Last month, I added my thoughts to a Gulf News article about co-payments in health insurance, which is the cost-split between employee and employer for medical services outside a company’s policy.
I am adamant that with the right limits, this should be an integral part of the solution to spiralling health insurance costs. But it’s important to understand how we got here, the entities involved in what we’re experiencing, and their contribution to a solution to ensure employees nationally continue to have access to treatment.
Where are we on policy rate increases?
Depending on the source of research, medical insurance costs rose in UAE between 8 per cent (according to Pacific Prime, comparing 2021-2022 average premiums) and 15 per cent in 2022 (Mercer Marsh Benefits), though GlobalData found an outlier of 20 per cent between the last two quarters of 2022. The MENA region is expected to see a price hike of 11.5 per cent this year).
Part of this price rise is systemic. Since Abu Dhabi and Dubai made health insurance mandatory, more companies have procured insurance for their staff for the first time, while the increase in the rates of some Diagnostic-Related Groups – the system of standardising costs attached to certain procedures – also had some effect, with insurers adjusting their pricing accordingly.
Separately, some insurers have also simply pushed up premiums due to other inflationary pressures and their own profit taking.
I emphasise that I have no issue with insurers making profit - within a range that’s sustainable. With no profits, it’s a broken model.
But this is where we need to understand the four entities involved when it comes to insurance cost and utilisation – all have a part to play towards more sustainable healthcare.
Four in the frame
The first of the four is therefore insurers. Now let’s look at hospital groups, which are businesses with their own P&L, with some in the public sector and some private. But it’s not as simple as that.
I find that patients continue to be exploited as a revenue stream. Further, there is a lack of efficiency in the system that’s led to some over-utilisation of policies.
While all industries need competition to improve cost for the consumer, we’re seeing the opposite happening. As more hospitals brands enter the country, prices have only increased.
The consumer is in a marketing wilderness – ever leaning towards the brand with the biggest advertising budget, and further from the reality that there is medical expertise at lower tariff hospitals that, if used, could make a big saving for the company come renewal.
Healthcare from insurers
Speaking of tariffs and brands, it’s worth noting that in other countries, there are facilities run not by hospital groups but insurers. This ensures that the insurers get value for money and reduce the over-use of pharmacy and diagnostics and have sustainable premiums.
The benefit of this model is that those employees with a policy with that insurer can access treatment, with the tariff set. Better still, they would not pay anything towards any co-payment structure to use that facility.
This may be absent from our market, but we’re talking about education and changing behaviour. This is where the next two of the four entities - employer and employee - come into the sustainability equation.
Companies that know about the brilliant physicians throughout the tiered system of healthcare can impart the same to their employees. Employees in turn can make informed choices, contributing through co-payment when they have personal preferences, but more often, using network hospitals that give them quality treatment.
I am so passionate about medical education as long-term strategy, providing a more financially secure environment for hard-working HR teams, just as co-payment with limits is an important contributor to maintaining a reasonable level of cover for all employees in the present.
The next step is tele-medicine…