The Abu Dhabi health authorities are planning healthcare reforms in a bid to reduce insurance costs and control medical spending.
Among the measures, individuals will no longer be able to seek treatment directly from costly specialists with effect from 1 September. They will need to get a referral from a doctor in the first instance to ensure better diagnosis. So far, patients have been able to obtain a second, third or fourth opinion from specialists without restriction and directly billing their insurer.
In addition, under the new rules, patients seeking a second or subsequent outpatient appointment for the same specialty within 21 days, without a doctor’s referral, will only be covered if the patient obtains pre-approval, reported The National.
This new process excludes a patient’s first visit for a specific symptom, children under the age of 18 and those aged 60 years and above. Health screening visits, vaccination visits, and emergencies will also be excluded from the changes.
Mr Stephen Maclaren, Senior Executive at Al Futtaim Willis, said: “If people are going from consultant to consultant without seeing a GP first, that is time consuming and expensive. They should be seeing a family practitioner first.”
Other changes include allowing better performing hospitals to share information and to mentor poorly performing medical facilities.
The latest reforms to shape healthcare in the capital are part of a two-year consultation between hospitals and Health Authority – Abu Dhabi (HAAD).
Insurance industry figures said the planned healthcare reforms are a step forward and will eventually help to reduce the cost of health cover.
Last year, insurers said as much as AED3.7 billion (US$1 billion) was lost to factors including identity fraud and a culture of over-prescription by doctors with financial incentives to prescribe brand-name drugs.
“These changes should hopefully reduce the amount of misuse in medical spend and will hopefully eventually benefit the members themselves,” said Mr Maclaren. M
AED1 = US$0.27