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Funding and reimbursement – planning healthcare pp
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Transcript of Funding and reimbursement – planning healthcare pp
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Funding and Reimbursement – Planning healthcare
Abu Dhabi Healthcare system
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History
• The restructuring of Abu Dhabi healthcare system started with the formation of HAAD and SEHA
• Prior to 2007, government owned healthcare facilities in the Emirate of Abu Dhabi were managed by the General Authority for Health Services (GAHS)
• In 2007, the Government of Abu Dhabi issued specific laws (Emirati Decrees) concerning the restructuring of healthcare provision in the Emirate. This resulted in the creation of SEHA and Health Authority-Abu Dhabi (HAAD)
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Process• HAAD is the regulator, Daman the
leading insurer/payer and SEHA the leading service provider
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Abu Dhabi health Insurance market
Universal healthcare coverage is mandatory, serviced by different insurance plans
Health Insurance is mandatory In 2011, Daman has 28.6% market
share of insured members in Abu Dhabi
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Insurance levels
o Thiqa Insurance Plan for nationals – exclusive to Daman, paid by government, Daman does not underwrite risk
o Basic Insurance Plan for lower income expats – exclusive to Daman, subsidized by government, Daman takes limited risk
o Enhanced Insurance Plan for higher income expats – no exclusivity to Daman and insurance companies take complete underwriting risk, premiums paid mostly by employers
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Coverage
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Increasing demand • Compulsory health insurance law
mandated universal coverage by 2007 and expanded coverage for Nationals to include private sector providers
• Health insurance makes healthcare more affordable for over 800,000 blue collar expats
• Supply constraint was eased by allowing Nationals free access to private providers
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Increasing supply
• Healthcare consumption is typically supply constrained; new private sector players may have induced demand
• Number of private hospital beds has strongly increased
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Issues for Nationals
• Limited patient contribution by nationals
• Unlike non-GCC countries, Abu Dhabi nationals are responsible for only minor co-payments at selected facilities (private sector pharmacies and dentists) leading to moral hazard
• Free healthcare system leads to overtreatment – unnecessary procedures
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Increased demand
• High per capita income coupled with sedentary lifestyle and dietary pattern has increased the incidence of obesity
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No. 1 for Diabetes in GCC
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Bed capacity
• SEHA is dominant player although the private sector is actively growing
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Inpatient care
• The public sector (SEHA) is the leading provider for inpatient care and this is expected to continue in the near to mid-term
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Outpatient care
• The private sector has focused on providing high margin outpatient care
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SEHA• Abu Dhabi Health Services Company,
Public Joint Stock Company was established in 2007
• SEHA became the vehicle to own and operate all of the public health facilities
• SEHA’s strategy must align with HAAD and Abu Dhabi Government
• Over 16,500 employees 12 hospitals, 2,369 beds
• 57 ambulatory and primary care centres • Comprehensive, integrated health system
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SEHA aims to:-
• Customers and Community Stakeholders- Manage Patients and Stakeholders Expectations effectively
• Financial- Manage financial performance to achieve efficiency and competitiveness
• Service, Quality and Operational Efficiency- Provide Integrated high quality and Patient Centered Services
- Deliver superior operational execution
• Learning , Growth and Infrastructure- Establish SEHA among the UAE employers of choice
- Develop National Leadership and support Emiratization
- Develop infrastructure to achieve world class standards
- Promote Research & Education
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Funding
• Insurance payments and government subsidy are the main sources of funding
• 40% - Daman and other insurance plus direct payments from patients
• 20% - Government mandates such as medical education
• 40% - Government subsidy • The goal is to have ZERO government
subsidy by 2015 / 2016
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SEHA output 2011
• Performed 5.2 million1 outpatient visits and admissions
• Delivered 18,298 babies • Performed over 39,000 surgeries • Patient satisfaction of 88.2% • Improved clinical outcomes • Reduced waiting times; improved access • JCI Accreditations and ISO Re-Certifications • Improved financial sustainability (increase net
patient revenue, 5.9%3 ahead of budget)
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Plans
• Total construction project cost in excess of AED 20 billion (USD 5.4 billion)
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Plans cont.
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Amalgimation
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Role of Healthcare in 2030 Economic
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SEHA
• …. and Abu Dhabi healthcare system vision states the need for a “predominantly private” provision …
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Task
• In twos or threes look growth in healthcare in respect of:-
1. Supply of health services?
2. Why demand is increasing?
3. Where is growth?
4. How will services be funded?
5. What is the role of SEHA?