Daman is the first health insurance company in Abu Dhabi to adopt the DRG system
In line with HAAD’s vision and the National Health Insurance Company- Daman’s ongoing efforts to adopt global best-practice in health insurance standards and processes, Daman announced that it has successfully processed more than 22,000 claims via the Diagnosis Related Groups (DRG) billing system since its introduction in August 2010.
The DRG system is regarded as the best-in-class system for increasing efficiency and reducing complexities in the billing process between healthcare providers and health insurance companies and for controlling the quality of the medical services. The DRG system has been adopted in several countries around the world including the United States of America, Germany, Australia and Singapore.
The DRG system classifies hospitals claims for inpatient services; it identifies patients with similar clinical profiles and pays the hospitals a fixed financial reimbursement for such patient profile. This reimbursement reflects the average amount of resources required to treat the patient, which is a distinct difference with the old pre-DRG system in which a hospital was reimbursed for each service delivered individually. The result should be a simplification of hospital billing and a stimulation to hospitals to limit unnecessary healthcare services (as these services would not lead to a higher payment any more). Following HAAD’s circular, sent out in July 2010, it has been mandatory for all hospitals and healthcare insurance companies to process all Abu Dhabi plan (basic) claims through the DRG system since 1 August and for SEHA hospitals to process Thiqa claims since November.
Daman is the first health insurance company in Abu Dhabi to adopt the DRG system and supported the swift migration to this new system through the creation of a dedicated help-desk and organization of interactive ‘question and answer sessions’ for its network hospitals to provide them with individual feedback on the application of the new system. In addition, Daman developed and rolled out an intensive training program for its medical staff, led by an experienced team of DRG experts from Germany.
Dr. Jad Aoun, Chief Medical Officer of Daman, comments: “The DRG system introduces fixed reimbursement tariffs for specific treatment areas, while significantly increasing the transparency and comparability of the cost of care based on the severity of diagnosis and resources incurred. It also incentivizes providers to allocate resources in a balanced way and thus limit the provision of services that have limited added value on the quality of care. The migration to DRGs is still in progress; Daman has successfully processed around 22,000 inpatient DRG claims from 31 hospitals to date. This has definitely made us optimistic on achieving our next milestone: - planned for the beginning of 2012 - which is to pay all our inpatient claims of Abu Dhabi hospitals through DRGs.