Free screening and treatment for three types of cancers and Hepatitis C will be part of the basic benefit plan of the Dubai Mandatory Health Insurance Scheme from January 2019.
A sum of Dh19 will be added per health insurance policy from January and pooled to help cover the costs of cancer treatment for low salary band workers, said an official.
In an interview with Khaleej Times, Saleh Al Hashimi, advisor of the Dubai Health Insurance Corporation at the Dubai Health Authority (DHA), said that under the Basmah initiative, the money will be pooled in the authority's trust account and be used to treat patients who have exceeded the sum insured for treatment of cancer.
"This will be applicable across the board even for companies giving the Essential Benefits Plan (EBP) with an index rate of Dh550. Over and above this index, employers will pay Dh19, which will then be pooled," said Al Hashimi, adding that in the EBP, all limit (Dh150,000) can be used for cancer treatment. "There are no sub-limits for cancer while screening is part of the package too," he said.
Already, 21 patients are being treated. "We want to move into the preventive medicine instead of curative because it reduces the costs," he added.
Another initiative is for treatment of Hepatitis C (HCV). To fulfill WHO vision of HCV elimination by 2030, Dubai vision is to reach elimination by 2021. Presently, prevalence of the disease in Dubai is approximately 0.23 per cent of the population.
"The programme will especially help those with limited coverage. It will lead to early diagnosis, reduce complications and provide financial and emotional support to patients with Hepatitis C," he said.
The authority is also in talks with a world-class pharmaceutical company to introduce pay-per-performance for treatment of lung cancer next year.
"This is a huge initiative and we are very happy about it," said Al Hashimi. Under this scheme, if the treatment is not effective, the company will pay back all the costs incurred on the treatment.
In 2017, the funding department also added screening services for diabetes, newborn and developmental screenings as part of the mandatory health insurance cover.
Talking about high insurance premiums for people above 60 who are still working, Al Hashimi said that those who were being denied insurance cover could approach the Dubai Health Insurance Corporation with evidence.
"Dubai is an open market and even when services are part of the EBP package, it is limited. We have packed in a lot of health services to benefit the community in the EBP while ensuring that the cost is affordable," he said, adding that these packages can be enhanced. Likewise, complementary medicine is covered by some companies but not part of EBP.
Additionally, a number of insurance companies are now encouraged to give wellness packages. "We tell people that insurance is not the only solution to wellness and employers are also encouraged to provide such packages," he added.
Al Hashimi stressed that mandatory insurance is not the only thing employers can do to preserve their employee well-being. Employers are encouraged to promote healthy living amongst their workforce, he said.
Ensuring essential benefits
Currently 12 companies are registered with the Dubai Health Authority (DHA) to offer the Essential Benefits Plan package. "We studied and selected these companies because we wanted only those companies that could cover the large population who did not have access to healthcare such as the labourers," said Saleh Al Hashimi, advisor of the Dubai Health Insurance Corporation at the DHA.
"We didn't want these companies to be burdened as well and that was possible only if they handled volumes," added Al Hashimi.
Initially, seven companies were selected and as more people became insured, the number of companies (Participating Insurers) was increased to 12. The criterion to qualify as participating insurers is higher than to obtain the DHA Health Insurance Permit, which is given to 49 companies currently.
"Other companies can apply too but they have to prove to the DHA that they can handle volumes and services," he said.
He also said that it was difficult to get 100 per cent insurance coverage. "In Dubai, currently we have 99 per cent of the population of Emiratis and residents with Dubai visas covered as compared to the US which is 92 per cent and Germany 90 per cent."
In 2013, when the compulsory insurance was rolled out, 1.8 million people were covered which increased to 4.7 million in three years.
Al Hashimi also said that the DHA's aim was to provide affordable and quality healthcare. "If you calculate, the insurance cost against monthly payroll for each company per employee comes to less than one and half per cent," he added.
Among other requirements to be able to give the EBP package, the company should give training to the insured in multiple languages. "We want them to explain to the people about the benefits they are getting in their language," said Al Hashimi.
eClaim in numbers in 2017
- Dh12.1 + billion claims (gross)
- 27.4 million electronic claims
- 4.5+ million insured members
- 2,800+ healthcare providers
- 70+ insurance companies/TPA
- 12,280+ insurance products
- 6.8+ million electronic prescriptions
- 88.1+ million submitted claim activity
- 25,600+ physicians claiming
By Asma Ali Zain
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