DHA reforms draw mixed response from industry

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There is still a great deal of confusion as to how mandatory insurance will impact on Dubai’s health systems. (Getty Images)

News of Dubai's health insurance scheme, unveiled last month, has split opinions in the medical industry.

Some healthcare professionals have welcomed the idea, citing better access to healthcare as a key factor in reversing the rise in chronic conditions, while others worried about the lack of detail revealed by Dubai Health Authority (DHA).

The majority of private facilities polled by Medical Times supported a move towards a primary care-led system. Danie Meintjes, CEO of Welcare World Health systems, said; "There are some good concepts in there - like having a family-focused gatekeeper of the primary services and then sending people through to the more expensive tertiary services."

Dr Alya Ahmed of APC Clinic gave a ringing endorsement of the plan. "It will change the way that medicine is going to be practised over here," she said.

She admitted, however, the scheme is likely to impact negatively on her clinic's finances and has certainly caused, "anxiety in the market".

A chief complaint was that the DHA has struggled to lay out in detail how the insurance scheme will be implemented. Hospitals claimed to have received only sketchy information. Dr Mohammad Rakhawy, deputy medical director of International Modern Hospital, said "full, written, detailed plans" were needed. "Nobody has the full plan yet, not even the DHA."

Other common themes included concerns about billing systems, the quantity of administrative tasks linked to the new system, and worries over the exact role of insurers and third party payers.

Underlying the unease is the sense that the funding system, which will see primary facilities receive a fixed fee per patient, will see some clinics run at a loss. The DHA has said payments may be risk-adjusted to reflect treatment costs, but facilities have not yet received a fee list.

"The capitation fee is a very high-risk model," said Meintjes. "We would like to get a better understanding of how the finance will follow the patient."

Other industry groups complained the capitation system created a conflict of interest between patients and providers. David T Youssef, managing director of insurance firm Goodhealth Worldwide, Middle East, suggested clinics would put their own needs first.

"If primary healthcare clinics receive a set fee per patient, as DHA is proposing, they will minimise high-cost procedures to maximise their return," he said. "There is a conflict of interest between the patient's needs and the providers, which will continue while there is a shortage of capacity."

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