OBG talks to Abdullah Al Sharif, Secretary-General, Council of Cooperative Health Insurance (CCHI)

 Interview: Abdullah Al Sharif

What steps are being taken to implement mandatory insurance for Saudis in the private sector?

ABDULLAH AL SHARIF: The cooperative health insurance law was enacted to mandate cooperative health insurance coverage in the Kingdom of Saudi Arabia. This law aims initially to cover all expatriates under the umbrella of cooperative health insurance coverage and then to extend coverage to Saudis working in the private sector, along with their families.

In implementing the law, health insurance companies must be certified to underwrite the insurance policies and guarantee the provision of services for the covered personnel. Health care providers must be accredited to meet certain minimum standards.

Other steps in the process to date include adopting appropriate medical coding, approving general forms and establishing criteria for pre-authorising health care services. Additionally, steps have been taken in establishing the contract between the health insurance companies and health care providers, as well as creating the necessary guidelines for governing the provision of health services.

How is the CCHI promoting awareness of the new law among the Saudi population?

AL SHARIF: CCHI ran a large awareness campaign about cooperative health insurance for one complete month using different communication channels including newspapers and local media. To ensure the message reached the broadest audience possible, advertising was also completed through international media, such as satellite TV channels.

It is essential to increase participation of the business community and communicate with chambers of commerce and other institutions throughout the country. Large private employers are also contacted directly to communicate the insurance requirements. These employers have produced numerous newspaper advertisements about the health insurance mandate for Saudis in the private sector.

What is the current strategy for increasing health coverage? How can beneficiaries be assured they will receive sufficient coverage and services?

AL SHARIF: The private sector is becoming extremely active on investments within the health care market, which helps the expansion of the sector. As of today, the CCHI has accredited 3000 health care providers, and contracted with 27 qualified insurance companies and six third-party administrators. A legal relationship between these health insurance parties ensures the quality of the services.

Currently, there is a periodical evaluation of insurers to guarantee that accredited private health care institutions are applying the national performance standards established by the Central Board for Accreditation of Healthcare Institutions. Also, by visiting health insurance companies and providers on a regular basis, we can help ensure compliance with the established rules and regulations.

In additional to inspections and evaluations, individual patients are able to submit complaints confidentially. If potential issues are identified through any channel, investigations are completed and any necessary actions are taken.

In terms of minimising medical fraud, what measures are currently being taken?

AL SHARIF: By spreading awareness among health insurance partners, the Kingdom has taken the first steps to combating fraudulent cases in health insurance. Currently, we apply controls in the insurance market which monitor the quality and cost of the services offered to beneficiaries.

CCHI has also introduced two information technology initiatives that will minimise medical fraud. The first project establishes a database on participants in the health insurance industry. The second project will standardise health insurance pre-authorisation requirements. Finally, CCHI staff are also trained in identifying and dealing with medical fraud.