Dubai: Beginning 2017, the Dubai Health Authority (DHA) has introduced a new insurance billing system that will simplify the payment process and provide more transparency and clear pricing for each medical procedure leaving no room for excess payment or over-billing, said a top official.
Already, hospitals in the city have been asked to begin shadow billing, creating a parallel billing system under the new payment system to assess its utility.
By 2020, every health-care facility will seamlessly adopt the payment process. Payment by this new system will simplify the process, encourage administrative efficiency, and base payments on patient acuity and hospital resources rather than the length of stay.
Dr Haider Al Yousuf, Director of public health funding at DHA, told Gulf News: “The International Refined Diagnosis-Related Group (DRG) system is the gold standard in international payment models worldwide. It has been implemented under resolution 21 of 2016 in line with the third and last phase of the health insurance system. It heralds a change in the payment model. Usually, if a patient undergoes a particular surgery, the final bill varies widely from hospital to hospital. But now with DRG, there will be a fixed fee for every procedure.”
This means no hospital or health-care facility can ask patients to do extra or unnecessary investigations. Of course, with the insistence on quality, the way the system will work is to add a mark-up on quality. For instance, if a procedure costs Dh100 and if a hospital falls below a set standard, 10 per cent of the fee will be subtracted. For a higher quality service, there will be a mark-up of 10 per cent.
Dr Yousuf said the process of establishing quality will follow a complex and composite measuring system where the rate of readmissions and failures will be taken into account. “A large number of procedures and services have passed through our e-claim system and every hospital’s rate of readmission, and a variety of data are already present. There will be a complex system of establishing quality criteria. In addition to quality, the system will also be a medical inflation indicator that will track increases in cost for the medical sector in collaboration with the Dubai Statistics Centre, which will produce indicators of inflation particular to health.”
