The Dubai Health Authority (DHA) has announced its plans to regulate the services provided through health insurance by the first quarter of 2013. The move comes in view of increasing number of complaints regarding insurance fraud, abuse, and cases of “over-treatment” in the emirate.
The health insurance industry in Dubai comprises of about 40 companies, with more than one million health insurance policy holders. Under the new monitoring plan, private health-care providers will be required to register with DHA. It is believe that under the watch of a regulatory body, users will be more clinically and financially protected.
The regulatory framework would also require health care providers to publish a price list for all their services. Prior approval of DHA would be required before any increase or decrease in the prices for services is made. An online system would also be implemented to track and analyze behavioral patterns, and detect any suspicious acts from the members, insurance companies, and health care providers. The DHA would then conduct investigation and have the authority to take action against the culprit.
According to Dr Haidar Saeed Al Yousuf, director of Health Funding Department at DHA, “we get complaints from [insurance] members saying they are covered but the insurance company had denied them the service or they go to a provider and they say that the provider is actually misusing their insurance package so they are over-investigating or over-treating”.
Industry experts claim that fraud and misuse accounted for around 30 per cent of health insurance money spent in 2011 in the UAE. The new regulatory framework has been welcomed by industry participants as it will help remove any trust deficit between the policy holders and service providers, and improve the overall status of healthcare facilities in Dubai.
The government of Dubai is also in the process of approving a regulation, which would make medical coverage compulsory for all in the emirate.