Dubai fund for not-covered medical bills

A government fund to cover unpayable hospital bills is in the pipeline, a Dubai Health Authority (DHA) official told Emirates 24|7.

The fund would be available to cover healthcare costs, often unaffordable for new parents.

Case in point

On February 28, Maqbool Parkar received a phone call from his wife.

Pregnant, she had started bleeding heavily. It was the phone call that changed his life, the new father narrates.

It was supposed to be twins, but only one child survived.

"That day, I rushed home to take her to the emergency section of our hospital. We were informed that her situation was critical and she might deliver due to excess pressure on the cervix.

"The next 48 hours the medical staff tried their best to delay the delivery, but as they say, when the time comes there is no way to stop it.

"The babies were finally delivered after two days of struggling, on March 2.

"On one hand, the sight of the two little ones in front of me was probably the happiest day in my life, while the risk the babies were facing with many of their organs not yet fully developed gave us shivers," narrates Parkar.

For the next 28-days, everything was about the survival of the two babies.

The passion with which the nurses and doctors worked in helping our babies to survive first and then grow clinically is commendable and my family will be forever grateful to them. Eventually one baby succumbed on March 9, as her organs gave up the fight.

"I stood that day helpless as that was the only time I was able to hold her."

Fortunately, the other baby was doing well.

Her growth was on track and it gave the couple reason to smile.

On April 13 she came home and parenthood could begin.

The above story portrays the roller-coaster journey new parents may go through when faced with premature birth of a child, or two.

Sadly, this difficult time is often accompanied by an immense financial burden, resulting from the high costs of NICU-care in hospitals and in limited options of insurance coverage for the treatment.

In Parkar's case, the treatment had cost them Dh420,000 - for each baby.

The insurance company was not willing to cover the bill, as it was excluded from maternity coverage.

Fund to the rescue

A health fund to support cases like these is in the pipeline, confirmed Haidar Al Yousuf, Director of Health Funding Department at the DHA.

"The model we envision is a DHA health fund that covers the small number of high expense cases or conditions that are not covered by insurance and that is something we are presently working on."

In terms of numbers, the percentage of babies admitted to NICU's under insurance coverage in Dubai in 2013 was 3.1 per cent of total number of live births in the emirate, explained the DHA.

In  0.08 per cent of the cases the bill exceeded Dh150,000.

The fund targets these bills, which are the minority of cases but yet important to focus on because it is mostly these cases that require most help, admitted Al Yousuf.

Further, the mandatory insurance scheme will provide support for those with relatively lower bills.

"The essential benefits package, which is now the minimum accepted cover for all new policies sold in Dubai, covers the child for 30 days under the mother's policy.

The aggregate annual limit for that policy cannot be less than Dh150,000 per year, and is usually higher," said Al Yousuf.

The maternity coverage can be consumed to cover general healthcare in case of premature birth.

"Therefore, as and when the phased introduction of health insurance takes place, and the population gets insured as per the DHA timelines, all these cases will get at least the essential coverage needed, if not more,” he added.

This assurance might help future parents dealing with a difficult encounter such as premature birth.

Insurance factor

"For me, the trouble started when I realised that the insurance coverage for my babies, which my company had added as dependents under me after they were born, did not cover the cost of the NICU treatment.

"On enquiring the reason for the decline, we were told that pre-maturity is a standard exclusion with all medical insurance providers and that there are a few cases where this condition will be covered, which was not the case for the current situation," said Parkar.

In addition to a more secure support network for cases like these, costs at the NICU units are expected to go down over the years, as a result of mandatory health insurance, explained Al Yousuf.

"In the absence of mandatory health insurance, the risk pool is lower and, therefore, insurance premiums are higher. When the whole population gets insurance, the risk pool gets wider and thus the premiums get lower.

"For healthcare facilities, this is an excellent opportunity to provide not only high cost services but to provide services at a lower price because a higher number of people can now afford those services due to mandatory health insurance.

"We will see all these benefits of mandatory health insurance in the next two to three years."

In phase one, by October 31, 2014, all  employers who sponsor individuals on a Dubai Residence Visa (including Free Zone established entities) with more than 1,000 employees on their sponsorship were asked to provide health insurance for their workers.

Companies with 100 to 999 employees have until the end of July 2015 as part of the phase two roll out of the scheme.

Companies below 100 employees have until end of June 2016 to cover their employees. All spouses, dependents  and domestic workers will also have to be covered by June 2016.

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