Health System Consolidation in the Middle East: Opportunity or Risk for Value-Based Care?

I remember sitting in a conference room in Dubai last year, listening to a hospital CEO explain why his organization was merging with three other facilities. "We need scale," he said. "Scale is how we deliver value."

I nodded, but a question stayed with me long after: Does bigger actually mean better?

Across the Gulf, healthcare leaders are betting big on consolidation. Hospitals are merging. Networks are expanding. The promise is clear: larger systems can invest in better technology, negotiate lower prices, and coordinate care in ways smaller providers cannot.

But I've watched enough of these mergers to know the reality is messier than the pitch deck suggests.

‍

Why Size Matters (Sometimes)

The advantages of scale are real. Larger health systems can afford the infrastructure that value-based care needs, such as data platforms, specialized centers, and integrated records. They can follow patients across multiple visits, which is crucial when managing diabetes or heart disease, conditions that affect millions in the GCC.

Then there's buying power. Specialty drugs eat upto 11% of health spending here. A big system can sit across the table from pharmaceutical companies and actually negotiate. They can tie payments to results instead of just volume.

The policy environment also supports this. The health departments have teams evaluating new technologies. Saudi Vision 2030 talks explicitly about outcomes-driven care. Consolidation seems like the natural path forward.

But here's what I've learned: the distance between a good strategy and making it work is where things usually fall apart.

‍

When Bigger Backfires

Consolidation doesn't guarantee better care. Sometimes it does the opposite.

When you reduce competition, prices often climb instead of dropping. Quality improvement slows down. Patients have fewer choices. Insurers lose leverage. The efficiency you were promised? It doesn't always show up.

I've seen this up close. Large systems get bureaucratic. Decisions take forever. Doctors and nurses on the ground feel disconnected from whatever the executives are planning. Want to implement patient outcome tracking? Good luck navigating the approval process.

And merging doesn't fix fragmented data. GCC health systems run through government facilities, military hospitals, insurance networks, and employer programs. It's complicated. If your digital systems don't actually talk to each other after a merger, you haven't created integration. You've just made the silos bigger.

There's also a fairness issue. Universal coverage for citizens doesn't always extend to expats. Merged systems might focus on profitable services, making access worse for some populations, not better.

A physician in Riyadh told me, "We merged three hospitals, but my patients still can't get their records to follow them. We're larger, but we're not smarter."

That stuck with me.

‍

What Actually Works

What is the difference between consolidation that works and consolidation that just concentrates power? It's all in how you do it.

Governance is everything. When hospitals merge, do doctors keep autonomy where it matters? Are you measuring patient outcomes or just visit counts? Can people see how treatment decisions get made?

Technology has to connect. Patient data needs to flow everywhere it's needed. That means records that actually work together, not just exist in the same company. Without this, you're building a bigger mess, not an integrated system.

Everyone needs to pull in the same direction. Doctors, insurers, regulators, and patients. They all need shared goals. That means balancing what works clinically, what costs, what's fair, and what patients actually want. Not just what the finance team prefers.

‍

What Happens Next

Consolidation isn't stopping. Market forces, policy goals, and competition guarantee that.

But whether these mergers deliver better care or just create supersized versions of our current problems depends on what happens after the contracts are signed.

Size gives you options. But options don't heal people, cut waste, or improve lives by themselves.

What you actually build: the systems, the culture, the commitment to getting it right. That is what turns possibility into better health.

And honestly? That's the only thing that should matter.