Medical insurance moving on from fee for service model

Significant changes in government health insurance regulations and rising populations can generate growth opportunities for private health insurers over the next three years

  
Image used for illustrative purpose. Male doctor standing looking out hospital window.

Image used for illustrative purpose. Male doctor standing looking out hospital window.

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Physicians will play a bigger role in the medical insurance revenue cycle as the industry moves away from a fee for service (FFS) model, experts at the fifth annual Mena Health Insurance Congress said.

The three-day event brought together several experts to discuss key topics affecting the health insurance market in the Mena region such as the role of insurers and healthcare providers, success strategies for the healthcare market, global trends, regulatory issues and managing rising healthcare expenses.

"The insurance industry is a very dynamic industry and there is a good relationship between patients and providers," said Sunil Raj, corporate insurance manager at Mediclinic. "In the long run, we cant look at a FFS model because the patient needs to manage their costs, and the provider also needs to manage the premiums of the patients. When we move from an FFS model to a value-based model, such as a diagnostic related grouping (DRG), then the quality of care improves and providers will be able to better manage different episodes as well as their costs. People will move from a non-physician supportive revenue cycle to a physician supportive revenue cycle. The next cycle that we have seen being started in the UAE is one where the physician will play a bigger role."

Oxford Economics forecasts that government spending on healthcare in the GCC will rise to $30.5 billion by 2021, from just $2.4 billion in 2016, an annual growth rate of more than nine per cent. Meanwhile, the private health spending will pick up the pace to meet rising demand over this period, aided by government policy such as Vision 2030. The UAE and Saudi Arabia command about 80 per cent of the insurance premiums in the GCC.

Experts noted that significant changes in government health insurance regulations and rising populations can generate growth opportunities for private health insurers over the next three years. The Dubai Health Insurance Corporation explained that there is fierce competition in the healthcare insurance sector. By January 2019 over 50 insurance companies, 23 third-party administrators (TPAs), and 103 brokers or intermediaries were already operating in the UAE alone. After the successful implementation of mandatory health insurance by the UAE, KSA is also stepping up efforts for mandatory health insurance for all employees in the private sector and their families.

Laura Gerstein, chief employee benefits officer, Axa Insurance, also spoke about the importance of moving away from an FFS model. "It is way more easy for us to manage the cost for a client if we shift to a value-based healthcare. In Dubai especially, the transparency with the client in terms of their claims report fosters a lot of smart questions from clients. As insurers, we need to find the right balance so that the insurance model that we end up with is one where the client knows that the premium that they are paying will result in efficient and effective care, and which is exactly what they need."

 
 
 
 

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