Hospitals gear up for National Health Insurance Scheme

Following the recent launch of the national health insurance scheme (Seha), private clinics and hospitals in the country are feeling challenged in terms of meeting its requirements.

Three private hospitals and nine polyclinics have been included in the mandatory health insurance scheme, along with several public hospitals, while others are readying themselves, not to be left behind.

The ambitious project aims to provide a health cover to all citizens and expatriates as well as visitors to the country, expectedly by the end of 2015.

Phase One was launched last July, covering Qatari females aged 12 and above, for health conditions related to gynaecology, obstetrics and maternity.

The second phase, launched on April 30, provides comprehensive insurance cover to all Qataris for their basic healthcare needs. This phase has also seen the scheme getting a new name, Seha, meaning “health”.

As per the schedule announced by the National Health Insurance Company (NHIC) earlier, white-collar expatriate workers and visitors will be included in the scheme in the first quarter of 2015, and blue-collar workers will be covered in the fifth and final phase.

By the end of next year, the entire population of Qatar and visitors are expected to have a mandatory health cover.

Soon after the launch of the second phase, several clinics and hospitals that had already been part of Seha came out with plans to expand and upgrade their facilities to meet an expected increase in the number of patients.

Those who have not joined the scheme yet say that they are busy preparing to fulfil the scheme’s conditions and requirements.

Seha is expected to bring about a dramatic shift in the healthcare sector in Qatar, which is heavily dominated by the public sector, in favour of private facilities.

In the second phase, the scheme allows all citizens to seek treatment at any private or public healthcare facility under scheme, and expatriates will also get this freedom when they are covered in the subsequent phases.

 A senior official from NHIC, which operates and manages Seha, recently said that some private healthcare service providers had complained about a rush of patients during the first phase because they were unprepared for it.

The service providers are being told to upgrade their facilities to offer quality services under the scheme.

Several healthcare service providers have admitted that joining Seha had become a major challenge for them.

“If we don’t join, we will be left out. We are planning to apply in June and we have sought an appointment with the NHIC to find out more details of the scheme,” said Dr Sameer Moopan, CEO of DM Healthcare Qatar, which runs four polyclinics.

“We are busy making preparations, especially training our staff in the unified coding system used in the scheme,” he added.

He said joining Seha may not make a big difference now, since the majority of the clinics’ customers — about 90 percent — are expatriates.

“We have already applied to join the scheme and are awaiting a reply from NHIC,” said Mohammed Imran, marketing manager at KIMS Qatar Medical Center in Al Wakra.

Several providers who have been part of Seha since the first phase say that the scheme has been progressing well, despite some problems in the initial phase.

“We saw about 25 to 30 percent increase in patient turnout during the first phase. We are going for a major expansion, in terms of facilities and staff, to meet an expected increase in the number of patients in the second phase,” said an official of Doha Clinic hospital.

He said a major problem faced in the first phase was familiarising doctors and staff with the new system.

“The doctors’ report  is crucial in deciding the cost of treatment. We will end up with losses if any details are missing in this report,” he added.

He said there was also some confusion about the payment system, which was later clarified by NHIC.

Under the scheme, the nature of cases reaching a general practitioner are classified into three categories — low complexity, medium complexity and high complexity — for the purpose of payment.

 “There was some confusion about the diseases included in each category. It is now clear after we got a clarification from NHIC,” said the official.

He said that Seha would force the private service providers to improve their quality to attract customers.

“Since the cost of treatment is unified under the scheme, hospitals and clinics cannot make profit by increasing fees. If they want to survive, they will have to attract more customers by improving the quality of service. That way, Seha could encourage healthy competition in the sector,” said the official.

It is optional for medical facilities to join the scheme, but once they do, they have to comply with the rules and requirements, including the fee structure, NHIC officials have clarified. They have also said that the fee structure was decided taking into account all expenditure.

Several citizens who are happy about the expansion of the scheme, have called for stricter monitoring in the second phase.

“Following the experience from the first phase, there is a need to monitor and apply restrictions to prevent misuse of the health insurance scheme by conducting unnecessary tests. Implementation of the second phase will reduce the large number of people on waiting lists at Hamad General Hospital, especially for surgery and at the primary health centres,” said Mohamed Al Hajiri, in remarks to a local Arabic daily.

What is Seha?

The National Health Insurance Company (NHIC) is a government-owned entity with its own management and corporate structure. The company manages and operates Seha, Qatar’s national health insurance scheme. 

How do I register for the scheme?

The basis for registration is the Qatari national ID card (QID). Seha uses the same identification number as the QID.

Only those who form a part of the group being covered receive services as part of the national health insurance scheme.  Non-Qatari residents in Qatar are enrolled by payment of a premium, which is to be done by their employer or sponsor.

Visitors to Qatar will be enrolled at the time of issuance of their visa, on payment of a fee to be determined according to the length of their stay in the country.

Does this mean I can go to a private hospital for treatment?

Yes. The ability to choose your service provider is one of the main advantages of the insurance scheme. Once the scheme is fully implemented, you can choose whether you wish to go to a private or public provider, depending on your preferences and needs.

Is there a monetary limit to the coverage?

There is no monetary limit to coverage for Qatari nationals, although there is a limit to the services covered. Elective procedures such as cosmetic surgery are not covered. Visitors will have a much more limited number of services covered due to the short nature of their stay in the country.

What types of services are covered under the insurance scheme?

Once fully rolled out, Seha will provide an insurance cover for basic healthcare services to everyone in Qatar.

What do I do if I want to have more services covered?

Coverage for services not included in Seha can be purchased from private health insurers in Qatar.

Does the scheme work outside Qatar?

The scheme operates only inside Qatar at present.

Who pays for the cost of insurance?

The cost of insurance for Qatari nationals will be covered by the government. Employers and sponsors will be responsible for covering the premiums of non-national staff and their dependents.

How much does the scheme cost?

Details in relation to the insurance premiums and the range of basic health services covered will be released to the public in due course.

What happens to the fees paid for existing private health insurance schemes?

Seha will work concurrently with private health insurance until it is fully rolled out in 2015, and until the Supreme Council of Health, as the regulator, announces phasing out of double insurance as each stage is launched.

The transition period is designed to allow employers and private health insurers time to reconcile the coverage of employees by their existing health insurance plans and Seha to avoid duplicate coverage and paying twice for the same service.

What if I already have health insurance? Do I need to sign up for Seha?

Seha is mandatory for all nationals, residents and visitors to Qatar. Qatari nationals are automatically enrolled, while non-national residents will be signed up for the scheme as part of their residence permit issuing process. Visitors will be required to purchase coverage for the duration of their stay in the country as part of their visa and entry formalities.

You may purchase supplementary private health insurance for services not covered by the national health insurance scheme.

Sources: Seha website |  The Peninsula | Image: QL Flickr Group