New Beginnings
Following the unveiling of Dubai’s new health funding system on 9 June 2008, His Excellency Qadhi Saeed Al Murooshid, director general of the Dubai Health Authority (DHA), has overseen significant work towards the new system which is due to become operational on 1 January 2009.
The new system will provide accessible and affordable healthcare coverage to all sectors of the population, national and non-national alike. To effect this vision the DHA will create a new funding agency. Laila Al Jassmi, former DHA Transition Director is expected to be the inaugural CEO of the new agency to be created to implement and oversee the system.
Extensive outreach to healthcare providers, employers, and the insurance community has occurred over the past eighteen months. Outreach to stakeholders will continue in the New Year with a focus on raising awareness in the general population as to what actions need to be completed in order to be compliant with the new legislation that will usher the system in.
Employers will bear the major cost of financing the system through a compulsory Health Benefit Contribution (HBC) which will be payable for all Employees resident in the Emirate of Dubai. The final figure for the HBC has yet to be confirmed but the DHA has stated that it will be a compulsory annual payment of between AED500 and AED800 per person. Sponsors of individuals and dependants, who are unemployed or whose employers elect not to pay their HBCs, will be responsible for the HBC payments for those individuals on their sponsorship.
It is intended that HBC payments will be made to Collection Agents, who are likely to include insurance or related companies, or other entities approved by the DHA. Insurance providers and those familiar with the industry such as third party administrators are encouraged to participate and there will be scope within the system for insurance providers to issue HBC compliant insurance policies and branded healthcards to employers and individuals.
In return for payment, Dubai residents and employees will be entitled to receive basic healthcare services which will be facilitated by participating Outpatient Care Practice (OCP) Clinics. OCP Clinics will be DHA licensed primary healthcare providers who have elected to join the system and appoint a Healthcare Management Company (HMC) to assist with management and administration services required by the system. Participating OCP Clinics will receive a risk adjusted (age and sex) Capitation Payment for every patient they have enrolled, and in return they will be expected to facilitate the basic healthcare services which they offer. The baseline definition of services will be set by the DHA, but may differ from clinic to clinic. HMCs will be responsible for helping OCP Clinics to ensure the provision of data to the Dubai Health Authority to enable it to monitor the system and review Capitation Payment on a regular (and at least once-annual) basis.
Following a competitive tender process a small number of HMCs will be engaged by the DHA to assist OCP Clinics fulfil their obligations to patients and the DHA. OCP Clinics will retain autonomy of their day to day operations, but will be required initially to appoint an HMC as assigned by the DHA to provide a range of support services including IT, financial and patient management.
Through the course of an 18 month stakeholder engagement with both professional and consumer audiences a number of companies have identified opportunities with the new system including those outside of the tender and application processes run by the DHA. The level of interest shown convinced the DHA that businesses, healthcare providers and insurance providers are not only ready to adapt to change, but are actively looking at ways they can embrace the new system.
Business Advantages
The implementation of the new system presents the insurance industry with a number of unique opportunities. The compulsory requirement for all residents to pay the HBC will lead to employers seeking health insurers who can facilitate the collection of Health benefit Contributions and provide competitive advantages by structuring benefits alongside the new healthcare funding system. In addition, those entities collecting the HBC on behalf of the DHA will be capable of issuing their own logo branded healthcare cards.
It is expected that Insurers will sell ‘top-up’ insurance packages to be tailored and offered to employers and employees/dependants, including ‘bundled’ products combining the HBC payment and selected ‘top-up’ benefits. This flexibility and choice is intended to provide Dubai’s population with the ability to manage their risk and provide patient choice, which will contribute to an efficient and robust economy.
The system should open up new revenue streams, such as providing insurance packages to OCP Clinics through stop loss insurance, or assisting with the management and administration of self-insured schemes, including reinsurance.
Future Activities
In addition to a new Dubai Law and implementing regulations, which will formally bring the system into existence, a number of activities will occur over the next month and beyond as the new system prepares to go live. These include:
- The HBC for 2009 will be announced. This will be regularly reviewed as the system evolves and the range of benefits increases.
- The Healthcare Management Companies assisting the DHA and OCP Clinics in the new system will be announced.
- Explanatory briefing sessions for employers, OCP Clinics and the legal community will continue. For further information please contact www.dhfa.gov.ae
- DHA will publish an initial list of primary healthcare providers interested in becoming OCP Clinics. Residents and Employees will be able to nominate an OCP Clinic from this list as their primary healthcare provider as part of the enrolment process.
- An employee data information template for employers to complete prior to submitting along with the relevant HBC to the DHA will be published.
- An employer information form to capture details of a company’s existing Health Arrangements will be published. Employers seeking to reduce the level of the HBC they will pay in 2009 should complete this form as soon as possible.
- DHA will publish a guideline for Service Coverage (the range of healthcare benefits) being introduced in January 2009.
- DHA will publish a list of Collection Agents.
- Patient registration forms to enable residents to elect their OCP Clinics will be published.
New Year
- The system comes is planned to come into effect 1 January 2009.
- All residents of Dubai will be required under law either to provide evidence of private healthcare insurance, or to pay the Health Benefit Contribution with effect from 1 January 2009 HBC.
- Sponsors are required to make payment of the HBC on behalf of persons on their sponsorship
- Employers are required to make payment on behalf of employees residing in Dubai
- Residents will be required to register at an OCP of their choice in order to enrol in the system
- Clinic Capitation Payments start to flow to OCP’s.
- A price list for Service Coverage will be published by all OCPs.
- Registered OCPs need to work closely with their HMC to develop its future strategy.
- Insurers are expected to introduce new HBC compliant insurance policies during 2009 as old policies expire.
- DHA will announce details of the proposed Disease Related Group system and undertake pilot studies to finalise mechanisms through which OCPs will commission specialist treatment.
2010 and beyond
- By January 2010 all Dubai residents or those holding Dubai residency visas will be enrolled in the system and their sponsor will be liable to pay Health Benefit Contributions
- All corporate health insurance policies must be HBC compliant
- New healthcare benefits will be introduced in phases until 2015