Michael Earley/ senior associate, Clyde & Co LLP

Michael Earley, senior associate, Clyde & Co LLP, talks to Ta’ameen Qatar about the planned roll-out of compulsory health insurance in Qatar.

Qatar’s rapidly increasing population, combined with continuing advancements in hi-tech medical technology and pharmaceutical innovations, have started to put pressure on the financial and infrastructure capacity of Qatar’s healthcare sector. Pursuant to the goals set out in the Qatar National Vision 2030, the State of Qatar has been working to implement a social health insurance scheme (SHIS) to provide universal healthcare access by 2014, in order to strengthen the country’s healthcare infrastructure.

The Supreme Council of Health (SCH), the governmental entity responsible for the development and implementation of the SHIS, revealed initial details in June 2012 of how the scheme will be implemented.

Currently the draft law that will implement the SHIS is under consideration with the Council of Ministers.

Although the draft law has not been circulated for wider consultation, several key details have been released by the SCH through local newspapers and media statements. According to these sources, the draft law provides that the government will pay the health insurance premiums for Qatari nationals while employers will be responsible for the premiums of their expatriate workers. Once the draft law has been approved and comes into effect, the government plans to require all residents and visitors of Qatar the country to have insurance coverage by the end of 2014.

The SHIS will be mandatory for residents and will be linked to the processing and granting of residence permits for expatriates. However the position with respect to the coverage of expatriates who are not sponsored by an employer (e.g. family dependents sponsored by the head of the family or selfemployed expats) remains unclear.

In preparation of the implementation of the draft law, the government has initiated the establishment of the National Health Insurance Company (NHIC), which will be wholly owned by the SCH. The NHIC will have a seven-member board of directors representing various ministries and other public and private entities, and will ultimately launch and regulate the SHIS by coordinating between insurance providers and SHIS beneficiaries. The scheme will be further supported by a third party administrator responsible for establishing a provider network and processing claims.

Currently the intention is for the SHIS to cover all public and private healthcare service providers in Qatar including primary, secondary and tertiary services.

Hospitals, clinics, polyclinics, as well as medical laboratories should also be included in the SHIS. The tendering process for the third party administrator is expected to commence in the near future.

The SHIS will be rolled out through a series of five carefully-planned phases. On 12th April 2012 the SCH announced that the pilot programme of the SHIS will be launched around November of this year, followed by additional phased programme rollouts to be completed by the end of 2014. The pilot programme will initially provide cover to approximately 75,000 Qatari women aged 15 years and above. Among the services to be covered by the programme are maternity, obstetrics and gynecology with more services becoming available at a later date.

The application of the pilot programme has been deliberately limited in order to enable the SCH to micro-manage a small portion of the public healthcare population, allowing them to troubleshoot issues as they arise whilst simultaneously limiting the impact of such issues.

The second stage of the SHIS is planned for July 2013 and will extend the scheme coverage to include all Qatari nationals working in both public and private sectors, and provide access to primary (public) healthcare facilities and some of the private hospitals. In October 2013, the third stage will be implemented entitling all Qatari nationals to basic services from all healthcare providers in Qatar. What basic healthcare extends to is still unclear, but it is unlikely to cover aspects such as dental or healthcare for example.

By May 2014, the fourth stage will extend coverage of all Qatari nationals under the SHIS to all services in the private sector and introduce partial out-patient treatment into the scheme. The final stage, earmarked for the end of 2014, will extend SHIS coverage to include all residents of Qatar with the majority of those covered eligible for the basic package healthcare benefits at both ‘primary and secondary levels’ as it describes them – although once again it is still unclear what these will comprise.

It should be noted that because the scheme is still in its early stages, there are in many respects not a lot of details as to the specifics. At this stage it appears the SCH is working from a framework which will populate over time.

The current intention is for private health insurance companies to operate under the NHIC as providers of supplementary health insurance services, whilst the NHIC will be the sole provider of the basic premium package. It is also envisaged that Qatari nationals will be entitled to receive a more enhanced basic package compared to other residents.

In addition to providing health insurance coverage, the SHIS will use the premiums collected to fund the scheme with the goal of improving the quality and efficiency of healthcare services being offered in the country, thereby potentially increasing the participation of the private healthcare sector in the scheme.

At this stage the SCH is conducting a comprehensive study in order to identify the overall costs associated with healthcare services in Qatar. The findings of the study will aid in determining the applicable premium amounts for the SHIS. Once the SHIS has been put in place, the draft enabling legislation may be reviewed subsequently and amended as necessary to reflect the development of the scheme.

Although the draft-enabling law has generally been agreed, the SHIS will not formally commence until the legislation has been promulgated. In the interim many residents (as well as stakeholders in the healthcare sector) anxiously await the rollout of the SHIS' first phase. Whilst it is likely that there will be quite a few challenges to face before the SHIS will be implemented effectively, it appears that Qatar is progressing the scheme at a pace that may well see its complete implementation prior to 2015.

The GCC 2050 healthcare challenge

One of the biggest issues Qatar and the wider GCC faces is what has been described as the ‘diseases of affluence’.

Obesity, diabetes and cardiovascular disease are putting a massive toll on GCC healthcare systems in terms of both resources and budgets. As reported, according to the International Association for the Study of Obesity, Qatar has the world’s sixth highest prevalence of obesity and the region’s highest obesity rate amongst boys. While a big problem, this phenomenon is not just restricted to the GCC. Global obesity has doubled since 1980.

On a wider scale, it is thought that the diabetes burden on the region’s healthcare systems by the year 2030 will run into hundreds of millions of dollars. Addressing this issue is a paper aptlynamed the GCC Healthcare Challenge 2050. By then, suggests the paper, Gulf countries combined will need as a minimum a total of 138,965 hospital beds, 140,334 physicians and 227,079 nurses. As we stand now, suggests the GCC Healthcare Challenge 2050, the Gulf region has not nearly enough. “Even as their numbers increase and they live longer, the inhabitants of the GCC are becoming increasingly unhealthy,” it states.

“With the exception of Oman, over half the population of each of the Gulf States can be considered overweight.” The issue does not only concern obesity and diabetes in themselves, but also related conditions such as heart disease, high blood pressure and stroke.

A more recent phenomenon in the region has been heart disease amongst a much younger age group – not least brought on by the exceptionally high prevalence of cigarette smokers.

Within Qatar and the wider Gulf, the issue remains on where the money will come from to meet the 2050 challenge. The answer, suggests the paper, is through public-private partnerships – taking the burden from the public sector’s shoulders and opening the field further to privatisation. A huge opportunity for GCC insurers to take advantage of what is currently the region’s fastest-growing insurance sector.