Integrated e-system for Mandatory Health Insurance in Oman

A tender will be floated shortly for the establishment of an electronic platform that integrates the various stakeholders and service providers that have a role to play in the roll-out of a comprehensive and robust Mandatory Health Insurance scheme starting from early next year.
The e-system, according to Abdullah Salim al Salmi, Executive President — Capital Market Authority (CMA), will link the Ministry of Health with various stakeholder agencies and related service providers in supporting the delivery of basic and emergency health coverage to Omani and expatriate employees of private sector establishments in the Sultanate.
“In the coming days, we will open a tender for the development of an integrated system that will contribute to the collation of high quality insurance data, which in turn will promote a unified system of insurance pricing, and minimise the potential for abuse,” Al Salmi said.
The official made the comments at the launch of the 12th Middle East Healthcare Insurance Conference on Monday.
Significantly, a centralised database for the health insurance sector has been a key demand of a number of insurers and service providers, given its importance in promoting transparency when universal health coverage becomes mandatory starting from early 2019.
It is expected that the database will serve as the nerve centre of an eco-system that integrates the databases of, among others, the Ministry of Health, Capital Market Authority, Royal Oman Police, Ministry of Manpower, various private hospitals, related service provides such as diagnostic labs and pharmacies, insurance firms and third party administrators (TPAs).
A unified database operated and monitored by the regulator, it is pointed out, will foster transparency and accountability within the mandatory health insurance scheme. With better public information on the pricing of services provided by hospitals, pharmacies, diagnostic labs and other market participants, service providers and insurers alike will be required to compete on the basis of quality, efficiency and performance as well. Clients will also be able to make more informed choices when selecting their insurers – an outcome that will contribute to a more professional, equitable and sustainable industry, experts stress.
Additionally, a unified database for health insurance will serve as a real-time repository for information on individual patients and their employers, their medical and claims history, type and cost of care provided by hospitals, pharmacies, diagnostic labs and so on. This information — suitably anonymised in the interest of protecting the individual’s identity — will allow for insurers to customise and price their policies based on the claims history of employees of their client organisation.