Dubai: A new insurance system that provides ease of payment and may bring down insurance premium will be introduced by the Dubai Health Insurance Corporation (DHIC) at Dubai Health Authority (DHA) from next year.
Diagnosis Related Group (DRG) classification, an internationally-vetted billing system, will use algorithms to fix base fees for treatments of a range of health conditions.
Gulf News has learnt that Dubai Health Authority has held several meetings with private hospitals in Dubai in preparation for DRG’s roll out.
Both private and public hospitals across Dubai will be covered by the system, which streamlines payment protocols, and both insurance and health sectors have welcomed the move towards greater transparency and accountability in medical procedure rates and billings.
Eventually, it is expected to bring down insurance premiums for UAE residents, as the entire billing system will move towards a more egalitarian method of payment.
How will it work?
When a patient reports to a hospital or clinic, the nature of their illness along with other variables such as his age, complication levels, and comorbidities (the presence of one or more conditions existing at once), will be taken into account to determine which algorithm the case falls under.
The insurance then pays a bundled payment and under this, the cost of treatment for medication, and duration of stay is all fixed.
A private hospital spokesperson said: “Hospitals will be graded according to the case, experience and their performance, earning points for their better performance.
"So we will have three aspects on which we can get a slightly better price – the relative rate, the grading by DHA and then we will have the privilege to negotiate with the insurance company on a case-by-case basis to get us a better price within that band of illnesses.”
Saleh Al Hashimi, CEO of DIHC at DHA, said: “The accuracy of medical coding plays an important role in DRG payments.
The accuracy of medical coding plays an important role in DRG payments. DHIC will be introducing measures to standardise medical coding and adjudication rules to streamline practices in claims processing across all insurers and hospitals
“DHIC will be introducing measures to standardise medical coding and adjudication rules to streamline practices in claims processing across all insurers and hospitals.
“DRGs will not streamline payment systems,” he added.
“But will help streamline the approval process for insured members by providing a calculated fixed price per inpatient service, in turn this will streamline payments to providers as any disputes between insurers and hospitals around the necessity of conducted procedures will be drastically reduced.”
How will it help you?
Once prices of treatments are standardised, services will be streamlined too. No patient will get over-prescription or over treatment and the duration and length of stay would also be considered in the fixed payment to the hospital. Under the new system, for example, if a certain illness requires a patient a four-day stay, the hospital will have to follow it.
Also, following a surgery or any hospital stay, if the patient has a relapse of any kind and requires a repeat admission, the hospital will get negative points and will also have to treat the patient without the ability to file for a claim from the insurance company, an official of a private hospital explained.
Once insurance companies are able to save amounts and are not overcharged in the long run, the benefits of this are expected to eventually filter down to the patients and there is a likelihood of premiums coming down.
Al Hashimi said: “The implementation of DRGs focuses on benefitting the patient by encouraging hospitals to improve efficiency and quality of patient care. In the DRG payment model, bundle payments encourage hospitals to be more cost effective in their care delivery. As a result, the cost of healthcare and premiums would reduce overtime. Hospitals will now be required to be more efficient in treatment, leading to improved patient outcomes and increased patient satisfaction while reducing waiting time for approvals.”
It means cost of treatment and duration of stay will be fixed, leading to greater transparency and accountability in medical procedure rates and billing.
Hospitals will get points for performance and be able to negotiate better rates with the insurance company, which in turn will bring down premiums for UAE residents.
It is expected to be rolled out across private and public hospitals in Dubai from next year.
