There are some 19,000 procedures listed on Abu Dhabi's new price list for basic healthcare services.
They represent the opening salvo of what looks set to be a long war on escalating medical costs in the capital.
At stake is not just the health of the population but that of the economy as companies come under mounting pressure to absorb healthcare costs while insurers are forced to sell policies below their real market value to compete. The trend is pushing the price of policies up by as much as 20 per cent.
Abu Dhabi health chiefs are struggling to cope with such runaway spending as insurance providers complain of fraud, misuse and waste. Caught in the middle are companies that have until now enjoyed artificially low premiums as a result of a race to gain market share as compulsory insurance schemes are introduced.
Now the healthcare honeymoon is over.
"We used to have employee benefit negotiations with HR managers when insurance policies were used to attract and retain high-calibre employees," says Dr Hazem Al Madi, the chief executive of Green Crescent, a top-five UAE insurer.
"Now all of our meetings are with the financial controllers: don't increase the premium, reduce the benefit - that has been the trend."
Adding to mounting healthcare costs are practices such as "upcoding" procedures performed on patients to generate more revenue for hospitals, over-prescribing medications and duplicate billing, where the same procedure is paid out for twice. Claims are running out of control.
"It's why you see pharmacies mushrooming everywhere," adds Dr Al Madi.
Booz & Co estimates the premium for providing health care to someone covered under the national scheme is just a quarter of the actual per capita cost of public healthcare provision. It cannot last and employers are already being forced to choose between paying more for policies or cutting benefits.
"It feels like the industry is navigating without a compass," says Jad Bitar, a principal with Booz & Co.
Setting mandatory tariffs may help to contain future inflation while also protecting smaller players.
From Dh158 (US$43.01) to fix a broken nose to more than Dh13,000 to remove a lung, every type of medical procedure is catalogued with surgical detail on Abu Dhabi's new mandatory tariff that comes into effect next month and determines prices under the most basic insurance. While some prices will rise, overall it is expected to slow inflation in the sector.
"Theoretically, a standard price list should control inflation but in practice it doesn't happen like this," adds Dr Al Madi.
"A real life example: previously, when a patient went for some physiotherapy, the insurance company would receive an invoice for five or six sessions.
"But after the coding system was introduced, healthcare providers started to use all the codes that fell under physiotherapy - so there was one code for warming the muscle, another for shaving hair and another for doing the massage - we started to receive five or six codes under one service, which is legally legitimate but which increased costs by 300 per cent in some cases."
It is an extreme example but it illustrates the challenges faced by regulators and what can be the blurred lines that separate misuse from fraud.
Mahmoud Ramadan AbuRaddaha is at the sharp end of healthcare reform in the capital, heading the Government prices and product benefits section at Health Authority - Abu Dhabi.
He says a number of initiatives have been implemented this year to address what were structural flaws in the healthcare system, such as an overreliance on consultants to do the job of GPs .
In most developed markets, the health system is triangular with consultants at the top, specialists below them and a larger number of GP's to form the base. But in Abu Dhabi the system has looked more like an inverted triangle.
"The old system compensated the physicians based on competency not necessarily on care delivered. So, if you have the flu and you go to see your GP the GP gets Dh45. If you have the same flu and go to a consultant, the consultant gets Dh125," he says, adding that drove hospitals to over-utilise consultants.
Healthcare spending per capita in the Arabian Gulf is growing at more than 5 per cent per year, according to the World Health Organisation - up from US$843 (Dh3,096) per person in 2000 to $1,224 in 2010. A rising proportion of that is going towards the cost of treating chronic diseases. More than 10 per cent of health spending in Abu Dhabi goes towards treating cardiovascular disease and 8.6 per cent to diabetes.
The prevalence of such chronic conditions has proved lucrative for drug makers. Alpen Capital expects pharmaceuticals sales in the GCC to almost double to $ 10.8 billion by 2020.
Yesterday, Gulf Pharmaceuticals opened a Dh500 million facility in Ras Al Khaimah capable of making 45 million vials of insulin every year for the treatment of diabetes.
The over-prescribing of drugs has been identified as a major concern by regulators and insurers.
"Those shopping bags you see full of drugs are an issue," says Mr AbuRaddaha, highlighting the danger posed by medicines, which may be harmless when used on their own but can be deadly in combination with others.
"My worry is that if a drug to drug interaction occurs the outcome is death, disability or loss of productivity days."
The surging cost of health care in the capital coincides with unprecedented investment in the sector with the arrival of the Cleveland Clinic next year and several smaller hospitals and clinics under construction.
But as insurance premiums spiral out of control, their services may be restricted to patients who benefit from a dwindling number of high end policies.
For the rest of the population, the menu of medical services covered by their insurers is unlikely to improve until savings are found elsewhere.
"You can have a good restaurant but what good is it if nobody can afford to eat there?" says Dr Al Madi.
scronin@thenational.ae
Results
6.30pm: Mazrat Al Ruwayah – Group 2 (PA) $36,000 (Dirt) 1,600m, Winner: RB Money To Burn, Tadhg O’Shea (jockey), Eric Lemartinel (trainer)
7.05pm: Handicap (TB) $68,000 (Turf) 2,410m, Winner: Star Safari, William Buick, Charlie Appleby
7.40pm: Meydan Trophy – Conditions (TB) $50,000 (T) 1,900m, Winner: Secret Protector, William Buick, Charlie Appleby
8.15pm: Al Maktoum Challenge Round 2 - Group 2 (TB) $293,000 (D) 1,900m, Winner: Salute The Soldier, Adrie de Vries, Fawzi Nass
8.50pm: Al Rashidiya – Group 2 (TB) $163,000 (T) 1,800m, Winner: Zakouski, William Buick, Charlie Appleby
9.25pm: Handicap (TB) $65,000 (T) 1,000m, Winner: Motafaawit, Sam Hitchcock, Doug Watson
Company%20Profile
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More from Neighbourhood Watch:
MATCH INFO
Manchester United v Brighton, Sunday, 6pm UAE
Most F1 world titles
7 — Michael Schumacher (1994, ’95, 2000, ’01 ’02, ’03, ’04)
7 — Lewis Hamilton (2008, ’14,’15, ’17, ’18, ’19, ’20)
5 — Juan Manuel Fangio (1951, ’54, ’55, ’56, ’57)
4 — Alain Prost (1985, ’86, ’89, ’93)
4 — Sebastian Vettel (2010, ’11, ’12, ’13)
england euro squad
Goalkeepers: Dean Henderson (Man Utd), Sam Johnstone (West Brom), Jordan Pickford (Everton)
Defenders: John Stones (Man City), Luke Shaw (Man Utd), Harry Maguire (Man Utd), Trent Alexander-Arnold (Liverpool), Kyle Walker (Man City), Tyrone Mings (Aston Villa), Reece James (Chelsea), Conor Coady (Wolves), Ben Chilwell (Chelsea), Kieran Trippier (Atletico Madrid)
Midfielders: Mason Mount (Chelsea), Declan Rice (West Ham), Jordan Henderson (Liverpool), Jude Bellingham (Borussia Dortmund), Kalvin Phillips (Leeds)
Forwards: Harry Kane (Tottenham), Marcus Rashford (Man Utd), Raheem Sterling (Man City), Dominic Calvert-Lewin (Everton), Phil Foden (Man City), Jack Grealish (Aston Villa), Jadon Sancho (Borussia Dortmund), Bukayo Saka (Arsenal)
FA Cup fifth round draw
Sheffield Wednesday v Manchester City
Reading/Cardiff City v Sheffield United
Chelsea v Shrewsbury Town/Liverpool
West Bromwich Albion v Newcastle United/Oxford United
Leicester City v Coventry City/Birmingham City
Northampton Town/Derby County v Manchester United
Southampton/Tottenham Hotspur v Norwich City
Portsmouth v Arsenal
The specs
Engine: Long-range single or dual motor with 200kW or 400kW battery
Transmission: Single-speed automatic
Max touring range: 620km / 590km
Price: From Dh250,000 (estimated)
From Zero
Artist: Linkin Park
Label: Warner Records
Number of tracks: 11
Rating: 4/5
COMPANY PROFILE
Name: Almnssa
Started: August 2020
Founder: Areej Selmi
Based: Gaza
Sectors: Internet, e-commerce
Investments: Grants/private funding
Background: Chemical Weapons
ENGLAND SQUAD
Goalkeepers Henderson, Johnstone, Pickford, Ramsdale
Defenders Alexander-Arnold, Chilwell, Coady, Godfrey, James, Maguire, Mings, Shaw, Stones, Trippier, Walker, White
Midfielders Bellingham, Henderson, Lingard, Mount, Phillips, Rice, Ward-Prowse
Forwards Calvert-Lewin, Foden, Grealish, Greenwood, Kane, Rashford, Saka, Sancho, Sterling, Watkins
Credit Score explained
What is a credit score?
In the UAE your credit score is a number generated by the Al Etihad Credit Bureau (AECB), which represents your credit worthiness – in other words, your risk of defaulting on any debt repayments. In this country, the number is between 300 and 900. A low score indicates a higher risk of default, while a high score indicates you are a lower risk.
Why is it important?
Financial institutions will use it to decide whether or not you are a credit risk. Those with better scores may also receive preferential interest rates or terms on products such as loans, credit cards and mortgages.
How is it calculated?
The AECB collects information on your payment behaviour from banks as well as utilitiy and telecoms providers.
How can I improve my score?
By paying your bills on time and not missing any repayments, particularly your loan, credit card and mortgage payments. It is also wise to limit the number of credit card and loan applications you make and to reduce your outstanding balances.
How do I know if my score is low or high?
By checking it. Visit one of AECB’s Customer Happiness Centres with an original and valid Emirates ID, passport copy and valid email address. Liv. customers can also access the score directly from the banking app.
How much does it cost?
A credit report costs Dh100 while a report with the score included costs Dh150. Those only wanting the credit score pay Dh60. VAT is payable on top.
Our family matters legal consultant
Name: Dr Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
Pari
Produced by: Clean Slate Films (Anushka Sharma, Karnesh Sharma) & KriArj Entertainment
Director: Prosit Roy
Starring: Anushka Sharma, Parambrata Chattopadhyay, Ritabhari Chakraborty, Rajat Kapoor, Mansi Multani
Three stars
British Grand Prix free practice times in the third and final session at Silverstone on Saturday (top five):
1. Lewis Hamilton (GBR/Mercedes) 1:28.063 (18 laps)
2. Sebastian Vettel (GER/Ferrari) 1:28.095 (14)
3. Valtteri Bottas (FIN/Mercedes) 1:28.137 (20)
4. Kimi Raikkonen (FIN/Ferrari) 1:28.732 (15)
5. Nico Hulkenberg (GER/Renault) 1:29.480 (14)
A Bad Moms Christmas
Dir: John Lucas and Scott Moore
Starring: Mila Kunis, Kathryn Hahn, Kristen Bell, Susan Sarandon, Christine Baranski, Cheryl Hines
Two stars
The specs: 2018 Infiniti QX80
Price: base / as tested: Dh335,000
Engine: 5.6-litre V8
Gearbox: Seven-speed automatic
Power: 400hp @ 5,800rpm
Torque: 560Nm @ 4,000rpm
Fuel economy, combined: 12.1L / 100km
Intercontinental Cup
Namibia v UAE Saturday Sep 16-Tuesday Sep 19
Table 1 Ireland, 89 points; 2 Afghanistan, 81; 3 Netherlands, 52; 4 Papua New Guinea, 40; 5 Hong Kong, 39; 6 Scotland, 37; 7 UAE, 27; 8 Namibia, 27
Match info
Bournemouth 0
Liverpool 4 (Salah 25', 48', 76', Cook 68' OG)
Man of the match: Andrew Robertson (Liverpool)
MATCH INFO
Manchester City 0
Wolves 2 (Traore 80', 90 4')
England ODI squad
Eoin Morgan (captain), Moeen Ali, Jonny Bairstow, Jake Ball, Sam Billings, Jos Buttler, Tom Curran, Alex Hales, Liam Plunkett, Adil Rashid, Joe Root, Jason Roy, Ben Stokes, David Willey, Chris Woakes, Mark Wood.
How tumultuous protests grew
- A fuel tax protest by French drivers appealed to wider anti-government sentiment
- Unlike previous French demonstrations there was no trade union or organised movement involved
- Demonstrators responded to online petitions and flooded squares to block traffic
- At its height there were almost 300,000 on the streets in support
- Named after the high visibility jackets that drivers must keep in cars
- Clashes soon turned violent as thousands fought with police at cordons
- An estimated two dozen people lost eyes and many others were admitted to hospital
Martin Sabbagh profile
Job: CEO JCDecaux Middle East
In the role: Since January 2015
Lives: In the UAE
Background: M&A, investment banking
Studied: Corporate finance
A Long Way Home by Peter Carey
Faber & Faber
Company%20Profile
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MATCH INFO
Championship play-offs, second legs:
Aston Villa 0
Middlesbrough 0
(Aston Villa advance 1-0 on aggregate)
Fulham 2
Sessegnon (47'), Odoi (66')
Derby County 0
(Fulham advance 2-1 on aggregate)
Final
Saturday, May 26, Wembley. Kick off 8pm (UAE)
More coverage from the Future Forum
The specs
Engine: 2-litre or 3-litre 4Motion all-wheel-drive Power: 250Nm (2-litre); 340 (3-litre) Torque: 450Nm Transmission: 8-speed automatic Starting price: From Dh212,000 On sale: Now
Company%20profile
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The major Hashd factions linked to Iran:
Badr Organisation: Seen as the most militarily capable faction in the Hashd. Iraqi Shiite exiles opposed to Saddam Hussein set up the group in Tehran in the early 1980s as the Badr Corps under the supervision of the Iran Revolutionary Guards Corps (IRGC). The militia exalts Iran’s Supreme Leader Ali Khamenei but intermittently cooperated with the US military.
Saraya Al Salam (Peace Brigade): Comprised of former members of the officially defunct Mahdi Army, a militia that was commanded by Iraqi cleric Moqtada Al Sadr and fought US and Iraqi government and other forces between 2004 and 2008. As part of a political overhaul aimed as casting Mr Al Sadr as a more nationalist and less sectarian figure, the cleric formed Saraya Al Salam in 2014. The group’s relations with Iran has been volatile.
Kataeb Hezbollah: The group, which is fighting on behalf of the Bashar Al Assad government in Syria, traces its origins to attacks on US forces in Iraq in 2004 and adopts a tough stance against Washington, calling the United States “the enemy of humanity”.
Asaeb Ahl Al Haq: An offshoot of the Mahdi Army active in Syria. Asaeb Ahl Al Haq’s leader Qais al Khazali was a student of Mr Al Moqtada’s late father Mohammed Sadeq Al Sadr, a prominent Shiite cleric who was killed during Saddam Hussein’s rule.
Harakat Hezbollah Al Nujaba: Formed in 2013 to fight alongside Mr Al Assad’s loyalists in Syria before joining the Hashd. The group is seen as among the most ideological and sectarian-driven Hashd militias in Syria and is the major recruiter of foreign fighters to Syria.
Saraya Al Khorasani: The ICRG formed Saraya Al Khorasani in the mid-1990s and the group is seen as the most ideologically attached to Iran among Tehran’s satellites in Iraq.
(Source: The Wilson Centre, the International Centre for the Study of Radicalisation)
Series information
Pakistan v Dubai
First Test, Dubai International Stadium
Sun Oct 6 to Thu Oct 11
Second Test, Zayed Stadium, Abu Dhabi
Tue Oct 16 to Sat Oct 20
Play starts at 10am each day
Teams
Pakistan
1 Mohammed Hafeez, 2 Imam-ul-Haq, 3 Azhar Ali, 4 Asad Shafiq, 5 Haris Sohail, 6 Babar Azam, 7 Sarfraz Ahmed, 8 Bilal Asif, 9 Yasir Shah, 10, Mohammed Abbas, 11 Wahab Riaz or Mir Hamza
Australia
1 Usman Khawaja, 2 Aaron Finch, 3 Shaun Marsh, 4 Mitchell Marsh, 5 Travis Head, 6 Marnus Labuschagne, 7 Tim Paine, 8 Mitchell Starc, 9 Peter Siddle, 10 Nathan Lyon, 11 Jon Holland
'Nope'
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