Oman foresees an estimated 320,000 domestic and farm workers being brought under the coverage of the Unified Health Insurance Policy (Dhamani) by the end of 2021.
Domestic workers and farmhands are targeted for coverage in the first phase of the implementation of the much-awaited mandatory health insurance programme. With effect from the first quarter of this year, newly arriving expatriate labour falling in two segments are required to be suitably covered as a precondition for working in the Sultanate. Coverage will be extended to existing workers in these categories when their visas come up for renewal.
Tourists and visitors to the Sultanate are also expected to be brought under the purview of the scheme in the near future.
According to senior officials of the Capital Market Authority (CMA), the inclusion of domestic and farm workers will dramatically ramp up the number of people enjoying health insurance coverage in the Sultanate. That number currently stands at approximately 500,000 insured lives, covering Omanis and expatriates as well.
In an article published in the latest edition of Middle-East Insurance Review, senior CMA officials Ahmed al Maamari, Vice-President (Insurance Sector), and Dr Mohamed Ghazaly, Expert Advisor, stressed the importance of the Dhamani health insurance programme as a “national initiative” to “promote local and international investment, and create sustainable growth of the private health and insurance sectors in Oman”.
The Dhamani health insurance system mandated by the Council of Ministers will cover private sector employees including their dependents (expatriate and local), domestic (and farm) workers and all visitors entering the Sultanate, they noted.
“The aim is to guarantee essential health care coverage, improved access, quality and affordability of health care for all Omanis and expatriates residing in (and visiting) Oman,” the officials said in the joint interview.
“The supporting regulatory framework and policies will encourage the private sector to raise revenues, pool and fund the ecosystem using the insurance mechanism as an alternative funding tool.
This will complement the existing, primarily government block funded healthcare financing system to offload the extra burden and empower the private health care and health insurance sector to positively contribute to health care and health funding capacities.”
Ahead of the implementation of the Dhamani scheme in earnest, the CMA has taken steps to pave the way for the development of the platform on which the system will be run in an integrated and holistic manner. A contract for the e-Health System incorporating an e-Claims Exchange has already been awarded. Phase 1 of this platform is expected to be fully deployed by the second half of 2021.
“This phase will include the implementation of the e-claims cycle comprising complete digitalisation, automation and standardisation of health insurance claims. All stakeholders will follow the end-to-end e-claims cycle from submission to payment of claims in electronic format using the Dhamani electronic platform. Some additional features include member eligibility verification, prior authorisation and basic reporting and analysis of utilisation data,” said the officials.
Envisaged in the second phase is the integration of processes such as e-prescription (and pharmacy benefits management), e-referrals (for consultation, laboratory and radiology), payment gateways, enhancement of data analysis through data warehousing and the introduction of utilisation monitoring systems to ensure sustainability.
“The third phase will introduce enhanced business intelligence and advanced analytics for quality management, member profiling, advanced monitoring (of fraud, abuse and waste) and the introduction of member engagement portals, as well as a digital health insurance marketplace,” the CMA officials noted.
The scope of the Dhamani scheme is proposed to be periodically expanded to cover other segments of the population, including Omani and expatriate workers (and their dependents) in the private sector. However, the timeline for this phased expansion will be based “approvals and directives from the Council of Ministers with close monitoring of the industry,” the officials added.
Oman Observer is now on the WhatsApp channel. Click here
