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Where possible, try and circumvent the 'price equals quality' myth. It will help with managing the next insurance premium. Image Credit: Shutterstock

The UAE is blessed with a multitude of private healthcare providers - from telehealth providers, primary health care centres, and right through to specialist hospitals. It also has large numbers of specialists and consultants who have practiced in various countries.

But how do you choose the right doctor, clinic or hospital for you?

Understanding the network system

All health insurance plans sold in UAE offer healthcare providers (hospitals, clinics, laboratories, dentists and pharmacies) based on the network system. This system tells you which healthcare providers you can seek services from. The healthcare providers in a network are determined by the insurance company or, where the insurance company outsources its claims administration to a Third-Party Administrator, by the TPA itself.

Network types are categorized from restricted networks with a limited number of providers to broader networks that include many. The choice is based upon the level of prices providers charge for their services. So, your health insurance plan may offer treatment at a limited number of providers that charge less for their services, to providing a very broad choice including at some of the most expensive hospitals. Networks can also specifically exclude some of the most expensive hospitals, or perhaps not allow you to seek out-patient treatment there.

If you decide to seek treatment from a provider outside your network, the insurer may either not cover your treatment costs, may only pay a specific portion of the total costs (typically 75 per cent or 80 per cent) or may ask you to make a higher co-pay (a percentage you have to pay yourself) or impose a fixed deductible or excess which you must pay.

It is therefore important you understand your network of providers.

Selecting a doctor

Once you know which providers to choose from, the next step is to find a doctor best suited to your needs. However, you may not know what your needs are. In most cases, look for a family physician, also known as a general practitioner. The GP will make an initial assessment of the symptoms and recommend medication or ask for further tests to reach a diagnosis. Once that diagnosis is made, the GP may then simply ask you to rest, make a few changes to your lifestyle or diet, prescribe medication or refer you to a specialist.

However, what if you think you know what the problem may be, such as a lower back pain or a possible lung infection? The temptation may be to go directly to an orthopedic or pulmonary specialist because your insurance company is paying. This presents a few problems for you.

Firstly, a specialist will be far more expensive. which means your share of the cost may be greater. Secondly, specialists are often incentivized to order tests and investigations that may not be necessary, and which will cost your insurance company more. This could eventually affect your employer’s health insurance premium, and result in them reducing the scheme benefits. Thirdly, some tests carry risks (such as X-rays) and if unnecessary, should be avoided.

Do your own research

Many healthcare providers now list their doctors and specialists on their websites including their qualifications, areas of expertise and languages spoken. Whether selecting your own GP or being referred to a particular specialist, always check them out online.

‘Price equals quality’ myth

Unfortunately, the health authorities in UAE do not publish what are known as quality of care outcome rankings or indicators that would enable selection of a provider based upon the quality of their performance in providing care.

The guide that many use is the price of services provided in the belief that the more expensive a provider is, the better must be the quality of care provided. This is the ‘price equals quality’ myth. But the price may be higher simply to cover the ‘free’ valet parking, gourmet food or fancy décor.

The best approach?

In almost all cases (except, obviously, emergencies) the best approach is to seek advice from a GP. This will potentially save money, almost certainly contain your employer’s (or personal) insurance premium increase at renewal, protect your scheme benefits as a result, and protect you from potentially unnecessary tests.