Qatar implements new universal health coverage mandate

Qatar launched a mandatory health insurance plan as a replacement for the previous public health insurance scheme, commonly known as SEHA, introduced in 2013. As in other GCC countries, Qatar’s reforms come in response to rising demand from an ageing population and the growing burden of non-communicable diseases, alongside the desire to rationalise public expenditure and increase private sector dynamism in all sectors of the economy.

Previous Iterations

The SEHA system envisioned the creation of a single government-owned National Health Insurance Company (NHIC) to provide basic cover to expatriates and Qataris, with the scheme administered by a third-party administrator. This allowed Qatari nationals to obtain free treatment at participating private facilities, in addition to the public health care facilities operated by the government-owned Primary Health Care Corporation (PHCC) and Hamad Medical Corporation (HMC).

However, soon after the scheme’s launch in 2013, it became apparent that the number of Qataris attending private facilities was becoming too costly and overburdening the system, which led to a postponement of plans to extend SEHA coverage to expatriates. As a consequence, the scheme was dismantled at the end of 2015 and the NHIC was disbanded. Following the dismantling of SEHA, the Qatari government absorbed the cost of residents’ and citizens’ health care after they paid their initial registration and administration costs. The country also had long-running discussions around how best to involve private insurers in the sector.

New System

In 2021 the Ministry of Public Health (MoPH) announced a new mandatory health insurance system to be implemented for all foreign residents in Qatar, as well as tourists and temporary visitors. The new system was promulgated under the Qatari Health Care Services Law No. 22 of 2021, which defines the controls, procedures, systems and standards necessary to provide health care services in government and private facilities. The law was published in the Official Gazette on November 4, 2021, and entered into force six months later. It repeals all former laws governing health services.

The aim of the new law is to provide high-quality care for all Qatari nationals and foreign residents in a manner that is financially sustainable, taking into account the shifting demographics and disease profile in the country. In Qatar between 80% and 90% of the resident population is comprised foreign nationals, who account for up to 95% of employees in the private sector, according to some estimates – although national efforts are under way to attract more Qataris to private sector jobs. Prior to recent legislation, in order to receive public health care services on a cost-effective basis, foreigners had to purchase a Hamad health card for QR100 ($27.45), compared to the QR50 ($13.72) fee for Qataris.

The new regulations introduce a number of changes to the previous system. As of May 2022 employers must enrol non-Qatari employees and their family members in the mandatory health insurance scheme for the duration of their employment term through contracts with insurance companies registered with the MoPH. If a foreign national’s arrival in Qatar was facilitated a recruitment agency, the recruiter must provide basic health insurance coverage until the foreign resident comes under the coverage of their employer. Meanwhile, all temporary non-Qatari visitors such as tourists and business travellers are mandated to have private health insurance for the duration of their stay.

Employers will have to prove that their employees are covered by the mandatory health insurance scheme when issuing or renewing their residence permits. Basic health insurance will also be a prerequisite for obtaining any form of permit or visa. Additional health care services above the basic health insurance requirement may be provided by the employer or recruiter as a matter of contract. In addition, fines of up to QR30,000 ($8230) will be issued to employers or recruiters who fail to provide basic health insurance to their employees and eligible family members.

Regional Comparison

The Qatari authorities hope that the new health insurance system will reduce waiting times at government-run health facilities, as well as facilitate timely appointments for medical consultations. According to the most recent data from the World Health Organisation (WHO), in 2019 Qatar’s total health care spending per capita was the second highest in the GCC, at $1810, with only the UAE recording a higher total of $1840. Prior to the recent reforms, the government accounted for approximately three-quarters of total health care spending, with the remainder covered by voluntary health insurance schemes (15%) and out-of-pocket spending (10%).

While the new scheme does not include mandatory insurance requirements for Qatari nationals, mandating privately funded health insurance for foreign residents and visitors is expected to ease the burden on public health care services, and free up public funds to invest in further improvements to PHCC and HMC facilities and services.

A similar outcome has been seen in countries such as Saudi Arabia, where all nationals and foreigners working in the private sector are required to have private medical insurance, and moves appear to be under way to also meet the health care needs of Saudi public sector employees through private health insurance. In the UAE, meanwhile, individual emirates offer slightly different schemes, but in general employers are responsible for covering the private insurance costs of foreign employees, whereas citizens are eligible for government-funded plans.

Industry Implications

The mandatory health insurance scheme should make a positive contribution to Qatar’s economy. With 2m-2.5m expatriates expected to obtain private health insurance through the new system, the country’s health insurance sector will benefit substantially. According to a 2022 report from global ratings agency Standard & Poor’s, the scheme could bring in an additional QR1bn ($274.5m) to QR1.5bn ($411.7m) in gross written premium in the coming years, while some industry estimates suggest the plan could generate QR1.7bn ($466.6m) to QR2.2bn ($603.8m) for the insurance sector as a whole.

The insurance reforms could also have a positive impact on the wider health care industry. To keep up with high demand, private health care providers will have to consider hiring more staff and investing in upgrading infrastructure and IT systems. Such developments should have a positive impact on employment and service provision.

2022 FIFA World Cup

The 2022 FIFA World Cup, which will be held in Qatar in November and December 2022, also has implications for the health care sector. To ensure optimum health security during the tournament, the 1.2m fans expected to visit will need to prove that they have valid health insurance recognised by Qatar under its new law, covering the duration of their stay in the country.

The significant influx of overseas visitors from a wide variety of countries during this period presents some challenges for the health care sector, beyond insurance requirements. The MoPH has worked with the WHO to develop simulation exercises for how to deal with potential medical emergencies at mass gatherings. It focuses on stringent preparedness, health security, infectious diseases, food safety, coordination and communication. The lessons learned from Qatar’s experience during the World Cup should help in designing health and safety measures for other large-scale events in the future.

As the first World Cup to be held since the start of the Covid-19 pandemic, Qatar should benefit from its widespread vaccination programme, which has ensured the population has high levels of immunity to the virus, with 90% of the population fully vaccinated as of early May 2022.

In an effort to build a positive public health legacy from the tournament, in October 2021 Qatar signed an agreement with the WHO to establish a multi-year collaboration with global partners that will promote physical and mental health, and serve as a model for ensuring future large-scale sporting events are healthy and safe. The WHO and Qatar will work closely with FIFA to undertake joint activities to promote healthy lives, health security, and physical and mental well-being during one of the world’s largest sporting events. With an influx of international visitors expected in 2022, the recent health insurance reforms covering non-nationals are timely, and should allow health care stakeholders to focus on showcasing the sector’s strengths and addressing other challenges presented by the event.