DOHA: The national health insurance scheme, once implemented, is expected to standardise services and fee structure at clinics and hospitals and end unnecessary treatment and medical tests.
Many in the private healthcare sector are keeping their fingers crossed, hoping that the scheme would not cause a dent in their revenues.
The mandatory health cover could drive more patients to private facilities, but it will also restrict their freedom to treat patients as they wish and impose fees unilaterally.
The Supreme Council of Health (SCH), the healthcare regulator, is set to implement the first phase of the scheme next month, targeting all Qatari females aged above 12. Besides the Women’s Hospital of the Hamad Medical Corporation (HMC), three private hospitals are involved in this phase.
Industry sources say that the scheme will provide the SCH with a mechanism to effectively monitor services and prices.
The SCH recently sent a strong message to all private clinics and hospitals by asking them not to announce any further hike in their prices until the scheme is implemented.
“The SCH will fix an average cost for each treatment and the providers will get only this amount, disregarding how much they spend. For instance, if we charge QR100 or QR1,000 for a treatment, we will get only what is fixed by the insurance provider,” said an official at a private hospital joining the first phase of the insurance scheme.
The SCH has set up the National Health Insurance Company which will manage the scheme. All healthcare services included in the basic package are covered by this state-owned company.
“Unnecessary tests and treatment will definitely be controlled since the doctors and healthcare facilities will be held accountable throughout the process starting from diagnosis to treatment. The SCH can effectively control the system because the insurance provider is also under its direct supervision,” said a physician who runs a private clinic.
All healthcare providers have been asked to adopt the ICD-10-AM coding system, as a prelude to implementing the scheme. Providers involved in the scheme are required to provide full details about the diseases, diagnosis and the treatment to the SCH using this uniform coding system.
“We already have the new coding system and we will start entering data as and when the scheme is implemented. We are expecting an increase in the number of Qatari women patients in the first phase of the scheme,” said the hospital official.
He said private clinics and hospitals would see more patients when the scheme is implemented but it will not necessarily boost their revenue.
“It all depends on how the cost is determined and managed by the insurance provider. When we have more patients, we will have to pump more money to develop facilities and infrastructure,” he added.The Peninsula
