A proposal has been raised for the Omani government to set up a supervisory agency to oversee the health insurance sector.
The health committee of the Oman Chamber of Commerce and Industry (OCCI) is weighing the proposal to combat potential abuse, manipulation, price-fixing, and even monopolies, in the health services sector ahead of the full implementation of the Dhamani health insurance platform in 2025, reported Oman Observer.
Mr Murtadha M J Ibrahim Al Jamalani, deputy chairman – OCCI Health Committee, said that the proposed Oman National Health Bureau’s (ONHB) would serve as an “independent and integrated supervisory authority” with representatives from the Ministry of Health, Financial Services Authority (FSA), 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 monopolisation by one or two major players, and handle uninsured cases.
Mr Al Jamalani explained that a sectoral watchdog is necessary for several reasons. For instance, procedures for addressing receivables and outstanding payments remain unclear, potentially giving rise to disputes.
Outstanding fee receivables due to health providers for the treatment and services provided to insured patients over months and years are jeopardising 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.
Furthermore, the OCCI Health Committee will 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 Dhamani platform is the Unified Health Insurance Scheme that makes health insurance coverage compulsory for private-sector employees.
The platform was officially launched on 1 October 2024, enabling all nine insurance players, three third-party administrators (TPAs) and 33 hospitals to exchange data on all health insurance transactions within the FSA’s sandbox environment.
The Authority in September 2024 set the following deadlines for the remaining market participants to be fully integrated with the Dhamani platform:
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Private health polyclinics and their branches (31 December 2024);
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Private pharmacies (31 December 2024);
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Private pharmacies with five or fewer branches (to be invited to join the platform on 1 January 2025 and complete the process by the year-end); and
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Private clinics (to be invited to join the platform on 1 January 2025 with a deadline to complete the process by 31 December 2025).