Questions/Answers

Insurance System for Advancing Healthcare in Dubai (ISAHD) is a comprehensive initiative initiated by Dubai Health Authority (DHA) in 2014 to: 1. Ensure the provision of health insurance coverage to ALL Dubai’s population with a focus on the underprivileged 2. Utilize insurance system to continually improve healthcare quality and accessibility to all the population and to support fact-based decision making by sector’s stakeholders. 3. Develop and implement an economically sustainable model for the health insurance sector in partnership with Private Sector 4. Enhance the governance framework and accountability of the public and private health sector As to realize these objectives, DHA: 1. Launched a central electronic system “E-claims” for processing & governing 100 % of health insurance transactions while continually improving its features to enhance quality and efficiency of health services in Dubai. System is used to generate Big data and reports used for fact-based decisions to enhance health sector. 2. Introduced a governance framework of legislation, operational guidelines, mandatory essential benefits packages, etc. In addition to monitoring mechanisms to ensure compliance of concerned stakeholders. 3. Developed and implemented a unique partnership framework with insurance sector, relevant government bodies and the healthcare providers ensuring mutual benefit and two-way communication & consultation.

Category applied for is “Category 1”, which directly responds to what ISAHD has succeeded in achieving. Prior to the initiative, only members of the population with high income or those working for employers that provide health insurance had direct access to quality healthcare. Rest of the population (especially those with lower wages) had limited access to healthcare leading to deterioration of overall health and well-being. ISAHD not only insured that all population members have access to quality essential health care but it also did so through an innovative and economically sustainable model in partnership with all Stakeholder segments.

SDG of relevance is “Good Health and Well-being”. Through ISAHD, Dubai Health Authority realized the following key outcomes: • 99.5 % of Dubai population (locals and residents covering all patients’ segments) have health coverage with mandated Essential Benefits Package i.e. screening & treatment of Hepatitis C, cancer, diabetes etc. • 100 % of health insurance transactions are governed & recorded • 100% of Dubai children’s essential vaccinations are fully covered along with BCG, Hepatitis B and neo-natal screening tests and necessary developmental screening • 99.5 % of Dubai women have full coverage for antenatal & maternity services, cervical & breast cancer among other benefits

• Health coverage: Prior to ISAHD, only 32% of Dubai population were insured, 2.9 million of non-insured were earning below 4,000 AED, resulting in deteriorating health conditions due to inability to pay for healthcare. • Insurance Packages: Government hadn’t set guideline for insurance packages, so, even health insurance offered was in most cases inappropriate / non-comprehensive. • Voice of the customer: No channel to receive and investigate customers’ complaints about health providers or insurance companies. • Waiting time: Due to manual processing of transactions, approval cycle for those insured lasted 15 hrs (outpatient), 3 days (inpatient). • Errors: Manual prescription of medicines led to 15.47 error per 100,000 prescriptions. • Government Responsibility: Despite that governance was part of DHA’s mandate, it didn’t have enough oversight over health insurance transactions. • 64.2 % of Dubai’s Deaths were due to Cancer: Yet more than 65 % of the population were not insured for cancer treatments & diagnosis. • Unnecessary health expenditure due to lack of awareness among private / public sector health care providers: an evident case was diabetes management (10 % of total Health expenditure in Dubai), where 47% of the total cost was due to unnecessary investigations at inappropriate intervals.

In consultation with stakeholders, DHA implemented a first-of-its-kind insurance management hybrid model, combining the two internationally followed models: Single Payer & Private Insurance. Where DHA mandates the Essential Package, governs it and continually improves its scope while sustaining the premium at a certain range. Through ISAHD’s economically innovative model, DHA was successful to mandate & sustain a low rate for the Essential Package at an economically viable range that is both payable by sponsors, yet profitable to Insurance companies. Through this model, population coverage reached 99.5% by end of 2017 while continually adding huge benefits to the Essential Package.

The system is unique and an original innovation created by Dubai Government. Worldwide, Health Insurance systems are split into two models: 1. Private Insurance: Full reliance on the private sector to provide health insurance services with limited government oversight. 2. Single Payer: Full dependence on the government to provide health insurance directly or through an insurance arm. By analyzing the efficiency and effectiveness of the two models, DHA realized that both models are not applicable to Dubai’s demographic structure and wouldn’t achieve an economically sustainable health sector that is why it created this hybrid model to fulfill the system’s objectives.

• Bahrain: DHA signed an MoU to provide technical support to the Supreme Council for Health to adopt ISAHD’s model due to similarity of demographic circumstances, using the same technologies used by Dubai. Initiative’s implementation already started. • Oman: Providing technical support to the Insurance Licensing Authority through official visits • Jordan: Request for provision of support to enhance kingdom’s insurance system by Jordanian Ministry of Health • Egypt: Presenting ISAHD at the “Health Policy Forum in MENA” and meetings with the Egyptian Ministry of Health to benefit from Dubai's experience In addition to knowledge sharing events in Kuwait & India.

Human Resources for running the project were 30 employees only. No consultancy companies were utilized except for the Electronic infrastructure. Financial resources: 1. Electronic infrastructure: E-claims system and its features were implemented using an innovative PPP with the system provider costing 0 AED. ISAHD portal and complaints management system were developed internally. 2. Legislation and Governance framework: All Legislations and guidelines were developed internally with no extra cost, and were announced through online via ISAHD portal, E-claims system, Emails, training sessions and workshops. 3. Change Management: DHA internally created a marketing plan using internal resources as to utilize its existing media and press channels, in addition to ads in existing ad spaces owned by DHA, TV interviews, social media feed and videos, roadshows in malls at no cost and in partner government entities (free), and using DHA’s existing service centers.

Economic sustainability: Thanks to the innovative business model, DHA was able to sustain the rates of the essential package despite the fact that more benefits are being continually added throughout the years and is forecasting it to sustain within the range for the years to come. In addition, the rate set is limited to 1.5% of total wages to ensure viability for private sectors sponsors. Also, through trend and cost analysis of all Dubai transactions, DHA introduced numerous policies that led to huge cost savings without impact on quality of service (ex. Diabetes Healthcare Standard) Environmental Sustainability: By automating 100 % of health insurance transactions across all of Dubai via E-claims system approximately 91 million papers were saved till date. Social Sustainability: Beside its huge social impact on those who had restricted access to quality healthcare, DHA included in the contractual agreement with the companies providing the Essential Benefits Package that these companies are obligated to offer free insurance packages for self-sponsors that cannot pay for their own or their families’ health-insurance for a total sum of up to 3,000,000 AED per company per year, hence a total social contribution of around 30 Million Dirhams yearly.

Yes

The initiative was officially externally evaluated by the Executive Council of Dubai as part of Dubai Government Excellence Program in January 2018. The evaluation was conducted by External assessors from outside of Dubai specialized in the spectrum of Excellence in Health Care and in the “EFQM” European Foundation for Quality Management Framework. ISAHD was assessed for the criteria of “Innovative administrative Initiative” including desk assessment, interviews and field assessment to evaluate the impact and significance of the initiative.

Criteria for evaluation included: 1. Creativity and innovation of the initiative 2. How the initiative corresponds to the Health care sector in Dubai 3. Identification of stakeholder segments, their needs and expectations 4. Alignment with Dubai Strategic Plan and UAE’s national agenda 2030 5. Planning & Resources mobilization 6. Change Management & value added partnerships with Stakeholders 7. Business Model utilized 8. Efficiency of Resource Utilization 9. Project Management of the initiative 10. Impact and Significance on the population & outcomes for stakeholders 11. Sustainability of the initiative and its transfer-ability to other sectors / emirate / countries

Key strength points: 1. Full health coverage was achieved as planned with continual improvements to healthcare 2. It contributed in reducing citizens traveling abroad for treatment from 3120 (2015) to 1500 (2017). 3. The initiative collected huge and accurate data that were not available earlier Key areas for improvement: 1. DHA can still improve the utilization of big data to predict future trends using artificial intelligence. 2. Maintaining and sustaining the quality of services and prices might become a challenge in the future 3. Limited human & financial resources had a negative impact on what the initiative could achieve.

Population: In designing, DHA conducted 10 Focus groups to identify areas for improvement. DHA implemented a huge communication plan explaining ISAHD, its governance, updates, customer rights and channels to complain. DHA created iPROMES portal, receiving complaints and suggestions from general public, received & processed 2774 requests till date. Private Sector: Insurance Companies: DHA established Dubai Payers Club, the first in GCC to organize events to present guidelines, sector trends and involve private sector in designing standards. Health care providers: DHA conducted workshops on new systems and legislations through 12,000+ hours of training to +3,000 service providers and used E-claims to communicate updates and ISAHD portal to respond to queries. Sponsors: Multi-channels campaigns were implemented to educate sponsors / employers about deadlines / rights and the availability of the minimum insurance policy and its rates and components. ISAHD portal & kiosks were used to respond to queries, responding within 24 hrs to 30,579 queries till date. Government Partners: Relevant government stakeholder participated in design through consultative sessions and in the launching phase through hosting kiosks at their premises. In implementation, DHA collaborated with DNRD to add insurance to residency visas process and is always consulting Federal Health & Prevention ministry and providing macro-level data to support Federal decision making.

Lessons Learnt: 1. Private Engagement is necessary: Through ensuring engagement with private sector, DHA succeeded in introducing ISAHD while maintaining the interests of relevant stakeholders in consideration. 2. Each country has its own characteristics to consider when implementing public models. Only through introducing a model that matches demographic setup of Dubai, DHA was able to roll-out an economically sustainable and value adding system. Further improvements: 1. Launch of a comprehensive portal, using quality of care criteria to make better use of the huge and valuable data made available. 2. Introducing further improvements to health care standards using trend