Bahrain seeks to improve health care delivery

Bahrain’s health sector is undergoing a series of changes under the National Health Plan (NHP) 2016-25 that are designed to improve patient choice, raise standards and encourage private sector involvement.

One of the plan’s landmark reforms is the rollout of a new health insurance scheme for citizens, expatriates and visitors, known as Sehati, or “my health”. The Ministry of Health has shifted from directly providing medical care to overseeing and monitoring health services. The plan has also led to the establishment of the Health Information and Knowledge Management Agency, an organisation tasked with monitoring and directing the sector’s activities alongside the National Health Regulatory Authority (NHRA) and Social Health Insurance Fund Authority (SHIFA).

To prepare for the new insurance scheme, Bahrain’s public hospitals and health centres have been granted greater autonomy and their financing structure has been overhauled to ensure that they can compete with the expanding private health care segment. The NHRA has also introduced several digital platforms for both patients and health providers intended to improve efficiency and transparency while ensuring that public facilities can keep up with the complex demands of the country’s expanding health care sector.

Social Health Insurance

The first phase of the kingdom’s Social Health Insurance Programme is set to launch in the second quarter of 2022 and will first cover expatriates. The programme is being rolled out in phases and will expand to include citizens by early 2023.

The scheme will consist of six health care packages for citizens, expatriates and tourists, ranging from government-funded mandatory care to employer-funded options. Mandatory basic health care for Bahrainis is funded by the government and available to all nationals, while the mandatory package for expatriates is funded by their employers. An optional package is available for both Bahrainis and foreign residents that is government subsidised for nationals and paid by the employer for expatriates. Visitors must also purchase health care, which they are expected to pay for themselves.

Patient choice is an important part of the reforms: the new system pairs all citizens and residents with a public or private primary care physician of their choosing. While Bahrainis will still be able to access free public health care, a 40% government subsidy incentivises nationals to register with private providers.

Expatriate Care

In March 2022 the NHRA announced that the new social health insurance provision for foreign residents was set to be launched in the second quarter of the year. The compulsory package, known as the Mandatory Private Cooperative Health Insurance Programme (PCHIP), provides access to public and private primary health care and emergency care for expatriate workers of a certain age. There is a spending cap that, if exceeded, impacts the premium rate paid the following year. Expatriates can also opt for private coverage, provided it includes all the services required under the mandatory package. Employers will be required to pay contributions towards their expatriate employees’ health insurance and, in some cases, that of their dependents.

This contribution will be added to employer fees for work permits and their renewal. Employers could be fined if they do not enrol their expatriate staff in the scheme. In 2015 the Ministry of Health decreed that private employers must purchase mandatory health insurance for all expatriate employees applying for work visas to the Labour Market Regulatory Authority. Private companies with fewer than 50 staff members were required to pay BD72 ($191) per foreign worker and BD22 ($58) for each Bahraini national. Companies with more than 50 employees were exempt if they provided their own health insurance scheme or a 24-hour clinic.

Bahrain is a popular destination for foreign workers: 77.6% of the kingdom’s workforce were expatriates as of the first quarter of 2021, according to the World Bank. The introduction of PCHIP for expatriate workers will mean that many foreign residents can access the same health care benefits as their Bahraini counterparts, a move likely to encourage an improvement in standards and attract additional foreigners looking to live and work in the country. Furthermore, the expansion of medical care provision and continued investment in the sector is likely to draw in foreign health professionals.

Funding & Autonomy

While a Supreme Council of Health (SCH) representative told OBG in 2019 that Sehati was not intended as a cost-saving measure, an actuarial study found that the programme could save approximately BD200m ($530.5m) per year through to 2038 – funds that are slated to be used to invest in improving the kingdom’s health services.

The creation of Sehati will completely overhaul the financing of health services in Bahrain. Previously, public health funding was determined by a set, often inflexible, central budget allocated by the Ministry of Health. This system meant that public hospitals were not held individually accountable and had little freedom to determine how funds were allocated.

Under the new Sehati system, SHIFA will be tasked with collecting insurance premium, making contracts with providers and collecting data on how services are being performed. SHIFA will pay hospitals and health centres based on the services they provide, and the main source of its income will be payments received by patients for services provided to them, determined by the global diagnostic-related grouping method. On the primary care side, family physicians will be paid based on the number of patients registered with them. Therefore, the new system incentivises health care providers to offer better services and treat more patients, fostering a more competitive environment.

Alongside providing further fiscal autonomy, Sehati aims to overhaul the way that public hospitals and primary care centres are managed. The reforms will establish a board of trustees tasked with overseeing a given facility’s functions and directing the board of directors so that services meet the necessary standards, ultimately granting hospitals and health centres greater autonomy in terms of day-to-day operations.

Private Sector Growth

The NHP reforms aim to encourage increased private sector involvement in health care. The introduction of PCHIP will be a major draw for private operators, with local media reporting that some medical professionals have argued that it could lead to large numbers of patients moving from the public to the private sector.

Sehati strengthens the position of the health care sector as an attractive location for private investment. Ali Al Mudaifa, executive director of investment origination for the Bahrain Economic Development Board, told attendants of the 2021 Bahrain-Korea Medical Partnership webinar in July 2021 that the GCC market is ripe for growth as its population continues to expand and mandatory health insurance schemes are rolled out across the region. He highlighted Bahrain as the “perfect place” for regional health services to establish themselves, given the size and location of the market, pointing out that 100% foreign ownership is permitted.

Digital Developments

Alongside the NHP reforms, the NHRA has introduced five new systems designed to improve efficiency within the health care sector. These include Munshaat, an online platform and mobile phone application launched in December 2021 for health inspectors to record digital health breaches. The app is the first of its kind to be used in Bahrain and has been rolled out across 822 facilities. It can only be accessed by NHRA inspectors and officials, who can use the data to track staff progress and ensure the inspection process runs smoothly.

Another online platform, Mehan, was also launched in 2021 alongside an app version. Mehan assists more than 18,000 health professionals with licence-related services, including applications, renewal and references. Lastly, an automated financial system has been introduced to simplify fee payments.

These new platforms will be especially important as Bahrain’s health care sector adjusts to the new insurance model and will be vital to ensuring that public sector health care providers can compete with their private counterparts, particularly amid the rise of telemedicine and e-health platforms.

In mid-2021 Dr Mariam Al Jalahma, CEO of the NHRA, told national media that there were plans to develop a new online platform for health administrators that will be accessible via Munshaat. This system will track every health care facility in the country, with applications, reports and violations all accessible on one platform, as well as details on topics such as employee licences and medical devices available on site.

The rollout of Sehati has also been accompanied by a mobile app provided by the Information and eGovernment Authority in coordination with the Ministry of Health, the NHRA and other authorities. The app enables users to find and contact authorised doctors and pharmacies in the kingdom; access details on medications; book appointments at registered health centres; and check the status of lab or x-ray results.