x Abu Dhabi, UAETuesday 25 July 2017

Curb healthcare costs to keep a good system

Before reducing health-insurance coverage, insurers should look at ways to reduce waste and inefficiency in the system.

In 2006, health insurance became universal and compulsory in Abu Dhabi. Emiratis now have the comprehensive Thiqa plan; expatriate employees and their dependents are covered through the workplace.

This provides both better health outcomes and peace of mind. The emirate can be proud of this social advantage (which Dubai hopes to match). But it is proving very expensive.

In the UAE as around the world, new medications, machines and procedures are extending and improving lives - at a cost.

As The National reported yesterday, health and insurance officials are warning that expenses are getting out of hand, and that coverage may have to shrink. The nature of the insurance market here, and fierce competition, have created unsustainably low "toxic" premium rates - toxic to the companies, that is.

This warning will stir anxiety around many watercoolers. When insurers and employers sit down to address the problem, the group not at the table may be the loser: the preferred option will be to reduce worker coverage, rather than raise the premiums that companies pay.

Before it comes to that, however, we hope that all concerned will take a hard look at certain factors that drive costs up. Outright fraud is an obvious target, but may be the smallest item on the list. Then comes the cost of sending patients abroad for treatment, but that practice is already declining as care here improves. More effort could also go into making sure chronic care is provided at the minimum cost consistent with effectiveness and patient dignity.

But by far the biggest potential for savings lies in curbing unnecessary care. In every country, the appetite for "free" medical care will meet or exceed the supply - but if the costs are paid by the government or companies, it's not really free at all. And for-profit clinics have an obvious incentive to offer as much medical care as they can, sometimes even if the care is unnecessary. So consultations, specialist visits, hospital admissions, tests, prescriptions and procedures all proliferate - and the bills mount.

This is a challenge for every health-care system. We all want a doctor, not an accountant, deciding what we need. Measuring health outcomes per dirham spent, and then recognising efficiency and spreading best practices, is a theoretical solution. Clinics that get the best results for the money spent could be rewarded. Charging patients a small fee per visit could also limit unnecessary trips to the doctor.

Until all such options are carefully considered, reducing insurance coverage should be deferred and resisted. Abu Dhabi's fine system is worth protecting.