Trends in international healthcare collaborations across KSA and GCC

The National Center for Healthcare Leadership (NCHL) is an American 501(c)(3) non-profit organisation dedicated to advancing healthcare leadership and organisational excellence in the United States and abroad.

One of NCHL’s premier membership programs, the US Cooperative for International Patient Programs (USCIPP), is the United States’ industry consortium of hospitals and health systems with international programs. USCIPP fosters peer-to-peer learning and organisational improvement through inter-organisational initiatives and the continuous and open sharing of knowledge and industry best practices. USCIPP’s organisational members all share a focus on caring for patients traveling to the United States from abroad, and nearly all USCIPP members also engage in healthcare collaborations with partners from around the world.

Figure 1. USCIPP Member Organisations as of September 2023

Ann & Robert H. Lurie Children’s Hospital of Chicago
Atrium Health
Baptist Health South Florida
Baylor St. Luke’s Medical Center
Boston Children’s Hospital
Brigham Health/Dana-Farber Cancer Institute
Broward Health International
Cancer Treatment Centers of America
Cedars-Sinai
Children’s Hospital Colorado
Children’s Hospital Los Angeles
Children’s Hospital of Philadelphia
Children’s Mercy Kansas City
Children’s National Hospital
Cincinnati Children’s
City of Hope
Cleveland Clinic
Cook Children’s Health Care System
Dignity Health International
Duke Health
Gillette Children’s Specialty Healthcare
Henry Ford Health
Hospital for Special Surgery
Houston Methodist
Indiana University Health
Johns Hopkins Medicine International
Keck Medicine of the University of Southern California
Kennedy Krieger Institute
Mass General Brigham
Mayo Clinic
MD Anderson Cancer Center
MedStar Georgetown University Hospital
Memorial Healthcare System
Memorial Hermann–Texas Medical Center & TIRR Memorial Hermann
Memorial Sloan Kettering Cancer Center
Moffitt Cancer Center
Nationwide Children’s Hospital
Nemours Children’s Health
New York University (NYU) Langone Health
NewYork-Presbyterian
Nicklaus Children’s Hospital
Northwell Health
Northwestern Medicine
Ochsner Health System
Rush University Medical Center
Shriners Hospitals for Children
St. Jude Children’s Research Hospital
Stanford Medicine
Texas Children’s Hospital
The James Cancer Hospital at The Ohio State University
The Paley Institute at St. Mary’s Medical Center
The Shirley Ryan AbilityLab
UChicago Medicine
University Hospitals Cleveland Medical Center
University of California, Los Angeles (UCLA) Health
University of California, San Diego (UCSD) Health
University of California, San Francisco (UCSF) Health
University of Pittsburgh Medical Center (UPMC) and Children’s Hospital of Pittsburgh of UPMC
Washington University School of Medicine in St. Louis
Yale International Medicine Program

International healthcare collaborations in the GCC

NCHL maintains a work product known as the USCIPP International Healthcare Collaborations Dashboard and Map as part of the business intelligence and international market analysis initiatives that the organisation leads for members of the USCIPP program. This unique tool uses a project classification typology that was developed by NCHL with input from USCIPP member organisations. It enables users to better understand the current players and projects in international markets of interest. Figure 2 outlines the top-level categories into which NCHL classifies all international healthcare collaborations.

While a collaboration may be most accurately described as falling into several of the categories above, the NCHL team assigns each relationship to a single category. Current work is underway to classify projects under multiple collaboration types where applicable. Criteria for inclusion include:

The collaboration must involve a hospital or clinical facility.
Collaborations involving only tech companies, insurance providers, non-governmental organisations (NGO), medical facilitators, or between two government entities (e.g., the Ministry of Health in two countries) are typically not included; there may be exceptions to this rule if, for example, an insurance company owns a patient care facility in another country.
Collaborations funded by non-profit/ NGO grants/funding are normally included and tagged as externally funded.
If the collaboration involves sending doctors to another country, it should be included only if both parties in the agreement are not government entities
As of September 2023, NCHL’s research has identified at least 267 active healthcare collaborations in the GCC, most of which are in Saudi Arabia or the United Arab Emirates. The GCC accounted for 21% of cataloged collaborations across the globe. Specifically, NCHL’s research has identified:
At least 133 active collaborations in the United Arab Emirates, which account for 50% of all collaborations in the GCC; the most common collaboration types in the United Arab Emirates are clinical and patient agreements (26%), followed by education and research (25%)
At least 65 active collaborations in Saudi Arabia, which account for 24% of all collaborations in the GCC; the most common collaboration types in Saudi Arabia are education and research (42%), consulting and advisory (23%), and direct ownership and joint ventures (12%)
At least 21 active collaborations in Kuwait, with education and research, clinical and patient agreements, and management services being the most common (each with 19%)
At least 17 active collaborations in Qatar, with direct ownership and joint ventures being the most common (41%), followed by consulting and advisory (24%)
At least 16 active collaborations in Bahrain, with education and research being the most common (44%), followed by clinical and patient agreements (19%)
At least 15 active collaborations in Oman, with direct ownership and joint ventures being the most common (80%), followed by clinical and patient agreements (20%)

NCHL’s research is based both on publicly available information and data provided by USCIPP’s member organisations directly to NCHL. While NCHL has a team dedicated to conducting ongoing market monitoring and updates its database with new collaborations each month, the figures cited above are almost certainly still an underestimate of the true number of international healthcare collaborations across the world.

USCIPP member organisations have communicated to NCHL that some of their international healthcare collaborations with GCC partners are covered by non-disclosure agreements and are therefore not listed in the public domain. The figures above frequently change as new collaborative relationships are added to the database and map.

Collaborations in Saudi Arabia

Saudi Arabia is a particularly robust example of cross-border collaboration in healthcare. In a country-level comparison of documented healthcare collaborations, Saudi Arabia ranks third, surpassed only by China (currently ranked first) and the United Arab Emirates (currently ranked second). The trends in Saudi Arabia’s market largely reflect broader trends in international healthcare collaboration across both the region and the world.

NCHL’s data and analysis show four notable trends in Saudi Arabia’s market:

Cross-border collaboration in Saudi Arabia has grown rapidly. The first documented collaborations in the country began in 2007 — by comparison, several countries have international relationships that date back to the 1990s or earlier. In just 15 years, Saudi Arabia has widely expanded both the size and scope of international healthcare partnerships.
The nature of collaborations reflects a particular focus on building healthcare capacity. Most identified collaborations in Saudi Arabia are either educational in nature or aim to increase the quality of and access to care through consulting, direct ownership, and joint venture agreements. The educational partnerships are primarily designed to increase the healthcare workforce’s access to training as well as facilitate cross-border knowledge sharing with international partners.
There is an increasing focus on specialisation. As of September 2023, only 13% of the collaborations in Saudi Arabia are specialised. This means that that the collaboration has a limited scope in terms of service lines covered by the relationship. While this is a small share of all collaborations in the country, it is noteworthy that almost every specialised collaboration began in the past five years. This demonstrates a shift towards addressing niche needs within the healthcare system. Some examples of specialised collaborations include:

a. In 2019, “Houston-based Baylor Genetics and Riyadh-based Saudi Diagnostic Limited, a subsidiary of King Faisal Specialist Hospital International Holding Company, signed (a memorandum of understanding) to exclusively work toward a strategic partnership agreement for all genetic testing and precision medicine in the Middle East and North Africa regions.”

b. In 2020, Jeddah Park Health established a collaboration with Johns Hopkins Medicine International through a “long-term clinical advisory engagement in developing the leading physical medicine and rehabilitation hospital in both the Kingdom of Saudi Arabia and MENA region. The collaboration calls for a general consultation from Johns Hopkins Medicine International on the planning, development, and launch of a standalone physical medicine and rehabilitation-focused facility.”

c. In 2023, “Olayan Financial Company, represented by Olayan Saudi Holding Company, and Vamed Group, the Austria-headquartered healthcare provider, [partnered] to open a new rehabilitation and long-term care hospital in Saudi Arabia with a 150-bed capacity.

4. International hospitals, healthcare information technology companies, and other healthcare-focused organisations continue to show strong interest in establishing new collaborations in Saudi Arabia – as do the national governments of their countries of origin. In a particularly recent example, in September 2023, the International Trade Administration of the US Department of Commerce led a delegation of 15 American healthcare companies — including five hospitals — on a healthcare-focused trade mission to Saudi Arabia. The purpose of the trade mission was to allow “participating US firms [to] gain market insights, make industry and government contacts, solidify business strategies, and advance specific projects with the goal of increasing US healthcare product and service exports.”

References available on request.

Callie Lambert is the Director of Research, and Jarrett Fowler is the Senior Director, Strategic and International Initiatives, at the National Center for Healthcare Leadership (NCHL) in the US.

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