Daman gets tough on inferior treatment

National health insurer warns hospitals that, starting next year, it will withhold payments if the quality of patient care falls short of a minimum standard.

Daman says it will conduct patient surveys and spot checks of medical records to verify the data presented to it.

Daman, the national health insurance company, yesterday warned hospitals that, starting next year, it will withhold payments if the quality of patient care falls short of a minimum standard. From January, the UAE's largest health insurance company will launch a so-called payment by results system, meaning hospitals - and eventually all providers of health services - will need to supply Daman with detailed information on the level of care patients are given.

This will include survival rates, re-visit rates and the extent to which patients later developed infections. Hospitals will also be required to compile information on their 10 most common medical procedures. The quality of the information and patient outcomes, Daman said, will "determine the reimbursement rates for rendered services". Should a patient not receive a satisfactory level of care, the hospital risks not being reimbursed for the treatment.

Dr Michael Bitzer, the chief executive of Daman, said: "We will now raise the game to reward hospitals and clinics that achieve excellent treatment results while penalising those that do not fully meet healthcare outcomes expectations." At the moment, patients covered by Daman receive treatment free in non-government hospitals, which then apply to the insurer for reimbursement. Yesterday's announcement is likely to lead to underperforming hospitals having to absorb much of the cost of treatment themselves. Asked whether the patient might then be pursued for the balance, a Daman spokesman said: "We cannot pass the bill on to the patient. This is between us and the hospital. The patient is out of the story."

The new arrangement will be mandatory for providers who wish to remain or become part of Daman's network. At first, only hospitals will be affected, but the system will later apply to clinics and private practices, too, although Daman did not say when that might happen. Healthcare providers will have to submit the information quarterly at first, and later monthly. The new rules, which replace the company's inspection-based ABC rating system, are aimed at boosting efficiency and are in line with similar changes by health insurers in western countries.

A Daman spokesman said penalties had not been decided, but there would be repercussions for institutions that failed to provide the data. In the UK, a similar scheme was introduced in 2003 to try to improve National Health Service facilities. However, there has been some debate about whether the result has in fact been a decline in aspects of care, with institutions reluctant to perform riskier procedures.

A study published in the British Medical Journal in August also found that length of hospital stay "fell more quickly and the proportion of day-cases increased more quickly where payment by results was implemented". Under Daman's system, the insurer will also conduct patient surveys and spot checks of medical records to verify the data they contain. It will start collating such statistics before the end of this year.

Khaled al Qubaisi, the chairman of Daman, said: "It is our primary responsibility to ensure quality services and value for money to all our customers." @Email:[e-mail]