By Fatima Muhammad
Saudi Gazette
OWNERS of hospitals and polyclinics have certain reservations about their dealings with insurance companies and have approached the Council of Cooperative Health Insurance (CCHI) in this regard.
The first problem, said Nasir Al-Zahim, head of the health services committee at the Jeddah Chamber of Commerce and Industry (JCCI), is that the insurance companies tend to put very low fees for hospital and polyclinic services claiming that the charges are in return of the large number of patient groups they are providing. He elaborated that by doing this the insurance companies do not consider the fees set by the Ministry of Health for services and consultations.
Furthermore, Al-Zahim said that while insurance companies can change the fees they offer to their clients based on the market demand these companies insist that the hospitals and polyclinics should stick to the charges earmarked in the contract. The issue here, said Al-Zahim, is that many contracts are valid for two to three years which might result in great losses to the health service providers.
In addition, insurance companies tend to apply discount measurements on the “claims” based on their own benefit, he said adding that the challenges facing this sector — especially from certain vested groups and lobbies of insurance companies — are forcing investors to leave the sector though they are the providers of about 30 percent of health services offered to the public.
Al-Zahim was speaking at an open discussion between health providers and the CCHI held at the JCCI recently.
An Egyptian investor, who is also an owner of a chain of polyclinics in the Kingdom, said one of the major problems for them is that the CCHI tends to close down violating insurance companies and then the investor struggles to find his money. “How can we get out money if the company has been closed down? We are lost in the middle as service providers, where should we go,” questioned the investor. He added that they suffer from the inspection tours from the insurance companies especially that many of those doing these inspections are doing it in an illegal way like visiting the location pretending to be patients. He said that many of these inspecting individuals are not even qualified and certified by the Saudi Council for Health Specializations. “In many cases these doctors are general practitioners who are not qualified to evaluate the work of specialized doctors,” he said.
He also added that insurance companies behave differently with group hospitals than small polyclinics. “The attitude is totally different and we at the polyclinics struggle a lot as the insurance companies are not favoring us and tend to prefer bigger hospitals.”
The committee members agreed that there must be a minimum fee for the services they provide, a need for unifying consultation fees in line with what the Ministry of Health has approved, and provide training for representatives of the insurance companies.
Wail Al-Dahasi, deputy secretary general of the CCHI for technical issues, said that there are 70,000 transactions between health service providers each day in the Kingdom and monitoring each transaction is a tedious job. He added that they are finalizing the new Saudi Health Insurance Bus (SHIB) which will be an online system and a portal that will ease electronic transactions and will allow service providers and insurance companies to make direct contacts through the council’s website.
Regarding the “claims” and the unpaid amounts which service provides demand, Muhammad Al-Husain, secretary-general of the CCHI, said that Saudi Arabian Monetary Agency (SAMA) is authorized to settle such disputes. He promised to support health providers through filing their claims to SAMA.
Regarding setting of minimal charges, Al-Husain said that it is in the jurisdiction of the Ministry of Heath and its officials will be part of future discussions on the issue.
Talking about ongoing tug of war between service providers and insurance companies, he said that each party sees itself as a victim. “It is not the time to find faults but to arrive at a point where all can meet to provide best health services to the public,” he said.
