The Capital Market Authority (CMA) has constituted up a special panel to develop price manuals that prescribe tariff ranges for various medical, hospital and diagnostic products and services offered to patients covered by the Mandatory Health Insurance System (Dhamani) when it is rolled out in the Sultanate later this year.
The move is part of a series of measures adopted by the sector regulator in collaboration with other stakeholders in limiting the potential for fraud, malpractice and abuse by service providers, insurers and patients alike when the Dhamani scheme is introduced.
According to Ahmed al Maamari (pictured), Vice President —Insurance Sector, CMA, the panel is made up of representatives from various stakeholder organisations, including the Oman Chamber of Commerce and Industry (OCCI), insurance companies, and independent experts.
The team will be tasked with formulating ‘price manuals’ for different kinds of medical products and service. These benchmarks will be eventually presented to the industry for further deliberation, he said.
The official made the revelations at a healthcare insurance forum organised with the support of the CMA last week. The panel’s work, combined with the imminent launch of an electronic platform to oversee the smooth operation of the Dhamani scheme, will address any concerns about transparency in the delivery of an effective and robust healthcare insurance system in the Sultanate, Al Maamari stated.
The Dhamani platform, in particular, will make it possible for price-gouging and other forms of abuse to be identified and unearthed as all of the transactions will be transparent, he noted.
But he stressed however that the CMA has no plans to play an interventionist role in the pricing of products and services offered as part of the Dhamani health insurance scheme, at least not during the initial stages of its introduction. The Authority will however monitor the performance of the scheme, the various players involved, and the price indicators driving the health insurance market. The regulator, he noted, would be keen to ensure that the market is governed by healthy competition and good practices.
“In Phase 1, the CMA will not enforce any price benchmarks at inception. The participating insurers will compete to service the portfolios where the market will determine the price. In Phase 2, leveraging the structured data, over a period of time, the CMA will develop scientific benchmark references for product prices in close collaboration with the market stakeholders before they are mandated,” Al Maamari said.
An estimated two million Omani and expatriate employees (and their dependents) of private sector organisations in the Sultanate will be covered by the Dhamani project when it is rolled out in stages in the coming couple of years, according to the official. This compares with an insured population size of around 400,000 people presently.
In addition, around three million tourists and visitors who travel to the Sultanate every year, will be covered as well.
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