In the summer of 2013 Qatar’s long-anticipated mandatory health insurance scheme became operational, representing for many an historic step in the country’s social development. The creation of the National Health Insurance Company in June with Al Khaleej Takaful Group appointed as the scheme’s third-party administrator, and the July implementation of the scheme under Emiri Decree No. 7 of 2013 came at the end of a lengthy planning process, during which time a number of concerns were raised regarding the concept’s viability.

Although in its early stages, the success of the scheme to date has answered many of the doubters. One of the first questions to be raised about the scheme when it was initially mooted was whether the country needed a new system at all. Although not referred to as such, a basic national health insurance system was already in place by which Qataris paid around QR100 ($27) per year for access to government-provided health services. The strongest argument for moving to a more comprehensive system – funding – carried less weight in a country accustomed to significant budget surpluses derived from its hydrocarbons wealth.

Five Goals

Qatar’s Supreme Council of Health (SCH), however, saw other advantages in the idea. “Actually, of our five goals, funding was last on the list,” Dr Faleh Mohammed Hussain Ali, the assistant secretary-general of the SCH, told OBG. In the SCH’s view, the new system should above all be a tool to improve quality, by which it can establish standards and monitor outcomes. Second, it should provide better access, opening up private sector health providers to Qataris who until now have been granted access only to public sector facilities with their health cards.

The new system is also expected to bring greater efficiency than was achieved under the old one, allowing the SCH to more effectively monitor spending and outcomes in the health arena. The fourth goal of the scheme, the provision of better data, is closely allied to the efficiency drive, building on the improvements already made in data availability to provide data at the granular level for decision making. Finally, funding remains a concern in the development of mandatory health insurance, despite the nation’s buoyant public accounts. “We are moving from a hydrocarbons-based economy to a knowledge-based economy, so more efficient financing of public services is important,” said Ali.

Addressing Concerns

During the scheme’s planning stage a number of more particular concerns were raised. One was the question of insurers clashing with health providers over costs and services – a problem that has arisen in a number of jurisdictions where mandatory health insurance has been introduced. In the event, this aspect of the scheme was settled remarkably quickly, with the SCH-led negotiations with the interested parties concluding in around three weeks.

One of the principal reasons for this success was that the SCH, unlike the health authorities of some other nations, opted against the idea of importing pricing frameworks from foreign jurisdictions and worked closely with Qatari health providers to establish locally based costings. “We went to the providers themselves and sat with them to take their numbers, so that when it came to the negotiations it was much easier to reach an agreement,” Ali told OBG.

The scale of the new project, and the demands it might place on the nation’s health care infrastructure, was another concern frequently heard in the run-up to its launch. Here, the SCH’s position was strengthened by the fact that the development of the scheme took place against a backdrop of parallel projects implemented as part a greater health strategy. “The scheme is just one project of 39 that the National Health Strategy incorporates, and quite a lot of the concerns that were voiced are tackled by these other projects. Issues such as capacity, quality and capabilities are all addressed by parallel projects going on at the same time,” Ali said.

The SCH, it seems, has answered its critics for now, and introducing mandatory health insurance to the population in stages has granted it time to address further issues that arise as the bold plan is implemented.