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Oman’s Dhamani health insurance platform on-boards over 100 entities

New milestone: The CMA is currently doing the groundwork to facilitate a scientific costing and pricing study to help standardise the pricing of services
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The first 100 stakeholders participating in the delivery of the National Health Insurance Project (Dhamani) have now been on-boarded and registered on the Dhamani platform underpinning the implementation of the compulsory health insurance programme in the Sultanate of Oman.

It marks the successful completion of a key milestone ahead of the planned roll-out of the Dhamani project – an initiative spearheaded by the Capital Market Authority (CMA) with the support of various government agencies.

When eventually launched in a series of phases, starting from later this year, the scheme will cover private sector employees – Omani and expatriate (along with their dependents) – domestic and farm workers and all tourists and visitors entering the Sultanate of Oman.

According to a senior official of the CMA, around 100 healthcare providers have been on-boarded and registered with the Dhamani Health Insurance Exchange Platform – the technological hub of the Dhamani project. Also enrolled are insurance companies and health insurance Third Party Administrators (TPA).

“With the initiation of the onboarding and registration process, we have now completed Phase 1A of the Dhamani Health Insurance Exchange Platform project, which serves as a key enabler for the implementation and monitoring of the entire Dhamani scheme,” said Dr Mohamed Ghazaly, Medical Insurance Expert – Capital Market Authority.

“The Dhamani platform is based on state-of-the-art technology, coding and messaging standards that will transform and digitalise the healthcare and health insurance industries in the Sultanate of Oman,” Dr Ghazaly added in a recent presentation to members of the Omani Medical Association (OMA) on the salient features of the Dhamani project.

Significantly, Phase 1B of the platform project is due to go live shortly, said the official. This phase will integrate the healthcare providers, insurance companies and health insurance TPAs and facilitate live health insurance transactions between them. At the same time, all of the key government stakeholder bodies, notably the Ministry of Health, Royal Oman Police, Ministry of Labour, and the Ministry of Transport, Communications and Information Technology will be integrated into the system as well.

“Following the Phase 1B Go-live, the Dhamani e-pay facility will be implemented as well, enabling near real-time settlement of adjudicated claims,” Dr Ghazaly stated.

Importantly, the roll-out of the Dhamani scheme will have a transformational impact on the healthcare sector, as well as the wider economy, according to the official.

“We envision the market evolving as greater numbers of people are covered by health insurance, which in turn will spur the growth of healthcare providers. In fact, the health insurance industry will serve as a credible funding source to enable the organic growth of the private healthcare industry,” he stated.

Furthermore, to ensure the equitable and sustainable operation of the scheme, the CMA is currently doing the groundwork to facilitate a scientific costing and pricing study to help standardise the pricing of services, said Dr Ghazaly. This study, undertaken in collaboration with the various stakeholders including the Ministry of Health, will also support adequate capacity planning for the healthcare sector.

At the same time, the CMA is working with the Ministry of Health to implement the Evidence-Based Clinical Guidelines that will help address the differences in opinions and inconsistencies in payer-provider interactions, promote optimal utilisation and improve efficiencies, he added.

During a Q&A session that followed the presentation, representatives of the Omani Medical Association highlighted the importance of having in place treatment guides for various health services, as well as the need to set up the necessary controls and procedures to avoid price inflation for treatment services.

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