diseases (2%) Cancer (1%) Infectious and parasitic diseases (%) Al Ain 6 Maternal and Perinatal conditions Non-disease conditions (14%) Digestive diseases (11%) Neuropsychiatric conditions (9%) Respiratory diseases (7%) Al Noor 6 Maternal and Perinatal conditions (21%) Digestive diseases (14%) Non-disease conditions (12%) Respiratory diseases (11%) Genitourinary diseases (10%) Al Mafraq 5 Non-disease conditions (24%) Maternal and Perinatal conditions (18%) Cardiovascular diseases (11%) Sense organ diseases (8%) Digestive diseases (7%) N M C Specialty 5 Cardiovascular diseases (19%) Digestive diseases (17%) Non-disease conditions (12%) Musculoskeletal diseases (11%) Maternal and Perinatal conditions (10%) Oasis 4 Maternal and Perinatal conditions (75%) Digestive diseases (6%) Non-disease conditions (6%) Genitourinary diseases (4%) Respiratory infections (3%) Al Noor - Al Ain 3 Maternal and Perinatal conditions (17%) Digestive diseases (17%) Non-disease conditions (13%) Cardiovascular diseases (12%) Genitourinary diseases (12%) Madinat Zayed 3 Maternal and Perinatal conditions (25%) Non-disease conditions (17%) Digestive diseases (16%) Cardiovascular diseases (10%) Respiratory infections (8%) Al Salama 3 Non-disease conditions (33%) Digestive diseases (17%) Respiratory diseases (10%) Musculoskeletal diseases (8%) Respiratory infections (7%) Life Line 2 Non-disease conditions (20%) Maternal and Perinatal conditions (18%) Digestive diseases (14%) Genitourinary diseases (12%) Musculoskeletal diseases (8%) Al Ahlia 2 Cardiovascular diseases (27%) Digestive diseases (21%) Genitourinary diseases (16%) Non-disease conditions (11%) Maternal and Perinatal conditions (7%) Al Rahba 2 Respiratory diseases (45%) Maternal and Perinatal conditions (35%) Digestive diseases (5%) Musculoskeletal diseases (4%) Genitourinary diseases (2%) N M C Specialty - Al Ain 2 Digestive diseases (2%) Musculoskeletal diseases (2%) Non-disease conditions (2%) Genitourinary diseases (2%) Cardiovascular diseases (1%) Behavioral Sciences Pavilion 1 Digestive diseases (99%) Musculoskeletal diseases (1%) Non-disease conditions (%) Genitourinary diseases (%) Cardiovascular diseases (%) Emirates French 1 Respiratory diseases (65%) Maternal and Perinatal conditions (12%) Digestive diseases (5%) Cancer (4%) Non-disease conditions (4%) Emirates International 1 Digestive diseases (24%) Non-disease conditions (16%) Maternal and Perinatal conditions (15%) Cardiovascular diseases (9%) Respiratory diseases (8%) Gulf Diagnostic Center 1 Respiratory diseases (32%) Genitourinary diseases (17%) Respiratory infections (9%) Digestive diseases (8%) Cardiovascular diseases (6%) Ghiathy 1 Respiratory infections (24%) Maternal and Perinatal conditions (23%) Digestive diseases (11%) Non-disease conditions (11%) Cardiovascular diseases (9%) Dar Al Shifaa 1 Respiratory diseases (23%) Digestive diseases (17%) Maternal and Perinatal conditions (14%) Genitourinary diseases (11%) Respiratory infections (8%) Specialized Medical Care 1 Genitourinary diseases (26%) Respiratory diseases (25%) Maternal and Perinatal conditions (13%) Digestive diseases (8%) Infectious and parasitic diseases (8%) Marfa Hospital 1 Maternal and Perinatal conditions (41%) Non-disease conditions (16%) Digestive diseases (9%) Respiratory infections (9%) Cardiovascular diseases (6%) Ruwais 1 Maternal and Perinatal conditions (54%) Digestive diseases (13%) Non-disease conditions (12%) Cardiovascular diseases (6%) Respiratory infections (5%) Silla 1 Maternal and Perinatal conditions (38%) Cardiovascular diseases (13%) Digestive diseases (12%) Respiratory infections (11%) Non-disease conditions (10%) Delma 0 Maternal and Perinatal conditions (30%) Digestive diseases (20%) Non-disease conditions (12%) Respiratory infections (9%) Skin diseases (7%) Al Reef Internaional 0 Musculoskeletal diseases (82%) Genitourinary diseases (6%) Non-disease conditions (5%) Cardiovascular diseases (2%) Digestive diseases (1%) National 0 Digestive diseases (34%) Genitourinary diseases (12%) Cardiovascular diseases (10%) Respiratory infections (9%) Non-disease conditions (8%) * Share of top 5 Diagnoses groups within providers Note Non-disease conditions includes injury codes ( ) Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

117 HAAD Annual report 2010 Providers 115 Financing Payers Encounters Providers Claims Centres & Clinics SEHA Note List of Non-SEHA facilities with more than 10 clinicians. Al Khobisi Clinic data is not available; no staff data on Al Masoudi and Oud Al Towba centrs Source Extrapolation and Facility submissions, Professionals licensing database Region Facility Encountes Total 2'595' Other 113 Island Abu Dhabi City Dental Center 40' Al Bateen 67' Al EttIhad Urgent Care 24' Al Khaleej 31' Al Khalidiya Urgent Care 42' Al Madina Urgent Care 10'488 Al Manhal 33' Al Mushrif 19' Al Rowda 30' Al Zafarana 44' Al Zafra Dental Center 23' Middle Al Khatim 19' Al Nahda 34' BAG 153' Baniyas 170' Khalifa A 173' Samalia 63 Samha 60' Shahama 147' Musaffah 17' Airport 6' Al Mafraq Dental Center 76' Eastern Al Faqah 6' Al Hayer 31' Al Jahili 86' Al Khazna 10' Al Maqam 103' Al Qua'a 36' Al Yahar 101' Hili 46' Mezyed 135' Muweiji 427' Neima 93' Niyadat 68' Remah 17' Shuaib 9' Swaihan 22' Tawam Dental Center 39' Zakher 27' Al Masoudi Center 69'460 Oud Al Towba Center 22'794 Western Abulabuad 1' Beda Mutawa 1' M. Zayed Center 4' Sir Bany Yas Physicians Dentists Nurses AHP Other Region Facility Encounters Physicians Dentists Nurse AHP Total 4'999' Other 2'793' Abu Dhabi Advance Cure Diagnostic Centre L.L.C 138' Island Falcon Medical Supplies 137' New National Medical Centre 119' Prince Specialized Medical Centre 97' Al Noor Hospital Clinics - Al Mussaffah 89' The Specialist Diabetes Treatment & Research Centere 66' American European Medical Center 66' Ibn Al Nafis Medical Centre 64' Al Musaffah Al Alhli Medical Centre 58' Taha Medical Centre 54' Abu Dhabi Knee And Sports Medicine Center L.L.C 43' Amrita Midical Centre 35' Al Hendawy Medical Centre 35' Al Ain Cromwell Hospital Management Co L.L.C Al Amal Medical Centre 35' Al Rawdah German Medical Center - L L C 33' Al Rafa Medical Center L.L.C 31' Al Bustan Medical Center 31' Etihad Airways Polyclinic 29' Gulf International Cancer Center 29' Al Kamal Medicdal Poly Clinics- L L C 29' Merhi Dental & Orthodontic Center 29' Canadian Medical Center Llc 27' Top Care Medical Centre Dr. Ahmed Hassan Fikri Medical Centre 27' Adco Medical Centre 24' Well Health Medical Center L.L.C. 24' Golden Sand Medical Centre 22' Exeter Medical Center 22' National Petroleum Construction Company Medical Center 22' Consultant Medical Centre 22' New Capital Medical Centre 22' Al Mafraq Medical Centre 22' Nadia Medical Center L.L.C 22' First Medical Center 22' American Crescent Health Care Centre 20' Dr.Munir Silwadi Dental Centre 16' Al Reyada Medical Centre 3' Prime Medical Center 1' Nova Dent Center ' Island Cosmesurge & Emirates One Day Surgery 110' Al Mazroui, One Day Surgery 45' Magrabi Specialized 42' Samaya Medical Center 19' Middle Lifeline Hospital - Day Care Surgery 86' Al Ain Al Sultan Advanced Medical Clinics 41' Mubarak Medical Center 31' Cosmesurge & Emirates Hospital For One Day Surgery Polyclinic L L C. 27' Fine Care Specialized Medical Centre 24' Morani Orthodontic Center & General Medical - L.L.C 24' Sultan Medical Centre 22' Western Alnoor Hospital Speciality Clinics Llc Madinet Zayed Branch 41' Al- Noor Hospital Clinics - Madinat Zayed 41'

118 To Ensure Reliable Excellence in healthcare to the community Providers Critical care bed capacity Grand Total ICU NICU SCBU Isolation CCU CICU CCU/ Medical Stepdown PICU Burns Other Grand Total SEHA SKMC Tawam Hospital Mafraq Hospital Al Ain Hospital Corniche Hospital Al Rahba Madinat Zayed Hospital Military Zayed Military Hospital Other Al Noor (Airport Road) Oasis Hospital Al Noor Al Noor Alain Ahalia Lifeline New Medical Center Emirates International NMC Al Ain 4 4 Al Reef 2 2 Specialised Medical Care 2 2 Al Salama 2 2 Franco Emirates Dar Al Shifaa 2 2 Source Operation Center as of 31st December 2010

119 HAAD Annual report 2010 Providers 117 Financing Payers Encounters Providers Claims Bed occupancy SEHA 2010 Private 2010 Average Occupancy above optimal level Normal Ward 100% 75% 50% 25% 0% ICU 100% 75% 50% 25% 0% Isolation & Burns* 100% 75% 50% 25% 0% Jan Apr Jul Oct CICU CCU CCU/Medical Stepdown Jan Apr Jul Oct NICU PICU SCBU Jan Apr Jul Oct Notes *All Burns beds are shown in green and are provided by Seha For the duration of 2010 the occupancy in CCU Private was < 5% and 0% in PICU Private, these are not shown Optimal occupancy is 85% for normal beds and 75% for critical care beds Source HAAD Operation Center

120 To Ensure Reliable Excellence in healthcare to the community Providers Blood bank donors National Expatriate Year Donors 25'850 24'758 21'834 19'461 16'737 National 4'240 4'116 3'832 3'311 2'664 Expatriate 21'610 20'642 18'002 16'150 14'073 14'073 16'150 18'002 20'642 21'610 Units donated 25'850 24'758 22'379 19'849 17'129 O + 9'441 8'960 8'314 7'242 6'396 A + 6'620 1'430 5'840 5'263 4'548 B + 5'423 6'421 4'294 4'040 3'396 AB + 1' '302 1' O - 1'274 5'130 1'346 1' '664 3'311 3'832 4'116 4' A B ' AB Source Abu Dhabi Blood Bank, Health Statistics Analysis

121 HAAD Annual report 2010 Providers 119 Financing Payers Encounters Providers Claims Inpatient market by value Diagnosis group Overall Top 5* 1st 2nd 3rd 4th 5th Maternal and Perinatal conditions 18 Corniche Hospital (25%) Tawam Hospital (21%) Oasis Hospital (9%) Al Mafraq Hospital (8%) Al Ain Hospital (7%) Non-disease conditions 17 Tawam Hospital (27%) Sheikh Khalifa Medical City (17%) Al Mafraq Hospital (13%) Corniche Hospital. (9%) Al Ain Hospital (8%) Cardiovascular diseases 12 Sheikh Khalifa Medical City (33%) Tawam Hospital (17%) Al Mafraq Hospital (13%) Al Noor Hospital (10%) Al Ain Hospital (7%) Digestive diseases 9 Al Ain Hospital (14%) Sheikh Khalifa Medical City (13%) Tawam Hospital (13%) Al Mafraq Hospital (11%) Al Noor Hospital (7%) Genitourinary diseases 6 Tawam Hospital (15%) Sheikh Khalifa Medical City (14%) Al Mafraq Hospital (8%) Al Noor Hospital (7%) Al Ain Hospital (4%) Respiratory diseases 6 Tawam Hospital (17%) Sheikh Khalifa Medical City (16%) Al Ain Hospital (13%) Al Noor Hospital (8%) Emirates French Hospital (7%) Cancer 5 Tawam Hospital (32%) Al Mafraq Hospital (24%) Sheikh Khalifa Medical City (20%) Al Ain Hospital (5%) Al Noor Hospital (4%) Musculoskeletal diseases 5 Abu Dhabi Knee And Sports Medicine (27%) Sheikh Khalifa Medical City (15%) Tawam Hospital (9%) Al Mafraq Hospital (9%) Al Noor Hospital (6%) Respiratory infections 4 Tawam Hospital (21%) Sheikh Khalifa Medical City (17%) Al Ain Hospital (16%) Al Mafraq Hospital (10%) Al Rahba Hospital (6%) Neuropsychiatric conditions 3 Behavioral Sciences Pavilion (21%) Al Ain Hospital (19%) Sheikh Khalifa Medical City (19%) Abu Dhabi Rehabilitation (17%) Tawam Hospital (13%) Sense organ diseases 3 Magrabi Specialized Hospital (17%) Samaya Specialized Hospital (17%) Al Mafraq Hospital (14%) Sheikh Khalifa Medical City (10%) Royal Spanish Center Lasik Eyes (9%) Endocrine disorders 3 Tawam Hospital (39%) Sheikh Khalifa Medical City (34%) Al Mafraq Hospital (7%) Al Ain Hospital (5%) Al Noor Hospital (4%) Infectious and parasitic diseases 3 Sheikh Khalifa Medical City (37%) Tawam Hospital (18%) Al Mafraq Hospital (11%) Al Ain Hospital (10%) Al Rahba Hospital (6%) Congenital anomalies 2 Sheikh Khalifa Medical City (57%) Tawam Hospital (18%) Al Mafraq Hospital (6%) Al Ain Hospital (5%) Al Noor Hospital (5%) Skin diseases 1 Al Mafraq Hospital (25%) Sheikh Khalifa Medical City (15%) Al Ain Hospital (14%) Tawam Hospital (11%) Al Noor Hospital (6%) Diabetes mellitus 1 Sheikh Khalifa Medical City (35%) Tawam Hospital (24%) Al Ain Hospital (14%) Al Mafraq Hospital (8%) Al Noor Hospital (4%) Oral conditions 0 Tawam Hospital (24%) Al Noor Hospital (19%) Sheikh Khalifa Medical City (17%) Al Farooq Medical & Dental Center (9%) Al Mafraq Hospital (5%) Nutritional deficiencies 0 Sheikh Khalifa Medical City (30%) Tawam Hospital (25%) Al Mafraq Hospital (13%) Al Ain Hospital (9%) Al Rahba Hospital (5%) Injuries 0 Sheikh Khalifa Medical City (88%) Al Noor Hospital (4%) Al Ain Hospital (3%) New Medical Centre (3%) Emirates French Hospital (1%) RTA 0 Sheikh Khalifa Medical City (89%) Al Ain Hospital (10%) Emirates International Hospital (2%) 100 * Share of top 5 providers within diagnoses groups Note Non-disease conditions include Injuries (ICD-9 codes ) Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

122 To Ensure Reliable Excellence in healthcare to the community Providers Outpatient market by value Diagnosis group Overall Top 5* 1st 2nd 3rd 4th 5th Non-disease conditions 19 Tawam Hospital (15%) Al Noor Hospital (7%) Al Noor Hospital - Airport Road (6%) Sheikh Khalifa Medical City (5%) Al Noor Hospital - Al Ain (5%) Diabetes mellitus 12 Imperial College London Diabetes Centre (44%) Tawam Hospital (6%) Sheikh Khalifa Medical City (5%) N M C Specialty Hospital (4%) Al Noor Hospital (2%) Respiratory infections 8 Al Noor Hospital (8%) Al Noor Hospital - Airport Road (5%) Tawam Hospital (5%) Sheikh Khalifa Medical City (3%) Gulf Diagnostic Center Hospital (3%) Oral conditions 8 Tawam Hospital Dental Services (16%) Al Mafraq Dental Center (8%) Abu Dhabi Dental Clinic (8%) Khalifa Health Center (4%) Bain Al Gesreen Health Center (4%) Musculoskeletal diseases 8 Sheikh Khalifa Medical City (8%) Tawam Hospital (8%) Al Noor Hospital (7%) N M C Specialty Hospital (6%) Al Noor Hospital - Airport Road (6%) Cardiovascular diseases 6 Sheikh Khalifa Medical City (12%) Tawam Hospital (7%) Al Noor Hospital (7%) Al Mafraq Hospital (5%) N M C Specialty Hospital (5%) Genitourinary diseases 6 Tawam Hospital (16%) Sheikh Khalifa Medical City (10%) Al Noor Hospital (7%) Al Noor Hospital - Airport Road (5%) N M C Specialty Hospital (4%) Endocrine disorders 5 Imperial College London Diabetes Centre (13%) Tawam Hospital (12%) Sheikh Khalifa Medical City (10%) Al Noor Hospital (5%) Gulf Diagnostic Center Hospital (5%) Digestive diseases 4 Al Noor Hospital (7%) Al Noor Hospital (6%) N M C Specialty Hospital (6%) Gulf Diagnostic Center Hospital (6%) Tawam Hospital (4%) Skin diseases 4 Al Noor Hospital - Airport Road (8%) Sheikh Khalifa Medical City (7%) Al Mafraq Hospital (7%) Tawam Hospital (6%) N M C Specialty Hospital (4%) Respiratory diseases 4 Al Noor Hospital (8%) N M C Specialty Hospital (6%) Al Noor Hospital - Airport (6%) Baniyas Health Center (5%) Al Noor Hospital (4%) Sense organ diseases 3 Al Noor Hospital (11%) Al Noor Hospital - Airport Road (9%) Tawam Hospital (8%) Sheikh Khalifa Medical City (7%) N M C Specialty Hospital (5%) Neuropsychiatric conditions 3 Tawam Hospital (19%) Sheikh Khalifa Medical City (16%) Behavioral Sciences Pavilion (12%) Al Ain Hospital (9%) Al Mafraq Hospital (6%) Infectious and parasitic diseases 3 Al Noor Hospital (9%) Tawam Hospital (9%) Al Noor Hospital - Airport Road (6%) N M C Specialty Hospital (4%) Sheikh Khalifa Medical (4%) Maternal and Perinatal conditions 2 Tawam Hospital (17%) Al Noor Hospital (12%) Al Noor Hospital - Airport Road (9%) Corniche Hospital (8%) Oasis Hospital (5%) Cancer 1 Tawam Hospital (39%) Sheikh Khalifa Medical City (13%) Al Mafraq Hospital (11%) Gulf International Cancer Center (9%) Al Noor Hospital (5%) Nutritional deficiencies 1 Imperial College London Diabetes Centre (23%) Al Mafraq Hospital (7%) Gulf Diagnostic Center Hospital (6%) Tawam Hospital (5%) Al Bateen Family Medicine Clinic (5%) Congenital anomalies 0 Sheikh Khalifa Medical City (39%) Tawam Hospital (26%) Al Noor Hospital - Airport (6%) Al Mafraq Hospital (4%) Abu Dhabi Rehabilitation Center (4%) Injuries 0 Al Mafraq Hospital (16%) Al Sultan Advanced Medical Poly Clinics (16%) Imperial College London Diabetes Centre (13%) Baniyas Health Center (11%) Emirates International Hospital (7%) RTA 0 Al Mafraq Hospital (82%) Sheikh Khalifa Medical City (4%) Talat Medical Centre (3%) Healthplus Womens Health Center (2%) Al Ahli Specialists Medical Centre (2%) 100 * Share of top 5 providers within diagnoses groups Source Health Statistics analysis; Cube 2010; categorization based on WHO classification of ICD diagnoses

123 HAAD Annual report 2010 Claims 121 Financing Payers Claims Encounters Providers Financing Encounters Payers Claims Providers

124 To Ensure Reliable Excellence in healthcare to the community Claims Outpatient market by value Claims per member per year, standardised Inpatient Outpatient Thiqa 183% 186% Average Claim Net (AED) Claims Claims per member Inpatient 7' ' ' % Basic 6'922 34'819 24' Enhanced 87% Enhanced 7'249 54'642 49' Thiqa 8'259 76'309 71' Outpatient '918'240 10'442' Basic 61% 56% Utilisation for (100%) Basic 144 2'928'380 2'106' Enhanced 323 4'145'873 3'931' Thiqa 310 5'843'987 4'404' Total '084'010 10'588' Notes Average utilization for population is set to 100% to allow comparison across inpatient and outpatient claims Average Claim Net is total Claim Net / Claims, represents the amount claimed from Payers by Providers Claims per member is defined as Claims over exposure defined as Members per year Source Health Statistics analysis; Cube 2010; 2009 Abu Dhabi Health Statistics Report

125 HAAD Annual report 2010 Claims 123 Claims by provider, 2010 As at 31 December 2010 Market Share Average Claim Net (AED) per Claim In Patient Out Patient Claims processing (days) Activity to Submission* Submission to Remittance** Facility Claim Net Basic Enhanced Thiqa Basic Enhanced Thiqa Basic Enhanced Thiqa Basic Enhanced Thiqa Total AED 4'540m 6'910 8'106 8' Tawam 13.3% 10'715 14'698 9' SKMC 8.5% 12'014 12'616 12' Al Mafraq Hospital 6.3% 7'233 7'027 6' Imperial College London Diabetes Centre 5.4% 2'463 1'830 3' Al Ain 5.2% 6'850 7'793 9' Al Noor 4.9% 4'703 8'077 7' Al Noor - Airport Road 4.7% 6'979 11'385 6' N M C Specialty 3.1% 7'509 8'448 6' Al Noor - Al Ain 3.0% 5'183 8'116 6' Al Corniche 2.3% 4'878 6'818 7' Al Rahba 2.0% 5'316 4'833 6' Gulf Diagnostic Center 1.6% 8'065 8'609 7' Oasis 1.5% 4'001 5'488 5' Al Salama 1.5% 4'631 4'939 4' Life Line - Llc 1.5% 4'193 5'718 8' Madinat Zayed 1.3% 4'880 4'528 5' Al Ahalia 1.3% 6'142 5'487 5' Baniyas 1.3% N M C Specialty - Llc 1.2% 6'540 10'208 5' Tawam Dental 1.1% 1'096 1' Emirates International 0.8% 4'372 4'899 4' Al Jahli Medical Center 0.7% Khalifa Health Center 0.7% Dar Al Shifaa 0.7% 4'741 3'813 3' MSA (Abu Dhabi Police) 0.7% Neima Primary 0.6% Bain Al Gesreen 0.6% Al Bateen 0.6% Specialized Medical Care 0.5% 3'484 4'231 3' Al Mafraq Dental 0.5% 1' Other 22.9% 3'686 6'956 8' Note Data relates to providers licensed by HAAD. Market Share break down represents proportion of the total amount claimed, Total represents total Claim Net *Activity to submission measured as average number of days to submit AED 1 from Activity Start Date to Claim Submission Date, using formulae: t xtvt / NPV with discount rate i=0, v = 1 / (1+i) and {xt} being the series denoted as Activity Net at duration t NPV is Net Present Value at par (0%) ** Submission to remittance is average number of days to remit AED 1 from first Claim Submission Date to first Remittance Advice Date using the same formulae Source Health Statistics analysis; Cube 2010

126 To Ensure Reliable Excellence in healthcare to the community Payers Financing Encounters Payers Providers Claims

127 HAAD Annual report 2010 Payers 125 Financing Payers Encounters Providers Claims Payer members Value Volume Thiqa 46% Thiqa 16% Enhanced 39% Basic 12% Enhanced 42% Basic 45% Members Change Contracts 2010 Premium (AED) 2010* Total Market Share 2'671'391 2'312'569 2'260' '823 2'718'869 1'427 Thiqa 422' ' '795 27' '155 Basic 1'204' ' ' '211 1'212' Total Enhanced 100.0% 1'044' ' '610 62'991 1'049'008 2'395 Daman 28.6% 299' ' '649-2' '159 3'879 Oman 16.4% 171' ' '735-34' '478 2'022 ADNIC 14.5% 151'654 90'190 97'058 61' '654 2'745 Al Khazna 7.5% 78' '648 90'229-59'501 78' Green Crescent 6.8% 70'881 21'341 49'540 70'964 2'080 Al Buhaira 4.8% 49'838 51'215 25'083-1'377 49' Al Wathba 4.6% 48'038 41'583 6'455 48'081 1'286 ArabOrient 2.6% 26'742 1'524 24'337 25'218 26'777 1'268 Al Ain Ahlia 2.3% 24'419 23'857 4' '426 1'351 EIC 1.7% 17'721 15'167 26'517 2'554 17'746 2'165 Methaq Takaful 1.6% 17'002 17'002 17' Alliance 1.4% 14' '960 13'941 14'822 1'118 Al Dhafra 1.2% 12' '087 11'633 12' Al Hilal Takaful 1.1% 11'075 5'003 6'072 11'084 1'377 RAK 1.0% 10'508 11'368 8' '508 2'203 ALICO 1.0% 10'384 1'030 6'431 9'354 10'384 3'051 Lebanese 0.7% 7'044 3'596 1'437 3'448 7' Qatar 0.6% 6'305 9'332 10'381-3'027 6'305 2'290 Al Fujairah 0.4% 4' '112 4'063 4' NGI 0.3% 2' '171 2'798 2'461 NoorTakaful 0.2% 2' '047 2'094 2'362 Takaful Emarat 0.2% 1'600 16'222 12'721-14'622 1' Royal and Sun Alliance 0.1% 1' '381 4'076 Abu Dhabi Takaful 0.1% 1'131 1'131 1'131 3'049 Arabia 0.1% 1' '076 2'261 AXA 0.1% 886 3'537 3'044-2' '802 United 0.1% 825 3'645 1'887-2' '665 Salama 0.1% 622 1' ' '750 Aman 0.0% '020 Dubai 0.0% 170 2'486-2' '077 Arabian Scandinavian 0.0% ' '361 Al Sagr 27'661 94'758-27'661 Saudi Arabian 2' '445 Note Presented data is subject to corrections; Market share calculation applies to Enhanced products only, in the table and over all packages in the pie charts * Premium relates to average Premium per member in force as at 31 Dec 2010, should be interpreted with caution due to quality of premium information Volume measured using Exposure per contract in force per day year 2010, so that one contract in-force throughout 2010 = Exposure of 365 days Source Health Statistics analysis; Cube 2010;2009 Abu Dhabi Health Statistics Report

128 To Ensure Reliable Excellence in healthcare to the community Payers Payer claims Market share Claims Days to Remit Change * Claim Net (AED) 2010** Claims per Member 2010 Value Value Thiqa 50% Thiqa 50% Basic 14% Enhanced 36% Basic 14% Enhanced 36% Total Claim Net 13'084'009 10'589'348 3'987'923 2'494' Thiqa 5'920'296 4'475'578 1'444' Basic 2'932'545 2'132'354 1'319' ' Total Enhanced 100% 4'200'514 3'996'092 2'668' ' Daman 51.5% 1'993'114 1'656'879 1'287' ' ADNIC 18.5% 733'321 42'914 32' ' Oman 8.4% 432' ' ' ' Al Wathba 3.3% 173'397 89'700 83' Green Crescent 3.2% 146'809 67'127 79' Al Ain Ahlia 2.0% 98'489 72'831 6'326 25' Al Khazna 2% 111'181 79' '078 31' Al Buhaira 1.5% 127'519 84'053 55'499 43' EIC 1.4% 66'261 69'999 72'802-3' ArabOrient 1.2% 47' ' ' ' Abu Dhabi Takaful 1.2% 51'659 49'146 47'599 2' Al Hilal Takaful 1.1% 42' Qatar 1.1% 34'359 14'480 36'874 19' RAK 1.0% 40'256 40'102 29' ALICO 1.0% 38' '824 47'742-86' Saudi Arabian 0.6% 17' '557 16' Methaq Takaful 0.2% 12' NoorTakaful 0.2% 7'750 1'366 6' Arabia 0.2% 8'936 1'369 1'015 7' Lebanese 0.1% 4'950 6'404 4'483-1' Royal and Sun Alliance 0.1% 3'656 1'297 2' Salama 0.1% 3'055 1'017 4'702 2' NGI 0.0% 1'474 2'590 2'215-1' Al Sagr 0.0% 2' ' ' ' Al Fujairah 0.0% 1'680 7'145 3'635-5' Takaful Emarat 0.0% Aman 0.0% 158 1'841-1' Alliance 0.0% '245-18' United 0.0% 60 16'439 2'867-16' Dubai 0.0% 30 3'641-3' Arabian Scandinavian 0.0% 5 2' AXA 0.0% 2 14'450-14' Al Dhafra 31'453 32'106-31'453 Note Data relates to providers licensed by HAAD. Market Share break down represents proportion of the total amount claimed, Total represents total Claim Net *Activity to submission measured as average number of days to submit AED 1 from Activity Start Date to Claim Submission Date, using formulae: t xtvt / NPV with discount rate i=0, v = 1 / (1+i) and {xt} being the series denoted as Activity Net at duration t NPV is Net Present Value at par (0%) ** Submission to remittance is average number of days to remit AED 1 from first Claim Submission Date to first Remittance Advice Date using the same formulae Source Health Statistics analysis; Cube 2010

129 HAAD Annual report 2010 Financing 127 Payers Financing Claims Encounters Providers Financing Encounters Payers Providers Claims

130 To Ensure Reliable Excellence in healthcare to the community Financing Enhanced plans premiums 8,116 Average Gross Premium 3,388 4, AED, 90, AED, 252,000 1, AED, 214,000 2, AED, 225, AED, 129, AED, 52,000 Number of Contracts Note 84,808 contracts have gross premium < 601 AED, inconsistent with the definition of GrossPremium on Source KEH and Products Search Engine Database; Strategy Analysis

131 HAAD Annual report 2010 Financing 129 Payers Financing Claims Encounters Providers Enhanced plans benefits 100% 90% % Cover Outside Network 100% Cover, 6% 85% Cover, 2 % Geographic Coverage + Home Country, 14% Annual Limit AED millions Other, 5 % 5.00, 2 % 2.50, 4 % 1.50, 2 % 80% 1.00, 11%. 75, 2 % 70% 80% Cover, 43% 60%. 50, 22% + International, 63% 50% 70% Cover, 2 % 40%. 30, 15% 30% 20% 10% 0 % Cover, 46% + Other Emirates In/Outpatient, 19%. 25, 36% 0% Other Emirates Emergency, 4 % Benefit Level Basic Product Better than Basic Product Note About 32% of the enhanced plans contracts are excluded due to non compliance with reporting of benefits information Source KEH and Products Search Engine Database; Strategy Analysis

132 Capacity Master Plan

133 Model Abu Dhabi s model of care 133 Model of care How health services are currently used, what s wrong? 134 Model of care what s new 135 World class healthcare 136 Plan* Current Service balance 138 Service capacity balance 139 Planning for healthcare services 140 Capacity plan by location 141 HAAD regulatory actions 143 Investor Recommendations Recommendations summary 153 Land requirements Recommendations for urban planners 154 Access requirements Recommendations for urban planners 155 Case example Recommendations for urban planners 156 Facility requirements Recommendations for investors 157 Service requirements Recommendations for developers 157 Specialised services summary 158 Specialised services certification and audit 159 Assumptions Current health facility Locations 145 Supply projections 146 density 147 projections 148 Demand projections 148 Demand projections by diagnosis category 149 Demand projections for doctors by specialty 150 * Detailed plans for specific locations and services are available on Note The data presented have been prepared to the best of our knowledge at the time of release. Although effort has been invested creativing consistancy and coherence, this should be considered work in progress. Feedback on content and layout are welcome.

134 Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. Ambulance Stations Land provision options (000 s people) (m s) 1 Residential Transient Land area Co-located GFA 3,6 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis Parking (spaces) Minimum service requirement Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service Estimated Resources 2 Physicians 4-6 Physicians Physicians Physicians Ambulance service Ambulance (land/air) Ambulance service Ambulances (land/air) Emergency services Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 To Ensure Reliable Excellence in healthcare to the community Model Model Model of care: How health services are currently used Patient self-care Non-emergency/elective Capacity master plan Total Planning % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 need under way need under way Ambulance station 2030 Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease management Triage ER Emergency Admission Preventive Emergency Including diagnostics Assumptions growth, scenarios Recommendations Land requirements: Guidelines for urban planners (millions) 5.0 High 4.5 Low 4.0 UPC growth, scenarios National Expatriate Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521'000 For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: OR OR Clinics Hospitals n/a 3/bed Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan

135 Model of care: How health services are currently used Patient self-care Remote support Screening Check-up Disease management Preventive Including diagnostics Non-emergency/elective Outpatient Clinic Ambulance Urgent Care Centre Triage ER Emergency Elective Admission Emergency Admission Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Region District Gap now Type Total Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis need under way need under way Ambulance station 2030 HAAD Annual report 2010 Model Planning Model of care 133 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Abu Dhabi s model of care Healthcare in Abu Dhabi faces growing demand for services arising from an expanding population 142,148 that has a deteriorating health status 149. The current population is young and has a high rate of chronic diseases that is set to increase as it ages. The current model of care in Abu Dhabi does not adequately support self care or prevention screening programmes are not sufficiently effective and diagnostic services are not integrated into care plans. Also, patients have undirected access to services and specialty care which leads to inappropriate use and, in turn, over-supply of services 134. Historically, Abu Dhabi has had a relatively limited supply of healthcare services, particularly hospital beds, which led to investment in infrastructure 3. Achieving world-class quality care, however, is about much more than new buildings 136. Before embarking on large-scale projects which affect community healthcare services long-term, it is important to be clear on what type of healthcare is appropriate for the evolving communities and population of Abu Dhabi in the 21st century. Abu Dhabi s model of care (see page 135) describes how healthcare should look in the future and is based on robust international experience**. The focus is on empowering patients. As a first step, pro-active checkups and convenient routine follow-up should help prevent disease. When there is a condition, patients should be supported to care for themselves, where appropriate given the growing burden of chronic disease the reality is that most such care is already managed by patients (and their families) themselves. This should be supported by targeted home care and the integrated use of telemedicine*. This has been shown to improve quality and improve access in rural areas an Urban Planning Council (UPC) survey of residents highlighted this as one of the top 2 priorities that concern communities while being cost-effective**. Patients will clearly still have reactive access to appropriate elective and emergency care, but this should be streamlined and optimised from the patient s perspective through an emphasis on early clinical triage. Diagnostics, for instance, should be available everywhere to enable one-stop-treatment. Making such ambitious changes to our healthcare system will requires countless small decisions on what to do and what not to do. HAAD s quantitative definition of world-class quality care 136 helps clarify how trade-offs should be made in delivering health services and transitioning to the new model of care. HAAD is facilitating these changes through the adoption of payment incentives, introduction of care pathways and streamlining of licensing processes in accordance with the intended service structure 139. * A randomised controlled trial of child pshychiatric assessment conducted by videoconferencing. Alford, R et al (2000). ** Impact of home care on hospital days: a meta analysis. Hughes, SL et al (1997)

136 To Ensure Reliable Excellence in healthcare to the community Model Model of care: How health services are currently used, what s wrong? There are no systems in place to support patient self-care and management of chronic disease Open access 1 Outpatient Primary care centre/ clinic Inpatient Ambulance Hospital ER Specialist Hospital admission Hospital specialist Screening Screening programmes are not (yet) fully aligned to prevent and treat chronic conditions Patient access to services is not streamed: leading to over-servicing, oversupply and inappropriate service use Laboratory & radiology Diagnostics Diagnostic services are not optimally integrated into treatment paths Notes 1Access to Seha hospital specialists is only via referral from Seha Centres/Clinics and ER departments. Some Seha Hospital ER departments also direct non-emergency patients to adjacent Urgent care centres Source Strategy analysis

137 Model of care: How health services are currently used Patient self-care Remote support Screening Check-up Disease management Preventive Including diagnostics Non-emergency/elective Outpatient Clinic Ambulance Urgent Care Centre Triage ER Emergency Elective Admission Emergency Admission Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Region District Gap now Type Total Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis need under way need under way Ambulance station 2030 HAAD Annual report 2010 Model Planning Model of care 135 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Desired model of care: what s new? Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease management Triage ER Emergency Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis

138 To Ensure Reliable Excellence in healthcare to the community World class healthcare Absolute targets must be met by all plans (including Basic), while improvements are paid for by differential budget Absolute target Target varies by plan Quality Health system Health performance indicators reviewed by Clinical Quality Panel, e.g., % of well-controlled diabetics Citizen satisfaction with health system Pathway Pathway performance indicators reviewed by Clinical Quality Panel, e.g., Diabetics with regular HbA1c tests Provider Provider performance indicators reviewed by Clinical Quality Panel Patient satisfaction from standardised survey conducted by HAAD Service level, such as Hotel services, e.g., 10 beds per ward for Basic, 2 per room most Enhanced, single room for Thiqa Intervention/Investigation level beyond a guideline-determined floor, e.g., it may be indicated to do 2 standard ultrasound scans per pregnancy, but an Enhanced/ Thiqa plan may cover more scans or higher specification scans Clinician experience, such as qualification level/years of experience of a clinician, e.g., Thiqa has preferential access to Consultants; Basic may have more junior Doctors, as long as Clinicians act within their respective privileges Access Network size Inpatients: at least 2 inpatient providers for secondary care and 1 provider for tertiary care 4. Outpatients: primary care within [30 minutes]; specialist outpatient care at least in Abu Dhabi or Al Ain, unless tertiary specialty Waiting time Emergency: critical care bed occupancy generally [<90%] Elective: [<6 months] Ambulatory: no waiting time beyond [3 months] Schedule of Benefits Authorization requirement Exclusions (Dental, Mental health) Member incentives Assume no material changes in the short run for Basic/Enhanced which are equilibrating, while there is still quite some movement on the structure of Thiqa benefits, including member incentives Cost 2 Reimbursement Market prices as a principle within a price corridor 1-3x HAAD s Basic product 2 Pay for Quality premium based on Provider quality (expected to be up to 10%) Reimbursement structure is fixed Reflects severity: DRGs for inpatients and E&M logic for outpatients Capital ~10 000AED/m 2 [US average] 120 m 2 /bed [AD private average] Premium+Subsidy per member 1 in AED as Health systems are designed to revenue Basic ~Thailand Enhanced ~Turkey Thiqa ~England Assumptions for evolving reimbursement Pay for Health pilots for Thiqa (short-term) Tendering process a la Medicare to set Lab rates for Basic product (short-term) Introduce capitation elements for outpatients, e.g., primary care in the medium term 1. Includes Insurance premiums, Thiqa payments, as well as funded mandates and capital, but not loss transfers. Government determines budgets for Basic and Thiqa, while Employers determine effective budgets for Enhanced, while Individuals can choose to add discretionary spending on health 2. This refers to Cost limits/prices; Funded mandates to follow the same logic and price levels as insurance-based system 3. Exceptions to market pricing are Specialised services provided by certified providers for which HAAD sets a uniform base rate; non-market DRGs only provided by SEHA at that time, where HAAD sets Gap=0 and Marginal=100% 4. Providers may be outside Abu Dhabi, but within the UAE if travel/accommodation are covered and provider complies with HAAD standards

139 Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. Ambulance Stations Land provision options (000 s people) (m s) 1 Residential Transient Land area Co-located GFA 3,6 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis Parking (spaces) Minimum service requirement Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service Estimated Resources 2 Physicians 4-6 Physicians Physicians Physicians Ambulance service Ambulance (land/air) Ambulance service Ambulances (land/air) Emergency services Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 HAAD Annual report 2010 Planning 137 Model Model of care: How health services are currently used Patient self-care Non-emergency/elective Capacity master plan Planning Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 need under way need under way Ambulance station 2030 Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease management Triage ER Emergency Admission Preventive Emergency Including diagnostics Assumptions growth, scenarios Recommendations Land requirements: Guidelines for urban planners (millions) 5.0 High 4.5 Low 4.0 UPC growth, scenarios National Expatriate Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521'000 For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: OR OR Clinics Hospitals n/a 3/bed Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan * A Review of the Needs & priorities for Community Services in Abu Dhabi. UPC, 2010.

140 To Ensure Reliable Excellence in healthcare to the community Planning Current service balance To obtain an accurate picture of capacity balance in the Emirate results from a detailed 2011 survey of 574 Clinicians were synthesised with interviews with Hospital Medical Directors and a number of quantitative sources Capacity Gaps Intensive and Critical Care medicine is the most severe capacity gap impacting healthcare services within Abu Dhabi. Severe capacity gaps also exist in Emergency care, NICU, Cardiology and Psychiatry 139. Reductions in the number of clinicians licensed have occurred in the four specialties facing severe capacity gaps: Intensive and Critical Care medicine, Emergency care, Neonatology and Cardiology 139. Health challenges. Growth in demand for healthcare services associated with the prevention and treatment of cancer, cardiovascular disease, diabetes, neuropsychiatric conditions is expected to be particularly high. Growth in demand for outpatient services is generally anticipated to be greater than for inpatient services 149. Growth. The number of clinicians licensed within the emirate has grown by 875 (17%) over the past year ensuring much wider coverage across the range of specialities. The number of facilities offering healthcare has also grown by 174 (10% ) to Waiting times have been reduced across all specialties with the exception of radiology as more facilities offer a broader range of specialties 139. The private sector has been responsible for the largest proportion (75%) of growth in healthcare capacity, however this growth has been predominantly in areas such as general and internal medicine and dentistry 139. There has been little or no growth in the specialties where capacity gaps exist with the exception of Obstetrics and Gynecology where further capacity is also expected to be added by new and existing providers in the future 146. Specialised service definitions were set out together with a process for issuing and auditing certificates of need in early , 159. Certificates of need ensure that required clinical standards are met and sufficient patient volumes are treated to maintain and improve clinical outcomes for complex health services 158.

141 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Planning 139 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Service capacity balance Specialty Gaps Physicians % Private Growth Intensive & Critical care medicine Emergency medicine n/a Neonatology Cardiology Psychiatry Obstetrics & Gynecology Pediatrics Oncology General surgery Pediatric surgery Facilities Internal Medicine Physical medicine & Rehabilitation n/a 1 Allergy & Immunology Cardio-thoracic surgery Orthopedics Family medicine Radiology <60 7 Neurology Anesthesiology Preventive medicine 2 1 n/a n/a Ophthalmology Infectious diseases Dentistry Urology General medicine N/A Pulmonology Pathology Nephrology Endocrinology Dermatology Gastroenterology Alternative therapies Oral & Maxillofacial surgery Rheumatology Otolaryngology (ENT) Total 5, Capacity Balance Waiting Times Critical capacity gap % private / public capacity High Shorter than 2009 Service capacity gap Growth - private Intermediate Longer than 2009 No capacity gap Growth - public Low % Private Growth Walk-in (minutes) Appointment (days) Source Gaps: 2011 survey of 575 clinicians; Interviews with Medical Directors; Planning analysis; Encounters: KEH; Physicians and Facilities: Licensing database; Waiting times: 2010 TPA analysis. Note Growth compares 2009 to 2010.

142 To Ensure Reliable Excellence in healthcare to the community Planning Planning for healthcare services Current Capacity gaps. Geographic coverage in the Emirate is generally good. There are, however, severe capacity shortfalls in the Desert Villages district, Umm Ghaffa and Nahel in Al Ain 141. Based on HAAD guidelines 154 moderate gaps exist in other rural locations. In rural areas, the key to patient access to high quality healthcare requires is innovation in delivering services, not primarily building new facilities. This might include the use of mobile and visiting clinics, and clinical staff on a visiting or rotational basis. In larger settlements of the Western region, the preexisting hospitals will need to adapt and respond to changing and growing needs, rather than the development of new access points. Significant population growth. The UPC 2030 plans envisages the population of Abu Dhabi doubling to over 4.6 million In Abu Dhabi region the old core (CBD and Musaffah) is expected to remain stable, with aggressive growth off island and in rural areas, e.g., Al Reem island and Capital district populations are projected to grow by over 200,000 respectively. Growth in 16 of the 28 districts is projected to exceed 60,000 in each case. in the villages along the road stretching east from Bani Yas and west of Al Ain city is anticipated to grow to over 220,000, transforming it from a predominately rural area to an urban corridor The Al Ain city population is projected to double by 2030 with more modest growth expected in the surrounding rural areas Western region population is projected to almost triple to over 300,000 with the biggest growth in Ruwais, Sila a and Mirfa 141. Significant additional capacity is required to meet growth in demand for healthcare services as the population grows 148 and ages. In existing developed areas the emphasis is on growing existing facilities to facilitate specialisation and scale. Existing development plans are focused on or close to existing population centres. - Hospitals, clinics and emergency network. According to HAAD guidelines the 2030 projected populations would require up to 20 new medium-to-large hospitals and 23 new clinics 141. The actual number required will depend on existing facilities who may expand services in response to population growth. The current ambulance service network will also need to expand to support populations in newly developed and remote areas Clinical staff. During 2010 the number of licensed Doctors within grew by 17% 139. However, attracting and retaining qualified staff remains a challenge for healthcare services across the emirate, particularly in rural areas. It is estimated that by 2020 up to 3,100 additional doctors and 5,800 nurses will be required, if turnover remains high, this translates into 1,400 doctors and almost 1,600 nurses to be recruited annually 148. Clinical training and education of a world class standard must be established locally to build a sustainable healthcare workforce and service supply. The risk of potential oversupply of healthcare requires careful management. For example, Khalifa City A currently has 6 provisional hospital projects 146, despite a projected 2030 population of only 70, Similarly, Al Ain city has 8 provisional hospital projects 146 with potential demand for In contrast to these examples, there are few health facility projects in rural areas of the emirate 146. HAAD guidelines for urban planners and developers aim to building of healthcare facilities occurs when demand exists, not years in anticipation 156.

143 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Planning 141 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Capacity plan by location Region District Gap now Type Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 need under way need under way Ambulance station 2030 Capacity Gap Sever Moderate None Supply Underserved Potential over Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis.

144 To Ensure Reliable Excellence in healthcare to the community Planning Capacity plan by location, continued Region District Gap now Type Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 need under way need under way Ambulance station 2030

145 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Planning 143 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations HAAD will regulate actively for positive change In addition to developing the model of care and planning for healthcare need, HAAD will Promote the use homecare, telemedicine and screening programmes by creating necessary prerequisites in terms of financing (schedule of benefits), reimbursement (payment codes) and licensing/ accreditation, and then aligning HAAD s licensing, care standards and quality audit practices accordingly. For instance, homecare reimbursement has been enabled recently, screening in the Weqaya and Visa programmes are being aligned, while telemedicine financing and reimbursement will be clarified. Create/continue taskforces for key planning areas with the mandate to align financing, reimbursement, licensing and quality audit to address capacity gaps and ensure care is integrated across the Emirate - 3 key specialties: Neonatal Intensive Care (NICU) Services, Emergency services and Mental Health Certify specialised services for Major Burns, Tertiary Cancer Surgery, Cardiothoracic Surgery, Neurosurgery, Infant Surgery (under one year), Solid Organ Transplants & Major Trauma. Certification will ensure that concentration of clinical experience can lead to improved clinical outcomes for patients. HAAD will set universal reimbursement rates (to be paid by insurers) for these services Prioritise licensing of healthcare professionals where there are acute shortages Intensive and Critical Care, Emergency Medicine, Neonatology, Cardiology and Psychiatry, as well as rural areas in general whilst maturing and strengthening licensing standards and procedures, e.g., by streamlining processes and supporting clinical training and privileging within the 2011 Professional Qualification Requirements (PQR). - Rural Transformation to address the specific healthcare challenges faced by rural communities of Abu Dhabi, including guidelines for serving communities of less than 5000 residents, e.g., using clinician rotations, mobile clinics, homecare and telemedicine to improve access

146 Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. Ambulance Stations Land provision options (000 s people) (m s) 1 Residential Transient Land area Co-located GFA 3,6 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis Parking (spaces) Minimum service requirement Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service Estimated Resources 2 Physicians 4-6 Physicians Physicians Physicians Ambulance service Ambulance (land/air) Ambulance service Ambulances (land/air) Emergency services Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 To Ensure Reliable Excellence in healthcare to the community Assumptions Model Model of care: How health services are currently used Patient self-care Non-emergency/elective Capacity master plan Planning Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 need under way need under way Ambulance station 2030 Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease management Triage ER Emergency Admission Preventive Emergency Including diagnostics Assumptions growth, scenarios Recommendations Land requirements: Guidelines for urban planners (millions) 5.0 High 4.5 Low 4.0 UPC growth, scenarios National Expatriate Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521'000 For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: OR OR Clinics Hospitals n/a 3/bed Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan

147 !! "" Model of care: How health services are currently used Patient self-care Remote support Screening Check-up Disease management Preventive Including diagnostics Non-emergency/elective Outpatient Clinic Ambulance Urgent Care Centre Triage ER Emergency Elective Admission Emergency Admission Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Region District Gap now Type Total Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis need under way need under way Ambulance station 2030 HAAD Annual report 2010 Model Planning Assumptions 145 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Current Health Facility locations # " #" " AL Corniche Hospital #! # v Al Salama Hospital # #" #!! " " " v #" # # "!! # # # # "! Franco Emirates Hospital! # # # # # # # #!!!! "! " " # # # "! # # # # # # # # # "! # # v! " " #!!! " "! #!!! "! "! " " " "!!! Lifeline " # Hospital Al Reef Hospital " v " v " " " "!! " " "! #! "!!" " "!! # # " v #!! "" " " " " " "! v v v v National Hospital #! #!!!! " "! "" " " " " Al Ahalia # Hospital " v v # ## # " AL MAZROUI #!! ""! # ## #!!! #! # #" " " HOSPITAL " " " " v " "!!!! " " # # # # " NMC " Specialty "! " " #!!" HospitalDar " "! # ## # # v Al Shifa Hospital " " # " " " " " # " " " # # # "# #! " Shaikh # Khalifa! #! "" # # # " Hospital " " " OBAGI! # HOSPTAL # # " " v v # # # #! "! #!! # # " # " # # # " " " " " " " " " #" #" # # # " "!! " #! Gulf Diagnostic!! Center "! Hospital " #" v #" " " " " #" # #" # # # # Zayed Military Hospital " v New Al Noor Hospital v #" " " Al Silla Hospital v #! Dalma Hospital v Al Rewaise Hospital Al Mirfa Hospital #" v v " #!! AL Rahba Hospital " # #"! Al Reef HospitalOBAGI HOSPTAL v Lifeline HospitalNational Hospital! AL # Mafraq Hospital v " ## # "!"" " " " " #" " " #! " " #! " ## # # # # #! " "! ## # #! " " Tawam HospitalOasis v!!!!!! ### # "!! Hospital " v v " """! " "" " " "" "! " v v! v v # Al Ain Hospital AL Saad Hospital " " #" # H Hospital Center Clinic Pharmacy " Gayathy Hospital v #"! Madinat Zayed Hospital v!# "! Liwa Hospital #" v # " AL Wagan Hospital v #! Source HAAD Licensing database, GPS survey; not all Center and Clinic locations shown

148 To Ensure Reliable Excellence in healthcare to the community Assumptions Supply projections Planned Completion Planned Completion Number of beds Region Beds likelihood Type Region Beds likelihood Type Planned 5,515 Anticipated 4,136 Anticipated by ,730 Note *Existing Hospital with planned expansion (total beds 112) Source Preliminary licensed facilities, Licensing & Strategy analysis Total 5,515 Abu Dhab - Island 74 Specialized Abu Dhabi - Near Island General 400 General 50 General 200 General 25 General 35 General 100 Rehabilitation 120 General 118 General 150 General 99 General 364 General 300 Specialized 150 General 210 General 100 General 180 General 100 Specialized 10 General 30 General 100 General 250 General 52 General 100 Rehabilitation Abu Dhabi - Not yet allocated/ On or Near Island General 65 General 150 General 50 General 40 General 117 General 50 Specialized 54 General 104 General 100 General 100 Rehabilitation 60 General 119 General 360 Rehabilitation 150 General 53 Specialized 100 General 32 Rehabilitation 235 General 28 General 31 General Al Ain General 70 General 51 General 50 General 85 General 50 General 50 General 50 General 30 General 50 General 60 General 50 Specialized 62* General 53 General 100 General Western General 54 General

149 Model of care: How health services are currently used Patient self-care Remote support Screening Check-up Disease management Preventive Including diagnostics Non-emergency/elective Outpatient Clinic Ambulance Urgent Care Centre Triage ER Emergency Elective Admission Emergency Admission Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Region District Gap now Type Total Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis need under way need under way Ambulance station 2030 HAAD Annual report 2010 Model Planning Assumptions 147 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations density Source Department of Planning and Economy (2005 Census), Strategy Analysis

150 To Ensure Reliable Excellence in healthcare to the community Assumptions growth, scenarios (millions) High Low UPC growth, scenarios National Expatriate Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521'000 Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Demand projections Additional capacity needs over 10 years Current 2020 CAGR Absolute Annualised 2010 Low High Low High Low High Low High Outpatients (m) As at 18 May 2011 Inpatients (000's) Including churn Beds 3,600 3,900 6, , Low High Doctors 5,600 7,300 8, ,600 3, ,200 1,400 Nurses 8,200 11,700 14, ,500 5, ,300 1,600 Notes Numbers have been rounded for clarity. Assumptions - Outpatient weight is 1, Inpatient weight is 10 - ALOS remains at the 2010 level of 5.7 in the High scenario and reduces to 5.0 in the Low scenario - Bed Occupancy remains at the 2010 level of 71% in the High scenario and increases to 80% in the Low scenario - Outpatients per Doctor remains at the 2010 rate of in the High scenario and increases by 10% in the Low scenario - Outpatients per Nurse remains at the 2010 rate of in the High and Low scenarios - Churn will remain at the 2010 rate of 17% for Doctors and 11% for Nurses Source HAAD Demand Model, HAAD Licensing Database

151 Model of care: How health services are currently used Patient self-care Remote support Screening Check-up Disease management Preventive Including diagnostics Non-emergency/elective Outpatient Clinic Ambulance Urgent Care Centre Triage Emergency Elective Admission Emergency Admission Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan ER Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Region District Gap now Type Total Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Growth Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis need under way need under way Ambulance station 2030 HAAD Annual report 2010 Model Planning Assumptions 149 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Demand projections by diagnosis category As at 18 May 2011 Deliveries Cardiovascular diseases Non-disease conditions Digestive diseases Maternal & Perinatal conditions Genitourinary diseases Cancer Sense organ diseases Respiratory diseases Respiratory infections Musculoskeletal diseases Neuropsychiatric conditions Infectious & parasitic diseases Occupational Injuries Other Injuries Endocrine disorders RTA Diabetes mellitus Skin diseases Congenital anomalies Oral conditions Nutritional deficiencies Inpatient CAGR Outpatient CAGR Low High Low High Notes Inpatient encounters in thousands, Outpatient encounters in millions CAGR Compound Annual Growth Rate Source HAAD Demand Model, Categorization based on WHO classification of ICD diagnoses

152 To Ensure Reliable Excellence in healthcare to the community Assumptions Demand projections for Doctors by specialty 2008 General Medicine L 2018H Pediatrics 2,353 4,123 4,636 Obstetrics & Gynecology Anesthesiology General Surgery Dermatology & Venerology Orthopedics Accident & Emergency Medicine Radiology Otolaryngology Pathology Ophthalmology Cardiology Urology Pediatric Specialties Intensive/Critical Care Medicine Endocrinology & Diabetes Nephrology Plastic Surgery Psychiatry Gastroenterology Cardio/Thoracic Surgery Neurology

153 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Assumptions 151 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Demand projections for Doctors by specialty, continued 2008 Neurosurgery Respiratory Medicine Rheumatology Oncology Vascular Surgery Physical Medicine & Rehabilitation Oral & Maxillofacial Surgery Infectious Disease Hematology Nuclear Medicine Tropical Medicine Occupational Medicine Allergy & Immunology Audiology Gastrointestinal Surgery Geriatric Medicine Oncology Surgery Aviation Medicine Genetics Clinical Toxicology L 2018H ,300 9,100 10,200 Notes Demand projections as at 30 June Based on net activity cost from sample of all activities submitted to KEH with valid clinician license number from 1 August 30 November 2009 (407,055 out of a total 1,044,102 activities for the period) as at 30 December 2009 and Doctor Specialties as at 8 December May include duplicate claims. Source HAAD Demand Model, HAAD Licensing Database, KEH, Strategy analysis

154 Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. Ambulance Stations Land provision options (000 s people) (m s) 1 Residential Transient Land area Co-located GFA 3,6 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis Parking (spaces) Minimum service requirement Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service Estimated Resources 2 Physicians 4-6 Physicians Physicians Physicians Ambulance service Ambulance (land/air) Ambulance service Ambulances (land/air) Emergency services Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 To Ensure Reliable Excellence in healthcare to the community Urban Planning Recommendations Model Model of care: How health services are currently used Patient self-care Non-emergency/elective Capacity master plan Planning Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 need under way need under way Ambulance station 2030 Remote support Outpatient Clinic Elective Admission Screening Ambulance Check-up Urgent Care Centre Disease management Triage ER Emergency Admission Preventive Emergency Including diagnostics Assumptions growth, scenarios Recommendations Land requirements: Guidelines for urban planners (millions) 5.0 High 4.5 Low 4.0 UPC growth, scenarios National Expatriate Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521'000 For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: OR OR Clinics Hospitals n/a 3/bed Note HAAD and SCAD are collaborating to align figures with official SCAD estimates; Estimates presented here are for internal HAAD use only Projections for Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan

155 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Urban Planning Recommendations 153 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Summary The rapid population growth and development in the Emirate of Abu Dhabi requires careful attention to ensure the availability of suitable healthcare services for the population. This plan accordingly includes guidelines for parties who play a key role in ensuring appropriate, quality healthcare services are available to the population in a timely manner: Urban planners high level indications of health facility requirements for anticipated populations to ensure that appropriate land is made available for these facilities at the planning phase. Developers a requirement for healthcare facility developers and operators to be engaged before developments are approved to ensure the new population will have access to appropriate, quality healthcare services in a timely manner. Healthcare investors to support investors with information regarding health service use, supply and demand and to meet regulatory requirements. Specialised services For some health services it is not clinically or economically feasible for services to be offered by many providers, usually due to low patient volumes. For these services a Certificate of need is issued to providers eligible to deliver for these services.

156 To Ensure Reliable Excellence in healthcare to the community Urban Planning Recommendations Land requirements: Recommendations for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: (000 s people) Land provision options (m s) Parking (spaces) Minimum service requirement Estimated Resources Residential Transient 1 Land area Co-located OR OR GFA 3,6 Clinics Primary care Pharmacy services (on-site or within 10 min walk) Laboratory service 2 Physicians 4-6 Physicians Physicians Physicians Ambulance Stations Ambulance service (land/air) 1 Ambulance Ambulance service (land/air) 2 Ambulances Hospitals 4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/ Cultural Centres, Pharmacies, Schools and Post Offices. Ambulance Stations may be co-located with other facilities including Hospitals, Civil Defense Stations, Police Stations and Municipal Offices Where facilities are co-located, adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis

157 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Urban Planning Recommendations 155 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Access requirements: Recommendations for urban planners Healthcare services should be provided to meet the following access requirements in relation to routine/elective services and emergency services: Routine/Elective Emergency services Urban Rural Primary care services within 20 minutes drive at maximum speed of 60 kph Primary care services within 20 minutes drive at maximum speed of 120 kph Ambulance access within 15 minutes, if via land driving at maximum speed of 60 k Ambulance access within 19 minutes, if via land driving at maximum speed of 120 kph Note Alternative solutions such as air ambulance should be utilised to achieve emergency service access requirements in rural and/or densely populated urban areas Source Department of Health UK, Strategy analysis

158 To Ensure Reliable Excellence in healthcare to the community Urban Planning Recommendations Case example: Recommendations for urban planners (000 s people) Land provision options (m2 000 s) Case example Villa and associated community facilities and retail development located adjacent to Al Rahba Anticipated residential population of 50,000 residents and transient (visitor) population expected to be less than 2,000 Residential Transient 1 Land area Co-located OR OR GFA 3,6 Facilities served (000 s) Land to be provided (m2 000 s) Clinics GFA +12 Land plot Ambulance Stations GFA + 3 Land plot Hospitals n/a n/a Development is for less than 60k residents, site analysis indicates that Al Rahba Hospital located nearby thus no need to provide hospital facility within development Source: Strategy Analysis

159 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Urban Planning Recommendations 157 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Facility requirements: Recommendations for investors Health facility developments must: Meet HAAD licensing requirements Ensure any designated minimum service requirements set out in the Land Requirements Guidelines for Urban Planners are met Additional guidance regarding healthcare capacity and demand projections are available within this document, HAAD s Health Statistics Service requirements: Recommendations for developers Developers for projects with intended populations of 5,000 or more must have engaged a developer and operator for the healthcare facilities within the development Developers should notify the Executive Council s Social Development Sub-Committee of their intended plans (copying UPC) in the context of combining/ sharing healthcare facilities with other social infrastructure, e.g., community centers.

160 To Ensure Reliable Excellence in healthcare to the community Urban Planning Recommendations Specialised services summary HAAD defines specialised services where there is evidence that concentrating clinical expertise improves outcomes substantively. HAAD will restrict provision of specialised services to facilities it issues a certificate of need to. All payers must fully and only reimburse certificated providers at a HAAD-defined base rate for such specialised services, which are specified at the DRGlevel. Current specialised services are: - Major Burns at Mafraq - Tertiary Cancer Surgery at Tawam - Cardiothoracic Surgery at SKMC - Neurosurgery at SKMC - Infant surgery at SKMC - Solid Organ Transplantation programmes at SKMC - Major Trauma research centre at SKMC - Major Trauma centre at Al Ain

161 Model of care: How health services are currently used Patient self-care Non-emergency/elective Remote support Outpatient Clinic Elective Admission Screening Ambulance Urgent Care Check-up Centre Disease Triage Emergency ER management Admission Preventive Emergency Including diagnostics Source Institute of Medicine 2001 Crossing the Quality Chasm, Bodenheimer et al 2002 JAMA, Department of Health UK 2001 Reforming Emergency Care, Picker Institute, Strategy analysis growth, scenarios 5.0 Popula on growth, scenarios High 4.5 Low Na onal Expatriate 4.0 UPC Year Low High '600 1'897'000 1'919' '200 1'907'000 1'971' '600 1'916'000 2'040' '000 1'925'000 2'113' '000 1'933'000 2'181' '500 1'941'000 2'244' '000 1'948'000 2'304' '500 1'954'000 2'362' '500 1'959'000 2'417' '000 1'964'000 2'470' '500 1'968'000 2'521' Note Nationals are rounded to the nearest 2.5% variance between high and low, and those for Expatriates at 5%. Source : SCAD population estimates; additional HAAD assumptions and analysis based on raw insurance data; 2030: UPC 2030 Plan Capacity master plan Facilities Clinicians Ratios 2030 Plan growth Hospitals Clinics Growth Region District Gap now Type Total % National Nationals Total Hospitals Clinics & Centres Nearby hospital Doctors Nurses Dentists Other Facilities /10000 Doctors /1000 Nurses /1000 Capacity Gap Supply Sever Underserved Moderate Potential over None Note Abu Dhabi and Al Gharbia populations based on SCAD 2005 census. Al Ain population based on 2008 UPC estimate. Source : SCAD, UPC 2030 plans. Clinicians and Facilities: Licensing database. Planned Facilities ; SEHA, UPC 2030 plans, HAAD Planning analysis. need under way need under way Ambulance station 2030 Land requirements: Guidelines for urban planners For planning purposes, land must be available for hospitals, clinics and ambulance stations to serve anticipated population as per the following guidelines: Land provision options Parking Minimum service Estimated (000 s people) (m s) (spaces) requirement Resources 1 Residential Transient Land area Co-located OR OR GFA3,6 Clinics2 Primary care Physicians Pharmacy services (on-site or within 10 min walk) Laboratory service 4-6 Physicians Physicians Physicians Ambulance Ambulance service Ambulance Stations (land/air) Ambulance service Ambulances (land/air) Hospitals4 Emergency services n/a 3/bed Beds Laboratory services 5 Radiology services Stand-alone building n/a 3/bed beds 5 Notes 1 Transient population includes staff and other non-residential visitors. 2 Clinics collectively refers to Clinics, Centers and Polyclinics. 3 Clinics may be co-located with other facilities including Mosques, Neighbourhood Commercial Centres, Sport Facilities, Community/Cultural Centres, Pharmacies, Schools and adequate transport options and shared parking must be made available. 4 If residential population is less than 60,000 or transient population is less than 180,000, land provision for a hospital facility needs to be made on a site-based analysis which considers the accessibility of existing hospital facilities. 5 Optimal hospital size is beds. 6 GFA Ground Floor Area Source Strategy analysis HAAD Annual report 2010 Model Planning Urban Planning Recommendations 159 Popula on (millions) Assumptions Abu Dhabi Desert Villages Rural 28,480 10,963 None 81, ,000 Al Falah Rural 4,028 1,996 None 95, ,000 Ghantoot District Rural 2,478 - None 97, ,000 Abu Dhabi Island Urban 313,809 44, ,529 3, , , ,000 CBD/Financial Centre Urban 174,625 14, ,131 1, , ,000 Musaffah Urban 141,268 2, (41,268) 3 100,000 Bani Yas Rural 47,245 27, , ,000 Al Shahama Rural 37,831 16, , ,000 Shamkhah Rural 15,839 10,674 None 1 114, ,000 Al Rahba Rural 15,315 13, , ,000 New Port City Rural 11,740 4,565 None 1 138, ,000 Capital District South Urban 9, None 1 45, ,000 Bain Al Jesrain Urban 7,694 4, , ,000 Khalifa City A Urban 5,317 2, , ,000 Grand Mosque District Urban 5,257 1,837 None 1 114, ,000 Inner Islands Urban 2, , ,000 Capital District North Urban 2,371 2, , ,000 Al Mina Urban 1, , ,000 Al Raha Urban , ,000 Yas Island Urban None 99, ,000 Mohamed Bin Zayed City Urban , ,000 Saadiyat Urban 122 None 119, ,000 Airport District Urban , ,000 Lulu Island Urban 75 None 19, ,000 Capital District Urban None 240, ,000 Mohamed Bin Zayed Centre Urban None 80, ,000 South Hudayriat Island Rural None 100, ,000 Marina Village Urban ,000 5,000 Al Suwwah Urban None 30, ,000 Al Reem Urban None 200, ,000 Al Ain Umm Ghaffa Rural 8,851 5,873 None 3, ,900 Nahel Rural 5,196 2,377 None 4, ,000 Industrial City Rural 48, , ,740 Al Salamat/Al Yaher Urban 37,544 23, , ,000 Al Dhahra Rural 4, None 1, ,000 Abu Krayyah Rural 4, None ,000 Al Saad Rural 3, None 1, ,000 Al Araad Rural 3, None ,000 Abu Samra Rural 1, None 558 2,500 Al Ain City Urban 343, , ,733 2, , ,300 Al Quaa Rural 12,512 4, , ,000 Al Wagan Rural 11,865 3, , ,000 Al Hayer Rural 11,484 2, , ,000 Al Dhaher Rural 10,641 7, , ,350 Remah Rural 8, , ,500 Sweihan Rural 7, , ,000 Al Khazna Rural 7,350 1, , ,000 Mezyad Rural 6,407 3,809 None 1 1, ,400 Al Shwaib Rural 3,260 1, , ,500 Al Fagah Rural 2, ,411 3,500 Western Liwa Rural 20, , ,000 Madinat Zayed Rural 29,000 6, , ,000 Ruwais Rural 16,000 1, , ,000 Mirfa Rural 15,000 3, , ,000 Ghayathi Rural 8,000 3, , ,000 Sila'a Rural 5, , ,000 Delma Island Rural 5,000 2, , ,000 Recommendations Specialised services certification and audit HAAD issues a certificate of need for 5 years (renewable) based on a successful initial audit. The certificate entitles facility staff to provide the specialised service at other licensed facilities, as appropriate. Operators submit to HAAD an activity-based budget for the subsequent Calendar year by April 30, net of all other payments. For any transition period to reach the full service specification, the Operator will also submit service specification milestones to be met by the beginning of each Calendar year. HAAD schedules an annual audit of the service against the service specification. HAAD pursues an escalation procedure in case of a failed audit: 1 Issue a deficiency letter with 90 days to correct deficiencies identified and re-audit the service after the 90 day period has elapsed. If the re-audit fails: 2 Issue an enforcement notice which may add, impose, vary or remove conditions with a further 120 days (maximum) to comply. Re-audit the service after the 120 day period has elapsed. If the second re-audit fails: 3 Consider suspension, removal and replacement of the managing operator responsible for service delivery of the specialised service.

162 To Ensure Reliable Excellence in healthcare to the community CEO Closing Statement I would like to extend a heartfelt thanks to our employees, customers, partners and stakeholders for enabling our mission of reliable E xcellence in healthcare. HAAD s achievements in 2010 would not have been possible without their support, collaboration and dedication. The Authority s strategic objectives are decided in cooperation with stakeholders through a transparent process of consultation, which in turn generates a high level of involvement, leading to success. Reliable E xcellence means many things to us. It means offering affordable access to healthcare through a flexible and efficient financial system, made possible through the successful implementation of mandatory insurance across the entire Emirate, as well as the introduction of the DRG payment system. It means providing world class quality care and outcomes through continual improvements in our process for licensing, inspecting and rating healthcare providers. These processes, coupled with an unwavering commitment to continuous reviews and evaluation, helps sustain E xcellence in healthcare. It means listening carefully to our customers and stakeholders. Our strategic priorities are based on stakeholder collaboration. We have television and radio programs where patients and the population in general can get in touch with HAAD decision-makers. A comprehensive patient feedback campaign involving surveys at different points of contact has indicated the highest ever levels of patient satisfaction and trust. Reliable E xcellence means offering a full spectrum of health services to patients, with transactions that are standardized for ease of reporting. We have automated the process of submitting claims so that our e-claims data can be used to understand health trends and plan capacity for excellent healthcare today, tomorrow, and the years to come. It means making sure that there is a skilled and sustainable workforce available to offer the best healthcare. The Authority is committed to finding, hiring and training UAE nationals, and offering them the best chances of personal development and further qualification, via residency matching programs and advanced degree programs in association with John Hopkins. It means working with international experts and local and regional partners to offer advice, strategy and services that benefit the community at the collective and individual level. And finally, it means operating in an environmentally friendly and sustainable fashion, while reaching out to the community through various CSR initiatives.

163 HAAD Annual report 2010 CEO Closing Statement 161 In summing 2010, the year was centered on the idea of Access. For the Authority, Access was an umbrella term covering improvements in transparency, insurance, financial structure, capacity planning for the future, e-services, availability and partnerships to improve patients ability to gain access to healthcare and to improve the quality and timeliness of the healthcare delivered. Looking forward to 2011, the Authority s focus will be on further improving the quality of care. HAAD is continuing its reform of the healthcare regulatory environment to introduce further improvements to the benefit of stakeholders, partners, customers and patients. Key improvements in 2011 will include: 1) Hospital Ratings: The first report on the structure, process and outcome measures for all hospitals in the Emirate of Abu Dhabi will be compiled by renowned ratings organization Thomson Reuters and published by HAAD. 3) An enhanced and more robust Weqaya disease management program 4) New standards to redesign emergency rooms 5) Progress with evidence-based clinical care pathways 6) Successful completion of the second round of the Tanseeq residency matching program 7) An enhanced capacity master plan 2010 was a notable year for the improvements introduced within the healthcare system through a robust regulatory environment. I am confident that 2011 will continue this rich vein of E xcellence. H.E. Zaid Al Siksek CEO, Health Authority Abu Dhabi 2) Revision of Professional Qualifications Requirements: To streamline the process of online application for professional licensing

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