'Buffet mentality' bloats health costs

Over-use of health insurance hurts those who are really in need, doctors say

ABU DHABI // When patients over-use health insurance, the people who suffer are the ones who really need medical care, said doctors.

"When something appears free, like insurance is for the patient, then 'buffet mentality' sets in," said Dr Zouhair Harb, a pulmonary, critical care and sleep medicine consultant at the Advanced Cure Diagnostic Centre in Abu Dhabi.

"Patients come in and ask to have their cholesterol checked, for example, despite having no risk factors or symptoms. When I ask why, they say, 'Why not?'" Dr Harb said.

And when doctors refuse to approve unnecessary tests, he added, some patients do not hesitate to "doctor-shop until they find someone to do what they want".

When the system is abused in this way, Dr Harb said, the price of insurance rises for people such as the self-employed.

There are, he said, some "unconscientious doctors that see a patient complaining of a cough for only five minutes, and end up prescribing a cough syrup, and a drug for allergies, and another one for asthma and maybe an antibiotic".

One of the highest cost factors for medical insurance in the UAE, said Carl Sardegna, the chief executive of Green Crescent Insurance Company, is medications: 35 to 40 per cent of all healthcare costs are drug-related. "This number is astounding and has to be brought down," he said.

One way to do that is to encourage the use of generic drugs, said Mr Sardegna. This is happening to some extent already in the UAE, he said. But there is a tendency in the country, he added, "to prescribe a lot of drugs … to reduce medical costs, this has to change."

Dr Michael Bitzer, the chief executive of Daman, the UAE's largest insurance provider, agreed that medically unnecessary claims that go undetected will ultimately result in higher premiums for customers. "For this reason, Daman has a claims department that employs trained and experienced professionals who are constantly working on reviewing claims to ensure that only medically necessary claims are accepted," he said.

However, that is not the case with all insurance providers, Dr Harb said. "When I order tests, especially in cases of emergency, that have to be approved ahead of time by an insurance company, I need to be sure that someone competent and medically informed is making the decision to deny or grant a procedure," he said.

Too many incidents of wasted time have shown that is not always the case, Dr Harb said.

"When you have incompetent people making big decisions, you could lose a lot more money and deprive the people who need the service."