Improving efficiency and reducing fraud in UAE's health insurance market.

Abstract

The World health report 2010 estimated that about 20-40% of all health sector resources are wasted and highlighted health care leakages-waste, corruption and fraud-as the ninth leading source of inefficiency of health systems. The health care system of the United Arab Emirates (UAE) is currently ranked 9th out of 55 nations assessed by the Bloomberg’s health care efficiency index-the United States of America ranks 50th. However, if efficiency is defined conventionally based on costs to achieve specified outcomes, the UAE health system has efficiency shortcomings in relation to health care costs by its citizens for overseas medical treatment as well as the per patient cost of treating diabetes annually-as high as $10,000 annually per Emirati citizen with complicated diabetes. One approach to improving efficiency of UAE’s current AED64 billion ($17 billion) annual health industry market is through universal health insurance, as it facilitates improvements in health outcomes by making access to high-quality health services more affordable and equitably distributed. The European Health Care Fraud and Corruption Network stated that, in 2008, of the annual global health expenditure of about US$ 5.3 trillion, at least 5% or about US$ 260 billion, is lost to fraud. According to 9 March 2016, UAE Gulf News report, AED 4 (11%) billion of the AED33 billion health insurance claims by individuals and health care providers are related to health insurance abuse and fraud. Using the newly implemented Dubai Mandatory Health Insurance Program as case study, this article critically reviews opportunities to improve the efficiency of UAE’s health insurance system and highlights approaches to tackling health insurance fraud and abuse, which adversely affect the efficient delivery of health services in UAE