New watchdog proposed for combating abuse in Oman’s health insurance sector
Conrad Prabhu
Business Correspondent - Oman Daily Observer; Magazine Editor - ENERGY OMAN
OMAN DAILY OBSERVER / 13 NOV 2024
CONRAD PRABHU
MUSCAT: Ahead of the full operationalization of the Dhamani health insurance platform, scheduled over the course of 2025, officials of the Oman Chamber of Commerce and Industry (OCCI) are weighing a proposal for the institution of a specialized watchdog dedicated to combating potential abuse, manipulation, price-fixing and even monopolization in the health services sector.
The proposed Oman National Health Bureau (ONHB) has been mooted by OCCI’s Health Committee as a safeguard against practices detrimental to the interests of consumers, on the one hand, and service providers, on the other, according to a key official of the Chamber.
“The proposed ONHB’s overarching mandate is to ensure that healthcare providers manage their claims processing, payment collection, and revenue generation efficiently,” said Murtadha M J Ibrahim al Jamalani, Deputy Chairman – OCCI Health Committee.
“By implementing a robust system, hospitals can increase their cash flow, reduce claim denials, and improve overall financial performance, all while adhering to regulatory requirements and insurance contracts,” he stated.
Speaking to the Observer, Al Jamalani said the Oman National Health Bureau will serve as an “independent and integrated supervisory authority” with representatives from the Ministry of Health, Financial Services Authority, Ministry of Finance, Ministry of Social Development, Royal Oman Police, and OCCI.
ONHB’s main functions are to apply corporate governance guidelines, ensure that health providers and hospitals do not engage in manipulation, deter any monopolization by one or two major players, and also handle uninsured cases.
Al Jamalani explained that a sectoral watchdog becomes necessary for several reasons. For instance, in line with free-market policies, the FSA has left it up to individual insurers to set health insurance premium rates, credit terms, and other conditions. Similarly, hospital and treatment fees fall under the purview of healthcare providers. However, procedures for addressing receivables and outstanding payments remain unclear, potentially giving rise to disputes.
“Outstanding fee receivables for treatment and services provided to insurance company patients over the months and years by health providers are jeopardizing the interests of patients, investors, and other stakeholders. The consequences of these challenges may have an adverse impact on the healthcare and insurance industries, as well as the national economy in general,” the official warned.
Furthermore, the OCCI Health Committee is keen to work with the FSA, Ministry of Health and Ministry of Labour to formulate a business code of conduct, among other operational manuals, to ensure seamless interactions between all the players involved in the health insurance system. The grading of hospitals based on their market segmentation is also envisioned.
The plea for a sectoral watchdog comes amid a strong uptick in the performance of the health insurance segment of the insurance industry. Health insurance written premiums climbed 12.9% to RO 216.213 million in 2023, up from RO 191.517 million a year earlier. Premium retention was 78.96% in 2023, similar to 2022.
Total health insurance gross claims paid in 2023 totaled RO 171.434 million, which was up 17% from the previous year’s total of RO 146.538 million. Health insurance represented 38.2% of the Gross Written Premium in 2023 against 35% in 2022.