Do not leave us at the mercy of insurance firms



Sabria S. Jawhar

Published — Thursday 20 March 2014

Last update 19 March 2014 10:20 pm

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Saudis working in the private sector will soon have insurance companies pay for their health care — ranging from inpatient and outpatient treatment to prescription drugs— which had been free under the Ministry of Health. This does do not bode well for the uninsured and the underinsured.
According to AlifArabia, the 2013 budget for health and social affairs expenditures grew 16 percent. That’s about SR100 million. The government is committed to building 19 new medical centers and five medical cities to expand the availability of beds to 6,200.
At the same time health insurance has exploded by 33 percent between 2007 and 2011 in Saudi Arabia, as private companies are now required to provide health insurance to expatriate and Saudi workers.
The problem with low-cost health care, which is no longer a government responsibility, is the lack of any specifics on how patients can obtain health care at no or minimal costs. The Ministry of Health has not provided patients with the mechanism as to how the new system will work. Further, while health insurance is now mandatory, the sad fact is that it is not always available to Saudis.
Here’s the reality: Not all private companies employing Saudis offer health insurance and most private companies do not provide employee identification cards.
In such a scenario the first task of hospital administrations will be to determine whether a patient is a public or private sector employee. Government employees have their own insurance and possess proper government identification. Private sector employees will have difficulty identifying themselves.
If hospital staff demands proof of private employment, the employee must obtain a letter, which will significantly delay obtaining the treatment and prescriptions. This is, of course, in the case of private employees who have health insurance. And of those who don’t have insurance? Where do they go? And who will provide treatment without paying the full cost?
Last year, I received authorization from my doctor at a private hospital to have a procedure performed and a prescription filled. But first my insurance company had to approve the treatment. The company refused to authorize the procedure and prescription, noting that it was not required for the treatment of my condition. This was in direct conflict with the diagnosis from the doctor. I ended up paying for the prescription at a considerable expense.
Private sector employees now face a triple threat under the Ministry of Health’s new health care policy. If the policy remains the same in which insurance companies are essentially a facilitator between the hospital and the ministry to fund medical services, then it is pretty much business as usual.
However, if insurance companies can dictate what services can be approved or denied, it will be a disaster for Saudis working in private companies. Under this scenario, they could be denied affordable health care if their company does not have health insurance and does not provide proper identification. They can be denied medical care if the insurance company does not agree with a physician’s plan for treatment. The employee is now at the mercy of the insurance company, which could have the capacity to deny a patient proper care even if it contradicts a physician’s diagnosis.
One thing that Saudis could take pride in is our health care system. It is not unlike the National Health Service in the United Kingdom with easy access to a general practitioner, emergency room treatment and medicine. It’s a dangerous move to take away immediate government-approved access to medical care and putting it in the hands of insurance companies with the authority to deny that access.
There has been considerable disappointment over the quality of public sector health care over the past decade. I am sure it’s one reason why the government has encouraged the growth of private hospitals and opened the market to health insurance companies. But by having insurance companies play a larger role in determining what kind of health care Saudis receive threatens to undermine one of the strengths of Saudi society, which are broad low-cost medical services to Saudis.

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