Dubai: An ageing population does not necessarily mean medical premiums have to automatically go up as well. With a few tweaks here and there, and especially on the mindset, the inflationary pressure on insurance premiums can still be curbed.
But to do that, there is the need to move away from a “provider-focused model, which has reactively focused on sick patients, to a member-centric model focused on healthier lifestyles and outcome,” said Richard di Benedetto, executive vice-president at Aetna International, the third largest health insurance company in the US, and one with a presence in the Gulf markets.
“Today’s health care systems focused on treatment — not prevention — are very often under strain and firefighting to manage financially and operationally. Wastage and inefficiency are an issue across all parts of the health care economy. In the US alone, it’s estimated that one-third of all health care spend — equating to $900 billion [Dh3.3 billion] per year — is wasted.
“Partnership between payers and providers considerably improves efficiency — by reducing the complexity of the system, reducing administration and aligning incentives around outcomes rather than volume.”
With Abu Dhabi and Dubai requiring compulsory medical insurance for all its residents, the insured base has expanded significantly.
More so after Dubai’s tiered approach to ushering in mandatory medical cover for all, including dependents.
In the last two years, the UAE’s health insurance market has seen a significant rise, but it has also been accompanied by insurance premium spikes (excluding that on the basic cover). Plus, the insured are finding that the 10-20 per cent payments they need to make as co-insurance on check-ups and medicines can prove a costly exercise.
Are there limits to what governments can do under the circumstances?
“I don’t think it’s right to say that there is only one approach that government can take,” said di Benedetto. “It very much depends on the specific health care characteristics and [the] social economic situation.
“It is about working innovatively and collaboratively with the medical profession and insurance providers to provide appropriate levels of coverage and care. [And] in a way that is going to also limit the level of premium inflation.
“Insurers have a responsibility to make sure that if it is necessary to rework premiums it is directly correlated to changes in the medical profession and the associated care costs. It should not be about making a higher margin at the expense of the member.
“Communication is key to this issue — to make sure customers understand the changes, and that detailed explanations are provided through a variety of methods depending on the nature or size of the change.”
Reaching out for health care online
Aetna is inching closer to the roll-out of its ‘vHealth’ service in Dubai, which will allow its members to “access primary care doctors online 24/7, offer prescription and referral services and keeps their health records in one place”. And it will also provide a personalised wellness advice.
“This facility allows us to take a broad view of a person’s health, which can generate much more specific care and wellness advice,” said Richard di Benedetto of Aetna. “It has been proven to considerably reduce the need for medical intervention and acute care, as chronic conditions are better managed and symptoms can be spotted much earlier.”
