Interview: Professor Maha Barakat
What changes to the reimbursement model are being considered to further incentivise investors as well as encourage quality outcomes?
MAHA BARAKAT: HAAD is consistently implementing enhancements to the reimbursement model in order to improve quality, access and cost. HAAD is currently working on producing reports on key quality metrics and intends to use the results for the pay-for-quality programme to incentivise higher quality health-care providers.
HAAD will introduce the right policies and actions to link quality performance to incentives – financial and otherwise – and to sanctions. We also intend for the results of the monitoring to be published and made available to the public. This will lead to an overall quality improvement at individual hospitals and on a system-wide level. Our intention is that this will only happen when we are confident that the results are valid and that the system has the capabilities and the skills to deal with the consequences without putting into jeopardy other aspects of quality or access. HAAD is designing a comprehensive procedure to specify how to link incentives and sanctions to performance.
What improvements are being made to the reimbursement system and tariff structure to address issues associated with an open system?
BARAKAT: The diagnosis-related groups’ prospective payment system for acute inpatient care has been implemented since 2012 and updated with an add-on payment mechanism to address the issue of high-cost implants. Co-payments are applied judiciously so as not to deter access to needed care. Out-of-pocket expenditure as a percentage of total health expenditure is less than 10% in Abu Dhabi compared to about 20% in the OECD. A mandatory tariff review was completed recently to enhance the signalling function of prices in order to demonstrate where resources are required and where they are not, and to avoid over- or under-investment in particular health care services.
What measures are being taken to streamline patient access to limit over-servicing, over-supply and inappropriate service use?
BARAKAT: Data analysis is being used to identify outlier practices and communicate the findings with the concerned parties in order to take remedial measures. Cases of suspected fraud are investigated according to provisions of the law. Pre-approval is required for some services that are costly and/or liable to potential abuse. Planned and random inspection visits are conducted, including mystery shopping, in order to ensure strict compliance with the regulations. The insurance companies are mandated to report cases of abuse, and this, in turn, triggers investigations.
In what ways are efforts being made by HAAD to support research and innovation that will lead to improvements in the quality of care?
BARAKAT: HAAD clearly appreciates the importance of research and innovation in providing value-based high-quality care, and we have included research and adoption of innovation among the key initiatives in our strategy.
There is a research base in Abu Dhabi, but we need to broaden and expand that. We are working with our local partners in the Abu Dhabi Education Council, local and international universities, the Abu Dhabi Health Services Company, Mubadala Health care and many others in order to push this agenda forward. This could be achieved through the allocation of grants, implementing well-defined structures and frameworks for research, identifying priorities for research and recognising efforts in innovation and research through distinction awards.
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