By Dina El Shammaa, Staff Reporter - Gulf News
Published: December 13, 2008, 23:45
 

Abu Dhabi: Electronic medical claims (e-claims) have been introduced in
one of the hospitals for the first time in the Emirate of Abu Dhabi,
Gulf News has established.

Joseph Boulos, General Manager of Nas, a Third Party Administrator (TPA)
for 14 health insurance companies, said that Oasis Hospital in Al Ain
had gone live with e-claims starting Friday. E-claims involves a
standardised coding system among health providers, resulting in a
simpler process for medical claims. It also reduces paperwork, saves
time and is economical.

"E-claims will soon become mandatory among all health care providers,"
confirmed Boulos. There are currently a total of 30 health insurance
companies in Abu Dhabi; with 29 of those contributing to 30 per cent of
health insurance services in the market. The rest comes from the
National Health Insurance Company (Daman).

"Competition is definitely healthy, because it lets the market decide
who is the fittest in terms of products and services. Daman used to be
the sole health insurance provider, now there are 30 others and this
number will increase by time," said Bolos.

e-claims

Dr. Finn Goldner in charge of Health Insurance Regulation at the Haad
announced that e-claims were mandatory for all Thiqa holders (which
includes health insurance for only Emirati nationals).

"There will be a new pricing list for the health insurance basic product
developed soon and by the end of 2009, e-claims will be mandatory for
all health providers with more than 20,000 counters," said Goldner.

Haad, unlike with health providers, does not influence the number of
health insurance companies in the market. "We encourage them to get
licensed. Some have a real focus on health care, others have an
accommodating line such as a TPA who aggregates claims for more than one
insurer," added Goldner,

Engineer Zaid Al Siksek, Haad Chief Executive Officer said that it had
received and reviewed 50 applications from healthcare investors out of
which only four were executed.

Duplication and fragmentation doesn't help in providing better patient
care, said Al Siksek. "We don't have enough patients to invest in all
the proposed healthcare projects."

Useful data: Health statistics

The current investment across Abu Dhabi in healthcare has been estimated
to reach Dh18 billion to date with an expected additional Dh5 billion in
the pipeline, said Haad officials.

There are over 50,000 people working in the health care sector in Abu
Dhabi, with 30 licensed insurers, six licensed third parties (TPA) and
over 900 registered health insurance products.

The types of health insurance products existing are:

Basic Product: This is for low income expatriates earning Dh5,000 or
less. Currently there are 850,000 basic product holders.
Enhanced Product: This is for individuals earning a salary over Dh5,000.
There are 500, 000 enhanced product holders.
Thiqa Product: This is for Emirati nationals. Currently there are
400,000 Thiqa card holders.