Abu Dhabi: The cost of surgeries at Abu Dhabi hospitals is determined by a number of parties.
The first factor that comes into play is the fact that all residents and visitors are covered by health insurance, mandated by the emirate’s health sector regulator, the Health Authority Abu Dhabi (HAAD). Each employer must offer at least the basic insurance package to employees, which offers outpatient treatment up to a set amount each year, and in-patient and emergency medical care.
“The cost of surgeries for basic insurance holders is determined by the HAAD, and communicated to all hospitals. These costs cannot be tampered with,” Dr Ali Al Ali, director at VPS Healthcare, told Gulf News.
Most residents, however, have access to health care insurance over and above the basic package, known as enhanced packages for expats and Thiqa insurance for Emiratis. While Thiqa is offered by the National Health Insurance Company (Daman), 39 licensed insurance companies currently operating in the emirate provide the enhanced insurance packages.
“The HAAD gives us the surgery’s cost for basic insurance holders, which acts as the minimum, and we can then negotiate the cost of a surgery for a resident with an enhanced insurance package by negotiating with the insurance company. The eventual cost paid by the insurance company cannot however exceed three times the cost of that surgery for basic insurance holders,” Dr Al Ali said.
As reported by Gulf News, the Abu Dhabi price list for health-care services, known as the mandatory tariffs paid by insurance companies to health-care facilities, was revised by the HAAD in October 2012. The decision decreased the reimbursements for surgeries by 14.9 per cent, for laboratory services by 24.4 per cent and for radiology procedures by 0.7 per vent. At the same time, costs payable for doctor visits increased by 24.6 per cent, while the cost for daycare services rose by 22 per cent and medical services by 0.05 per cent.
Officials said at the time that the redistribution of costs payable was being undertaken to improve the efficiency of the health-care market. In particular, the changes were expected to increase the amount of time physicians were willing to spend with patients, while keeping the amount of tests prescribed to a minimum. In addition, it was hoped that more facilities would provide daycare procedures, in which a patient is administered and discharged after a procedure within 12 hours, thus freeing up in-patient beds for more pressing treatments.
Certain types of care are, however, not covered by most health insurance packages offered to expatriates, including dental care, psychiatric treatment and cosmetic procedures. In these cases, many residents say they prefer to go home to their countries and seek medical help.
