This presentation was made during my stint at Cognizant in the Yr.2006-07, which was appreciated by the senior management including Mr. Francisco D'Souza (CEO) after which Cognizant entered into The Middle East market with it's first project i.e. Daman.

1. © 2008, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Opportunities in the Middle East
-East meets West
Nov 20th , 2007
Author: Abu Isaac

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© 2008, Cognizant Technology Solutions.
Introduction
 GCC* governments currently provide the lion’s share
of health-care financing—approximately 75 percent.
 To lessen the burden, all GCC countries recently
passed, or are in the process of passing, sweeping
health-care insurance legislation
 Demand for private health insurance products has
risen significantly since the start of 2007
» Growing at over 21% annually
» Premium growth outstripping major industrialized
nations
 In Saudi Arabia alone, demand is such that estimates
predict that the health insurance sector will be worth
more than SR15 billion (USD 4 bn) by 2009.
 Abu Dhabi & Dubai passed laws requiring all
employers in the Emirate to provide minimum cover
for their employees.

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© 2008, Cognizant Technology Solutions.
Drivers
 Cost: Total healthcare spending in GCC countries will rise to about $60 billion by 2025, from
almost $12 billion today.
» With most pharmaceuticals, medical equipments and medical service providers imported,
healthcare costs are even higher, so insurance is viable, if not critical.
 No Tax: These countries don’t have taxes and hence unable to pay for the increasing medical cost
 GDP Growth: Healthcare spend is expected to grow significantly in the period between 2006-2015,
driven primarily by growth in GDP/ capita
 Agreements with a growing number of blue-chip medical companies, such as Cleveland Clinic and
John Hopkins Medicine, to set up operations in the GCC region
 More insurers, MCOs and TPAs getting into the picture to meet the demand
 Saudi Arabia, the largest GCC member taking the first step, many others following suit
 Multi-billion dollar healthcare projects like “The Mother
of Emirates Healthcare Complex”, “Dubai Healthcare city”,
Hamad Medical City” etc
 Huge investment in pharmaceuticals and increasing privatization
 Population Growth, ageing and increased diseases

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© 2008, Cognizant Technology Solutions.
Healthcare Demand
 Demand for treatment: It is estimated that, over the next 20 years, the demand for
healthcare in GCC will rise 240 percent resulting from steep increase in cardiovascular
diseases and diabetes related ailments
 Demand for hospital beds: By 2025 demand for hospital beds will have more than
doubled; the region will require more almost 162,000 beds in all. Saudi Arabia and UAE are
expected to register the greatest percentage increase in demand.

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© 2008, Cognizant Technology Solutions.
GCC Healthcare Market Summary

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Players in the Market
 MEDNET (TPAs for Aetna in UAE)
 Nextcare
 CIGNA International
 EUROP Assistance
 BUPA Middle East
 Good Health
 Royal & Sun Alliance
 Global Health Insurance
 Saudi-Indian Insurance Company
 SABB Takaful Company
 Dubai Healthcare City
 John Hopkins International
 Saudi German Hospitals
 Emaar Healthcare
 AXA Insurance Gulf
 Qatar Insurance Company
 Arabian Scandinavian Insurance Company
 Oman Insurance Company
 Daman- The National Health Insurance Company
 and lots more...
Providers Stats

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© 2008, Cognizant Technology Solutions.
Saudi Arabia
 The Kingdom has made health insurance compulsory for all expatriate workers
 Expects the healthcare insurance market to grow at 25% annually
 4 million expatriates treated in hospital every year in Saudi Arabia
 Health insurance industry is booming with total number of registered people under the
national health insurance scheme rose to 2.64 million
 A health insurance policy from an approved cooperative health insurer is now a requirement
in the granting of Iqamas* and work permit renewals
 The Kingdom’s fast-growing pharmaceutical sector is contributing to the good health of
insurance company investments
 Health insurance law is being implemented in phases
 Companies with more than 500 expatriate workers to be covered first
 The next phase is to be imposed on companies having 100 workers and more
 Finally, coverage will extend to all workers including housemaids
 Eventually health insurance would be made mandatory for Saudi citizens
 Foreign insurance companies to open their branches in the Kingdom. Includes well-known
insurance companies from Britain, Germany, Switzerland, Japan, India, Holland, the United
States, Bahrain, Jordan, Lebanon and France
 Insurance companies are obliged to float at least 25% of their shares on the Tadawul, the
local stock exchange, and meet other regulations
 Health insurance premiums, which accounted for about a third of
the total market, grew 64% to SAR2.2 billion

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© 2008, Cognizant Technology Solutions.
UAE- Abu Dhabi
 Health insurance to become compulsory in the UAE soon
 The United Arab Emirates is divided into seven Emirates having different rulers and rules. The
emirates of UAE are
» Abu Dhabi
» Ajman
» Dubai
» Fujairah
» Ras-Al-Khaimah
» Sharjah
» Umm-Al- Quwain
 The Abu Dhabi Health Insurance Law
» Begun implementation of its first phase on July 1st 2006
» All local and federal Government, Quasi-Government, and Private Companies with over
1,000 workers to provide Health Insurance to all their employees and their dependents
» Phase II began on January 1st 2007, and will cover all expatriates residing in the capital
» Abu Dhabi Population to soar in the next several years fuelled by trade and tourism

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© 2008, Cognizant Technology Solutions.
UAE- Dubai
 Dubai government in the final stages of implementing comprehensive
new health insurance arrangements in the Emirate by 2008
» The plan follows Abu Dhabi's universal health insurance scheme
» Dubai's new health insurance law is expected to take few months to formulate
» The law will enable all in the country to pay insurance EMIs and get health coverage.
 Under the plan, all UAE residents can seek treatment at hospitals in the UAE, including
private ones, listed by the new federal insurance provider
 The goal is to ensure access to healthcare services for all, particularly the middle to lower
income level workers such as construction workers
 Dubai Healthcare City (Free-Zone) managed to attract high-profile names in healthcare such
as Mayo Clinic, Moorfield's Eye Hospital and Harvard Medical School-Dubai Centre
 New hospitals coming up are the Bumrungrad Hospital, the Saudi-German Hospital, the
Canadian Hospital, the annexure of American Hospital and lot more.
 Major international healthcare businesses such as BUPA, MedNet, Swiss Re and InterGlobal
have already responded as well as a number of prominent regional insurers such as Arab
Orient, Emirates Insurance, Al Khazna and Daman
 The Government established the national health insurance company, Daman, early in 2006.
By December 2006, Daman reported to have issued approximately 200,000 health cards

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© 2008, Cognizant Technology Solutions.
The rest of GCC
 Bahrain: Recently the Ruling Council approved health insurance plan for expatriates
» Implementing a 5 stage health insurance policy covering citizens in phase II
» Hospitals in Bahrain have direct billing facilities with the several insurance companies like
Cumberland Insurance, CIGNA Healthcare, International Health Insurance (IHI)
» Batelco, Bahrain's leading Telecommunications Company, has signed an agreement with
Solidarity to provide health insurance coverage for Batelco staff
» Plans to outsource non-core medical services
 Qatar: Implementing health insurance in a phased manner
» With the launch of “Qatar Financial Center” in Doha, things have changed
» New private health insurance companies are entering Qatar in a big way
» First step towards privatization with the creation of National Health Authority (NHA) in 2005
» Creating a National Health Database
» “AXA Insurance Gulf” won the healthcare insurance bid for Qatar petroleoum covering
12,000 employees and 23,000 of their dependants
» Healthcare budget in 2006/07 rose 18.2% to QR 3.8bn (USD 1 bn)
 Kuwait: Does not have any healthcare insurance plan, but the government is thinking to revamp
the entire healthcare delivery and insurance system

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© 2008, Cognizant Technology Solutions.
Opportunity
For Insurers
 Huge market in Saudi Arabia and UAE with expatriates population of 50-60%
 Government’s lack of experience in running complex healthcare insurance system is actually
an opportunity for international payers
 GCC governments often pay big money to insurers for hiring and training locals
 Plethora of opportunities if the government adopts appropriate policies and regulations. GCC
states are rising to the occasion and are already elevating the private sectors role in
healthcare
Opportunity for Cognizant lies in building IT-enabled transparency of Business Process
 Helping to build the e-claims model for insurance companies
 Can reduce dependence on dollar, increase revenue and diversify geographically
 Potential for other verticals in Cognizant
» BFSI- Dubai and Doha competing to become the financial hub of Asia. The market size
of Islamic banking solution is $300 billion
» RHML- Booming market for retail, hospitality, manufacturing and logistics
 Middle East presence makes it easier to enter European markets
 Huge opportunity to enter the “Provider” market as it is wooing big names
from the west

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© 2008, Cognizant Technology Solutions.
Road Blocks
 Takaful* health and life policies are complex
» The main drawback is that the law forbids investments in a wide range of industries –
including armaments; and most health and life insurers cannot control where their
parent companies invest funds
 The current policies and regulations are a roadblock but they are fast changing
 Finding talent as people consider a job in the GCC countries as a stepping stone to much
greener pastures of Europe or US.
 Few people have experience or skills at the point where healthcare and finance intersect.
 Very low IT penetration. However the potential for Cognizant is huge.
 The GCC expatriate population is traditionally fairly transient, which provides healthcare
insurers with specific challenges as policyholders may change more frequently than in other
countries.
 Different rules in different emirates and GCC countries might confuse the customer as well as
the health plans

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© 2008, Cognizant Technology Solutions.
 TCS almost doubling the revenue its makes from GCC every 12 months
 Infosys has offices in Sharjah, UAE
 Accenture has office in Abu Dhabi and Dubai
 Covansys has a good middle east network
 IBM has big operations in the middle east with office in Dubai
 Wipro has offices in both Saudi Arabia and UAE
 Perot Systems, IBM are the Gold sponsors for Arab Health
 3iInfotech is penetrating The Middle East market in a big way trying to increase
their visibility in this market considerably
 Satyam's business growing by around 70% year-on-year in the Middle East alone
What about
Cognizant?
Competitors …a Quick Glance

14. © 2008, Cognizant Technology Solutions. All Rights Reserved.
The information contained herein is subject to change without notice.
Thank you

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© 2008, Cognizant Technology Solutions.
Appendix- Upcoming Forums for Cognizant
 Arab Health- The leading international healthcare exhibition and congress held every time
in Dubai (27th -31st January 2008)
 Insurex- Middle East's premier independent insurance conference (8th -9th April 2008)
 Healthcare Management Forum- The Middle East conference for healthcare
providers (27th -31st January 2008)
 Healthcare Arabia- Launch pad in the Middle East for global healthcare product
manufacturers and service providers (20th – 24th November 2007)
 GITEX Technology Week 2008- The leading international IT Trade event for
Enterprise and SMBs for the Middle East, Africa and South Asia. Satyam and Wipro sets up
stall here every year.

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© 2008, Cognizant Technology Solutions.
Market Entry for Cognizant
 Joint Venture or an Alliance with the local players like Waseel, Daman etc
 Set up our own development center in any of the free zones available all over GCC
 Establish a development centre in Egypt targeting Middle East and global businesses
» Smart Village - a 450-acre business park for IT and telecom companies in Cairo
» Cheap Labor available in plenty
 Setting up regional offices in GCC with development centers in India itself
» Can leverage on the Kochi development center because of the State’s inherent bond with the GCC countries
especially the Smart City campus built by the Dubai Govt (Possibility )
 Acquisition of a local company and integrating it with Cognizant though some GCC
countries don’t allow take-overs