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Abu Dhabi health authorities introduce new reforms to curb costs
Posted on Aug 31, 2017 by Jessica Lindeman
Abu Dhabi health authorities have recently introduced a number of healthcare reforms to curb health insurance costs and healthcare spending. Among the recent changes, adult patients will no longer be covered for seeking a second or subsequent appointment directly from a specialist within 21 days without a referral from their general practitioner. Other measures include allowing better performing hospitals to share information and to mentor healthcare facilities that have been performing poorly. Here, we provide an overview of the new healthcare reforms recently introduced in Abu Dhabi.
An overview of the new reforms introduced by HAAD
Last year, AED 3.67 billion was lost to factors including insurance fraud and a culture ofover-prescribing by doctors, who receive financial incentives to prescribe brand-name medications. In a bid to curb health insurance costs, control medical spending, and improve the quality of medical care, the latest reforms to shape healthcare in the UAE’s largest Emirate are part of a two-year consultation between hospitals and the Health Authority - Abu Dhabi (HAAD). Key reforms include a new mechanism to access outpatient services, as well as a new quality reform program, both of which are believed to be a large step forward that will eventually help reduce the cost of health cover.
New mechanism to access outpatient services
Effective from 1 September 2017, adults seeking a second or subsequent outpatient appointment for the same specialty within 21 days without a GP’s referral will only be covered by their health insurance if the patient obtains pre-approval from their insurance provider. Up until now, patients have been able to seek treatment for the second, third, or fourth time from a specialist without restriction. This new measure will help clamp down on patients self-referring themselves to expensive specialists, as adults will now need to first obtain a referral from their doctor for a second opinion.
Exclusions to the new reform include:
- A patient’s first consultation for a specific symptom
- Children under 18 years old
- Adults aged 60 years old and above
- Health screening visits
- Vaccination visits
- Emergency visits
New quality reform program
As part of the new JAWDA Quality program, over the past two years healthcare operators have collaborated to form a set of quality metrics, which now enable HAAD to assess hospital and clinic performance on a month-to-month basis. The data goes to a dashboard, allowing HAAD to identify which healthcare facilities are failing and in need of quality improvement advice.
“One of the features that makes this program unique, is that quality scores will be dynamic and change from month-to-month related to each month’s performance – so healthcare providers who promptly correct deficiencies will improve their quality score in the subsequent month”, says Professor Maha Barakat, Director General at HAAD.
In future, healthcare facilities’ performance information will become publically available on a dedicated online portal as early as 2018, allowing patients to vote on their feet.
Background on health insurance reforms in Abu Dhabi
As the first Emirate to make health insurance mandatory, the Abu Dhabi Health Insurance Law was first introduced in 2005, requiring all residents to have basic health cover by June 2006. There are two types of plans under this law:
- The Thiqa Plan (for Emiratis)
- Basic Plan (for expat workers with a visa issued in Abu Dhabi)
Several modifications to both the Thiqa and Basic Plan were implemented in July 1, 2016:
Basic Plan
Changes to the basic plan include:
- An increase in the annual premium from AED 600 to AED 800 per employee (or dependent under 18 years old). Higher rates may apply to older dependents.
- Employees over 40 years old will have an optional co-payment of 50%, but this percentage can be lowered depending on negotiations between the employee and employer.
- It is now optional for the employer to contribute up to 50% of the insurance premium for any of their employees’ dependents. Previously, employers had to pay in full for both employees and their dependents.
- A new additional mandatory premium for married females.
Thiqa
Changes to the Thiqa plan include:
- Policyholders must now pay a 20% co-payment for private healthcare treatment.
- Orthodontic coverage no longer apply to those aged 18 or older unless it is deemed medically necessary.
- Coverage for treatment outside of Abu Dhabi are subject to a 50% co-payment if the same treatment is available locally.
Looking to learn more about how the new Abu Dhabi health insurance and healthcare reforms may affect you? Be sure to contact the experienced advisors at UAE Medical Insurance today! They are on hand to answer all your questions regarding health insurance and healthcare in the UAE, give you impartial advice, and offer you a free health insurance quote.
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