New insurance billing system in Dubai from 2020
From 2020, public and private hospitals across Dubai will introduce a new insurance billing system – Diagnosis Related Group (DRG) – which is expected to standardize the way insurers are billed, and consequently, lead to cheaper insurance premiums for policyholders.
The new insurance billing system will be overlooked by the Dubai Health Insurance Corporation (DHIC), a subsidiary of the Dubai Health Authority (DHA).
In this article by Pacific Prime Dubai, we will explore the latest by understanding what this new billing system entails, and discover the benefits for insurers, hospitals, and policyholders across Dubai.
What are the responsibilities of the DHIC in Dubai?
The DHIC is responsible for managing and overseeing health insurance in Dubai and seeks to ensure high-quality health insurance for Dubai’s citizens, residents, and visitors, and also protect the rights of policyholders. As well as contributing to the design of health insurance packages, the DHIC is responsible for the licensing and regulation of health insurance companies, claims management companies, service providers, and insurance brokers.
As a subsidiary of the DHA, the DHIC manages the Dubai government’s health insurance program and issues reports related to health insurance and health economics. Recommendations are then made to ensure that the insurance industry is well informed and regulated on the health insurance trends.
What is the DRG classification system?
The Diagnosis Related Group (DRG) classification is an internationally vetted billing system, that uses algorithms to fix medical base fees for treatments of a range of health conditions. The idea behind this well-established billing system came about in the late sixties at Yale University. The purpose of developing the DRGs was to create an effective framework for monitoring the quality of care and utilization of hospital services and resources in a hospital setting.
Today, DRGs are an integral part of many of the world’s major healthcare systems. They are widely used because they effectively bundle inpatient hospital services into a single group for each inpatient stay. This makes it easier and simpler to reimburse medical bills.
How will the billing system work?
The process is simplified and will bring efficiencies to many areas and departments in the healthcare industry. Under this new billing service, when a patient reports to the hospital or clinic, the illness or condition, along with other variables, such as age, complication levels, and co-morbidities are all taken into account to determine which algorithm the patient’s case falls under.
Once the patient is discharged, the insurance company then pays a bundled payment to the hospital for the cost of treatment. As a result, the process becomes very much streamlined.
Public and private hospital systems in Dubai
Both private and public hospitals across Dubai will be covered by this system. Meetings have been held between hospitals and the DHA to make preparations for next year’s new billing system. To make the transition, hospitals have already started shadow billing to understand how the system works. Patients in Dubai will be able to pay for bundled treatments instead of paying separately for services and medications.
Why utilize this payment system?
The DHA is adopting this health insurance payment model and regulation to ensure the sustainability of the Dubai health system by providing incentives for improved efficiency and quality.
According to an article by Khaleej Times, Saleh Al Hashimi, CEO of the DHA’s Dubai Health Insurance Corporation confirmed the introduction of the system will make Dubai’s hospitals more efficient at treating patients and getting them discharged sooner.
What are the benefits of DRGs in Dubai?
There are a plethora of benefits to be gained for patients, policyholders, insurers, and hospitals once the DRG classification systems are in full swing in 2020.
Cost and services will be standardized
It is forecasted that once prices of treatments are grouped and standardized, hospital services for patients will be streamlined too. Since the prices and services will be monitored by the new billing system, no patient will get overprescription or overtreatment.
In addition, the length of stay would also be considered in the fixed payment to the hospital. This would mean that if a patient with a certain illness requires a four-day stay, the hospital will have to adhere to it. This puts patient experience at the center and achieves the goal of ensuring patients recover fully within a safe and well-monitored health setting.
Hospitals earn points for improved hospital efficiencies and excellent patient care
The new billing system will reward hospitals that provide excellent services and patient treatment for inpatient and outpatient care. Hospitals that pursue the needs of patients and perform highly are rewarded with points. These points are given in recognition of delivering compassionate care and transparency. Hospitals that accrue high points are ranked highly and have the leverage of negotiating better rates with insurance companies.
However, hospitals can easily be penalized and, in effect, lose points if their patients have a relapse of any kind, and therefore requires a repeat admission. This ensures that hospitals continually aim to provide effective care, from admission to discharge, to ensure patients recover fully. If patients are readmitted then the hospital will also have to treat the patient without the ability to file a claim from the insurance company.
Cheaper premiums for policyholders
As insurance companies are reimbursing medical bills that are predetermined, they are able to foresee cost and not overcharge or, in other words, charge high premiums in the long run. Policyholders will eventually pay cheaper premiums for their health plans and make considerable savings.
Policyholders are likely to develop further trust as the billing system becomes more transparent. There is also increased accountability of how premiums arise and this helps Dubai’s residents understand better what they are paying for.
Mandatory to secure a health insurance plan in Dubai
If you are looking for medical treatment in Dubai, it pays to be covered by private international health insurance. Since January 2015, the Health Insurance Law for Dubai (Insurance Law No. 11) made it mandatory for expatriates and foreign workers in the country to have private health insurance in place. This was applied to spouses, dependents, and domestic workers from 30 June 2016. Employers in Dubai will likely provide coverage through group health insurance plans and sponsorships, however, it may be that the coverage is limited and does not fulfill the needs of the individual or family.
Who to speak to for your health insurance needs?
With the vast array of individual and family health insurance plans in Dubai, determining the best source of support can be a challenging and mammoth task.
Pacific Prime Dubai’s health insurance experts are able to provide a free quote and make substantial comparisons from a number of Dubai’s insurance companies.
His expert view and wealth of knowledge on insurance can also be found in his blogs for China, Dubai, Hong Kong, and Singapore.
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