New Price list for HealthCare Services in the Emirate of Abu Dhabi

The rates included in the MT represent the Gross Amount due to healthcare providers for services performed for insured patients who is covered under the Basic Product (white card). As well, it acts as the accepted floor and ceiling ( three times the rates included in the MT) of the insurance reimbursement rate for medical services in the Emirate of Abu Dhabi for the other insurance products (Thiqa and Enhanced).

The new changes were the result of a thorough study of the medical services, provided in the Emirate of Abu Dhabi (May 2010-April-2011) which is captured using HAAD e-claim platform, structured pricing methodology that is guided by international standards, and a comprehensive coding system.

According to the new MT list, the Day Care services rates will increase by 22 percent and surgeries rates will decrease by 14.9 per cent. Radiology and other Medical services rates will witness a minimal drop 0.7 per cent and increase of 0.05 per cent, respectively. Laboratory services rates will drop 24.2 per cent while the doctor visits will increase 24.6 percent.

Moreover HAAD has adopted a collaborative approach to establish the MT pricelist by engaging providers and payers through feedback collection sessions, establishing an advisory panel and conducting workshops to address stakeholder concerns

Commenting on the new price list, Sultan Sayed Ashkar Al Dhaheri, Director of Health System Financing at HAAD said: “In delivering against our vision “To Ensure Reliable excellence in Healthcare to the Community” a series of initiatives has been taken to sustain the market. The Mandatory Tariff and associated Claims and Adjudication Rules, as well as internationally refined Diagnosis Related Groups (DRG) Prospective Payment System, are key initiatives that have produced a positive impact on the healthcare system.”

“As for the overall financial impact, and due to the significant rates increase in the Mandatory Tariff issued in Aug 2010, and the low visibility to the cost of healthcare services in the Emirate, the new rates list was decided to be overall price-inflation free. Notwithstanding, the new pricelist has revised the reimbursement of the various service categories over the previous rates to further stabilize the market while continue encouraging investment in the underserved healthcare sectors” Al Dhaheri added.

The new prices have been established using Relative Value Unit (RVU) for Medicare - United States - in 2011, to calculate the proper price difference between the different services.

Mahmoud AbuRaddaha, Section Head, Gov’t Prices and Product Benefits at HAAD said: “In the absence of actual health services cost data of the service provider, the Relative Value Unit (RVU) is considered the most equitable and appropriate reference for the calculation of prices. The use of "actual cost paid" for the basic product without increase or decrease, made the proposed prices for 2012 as a "redistribution of the total cost of various health care services” to achieve the desired objectives without causing inflation in the total price of health care services in the Emirate.”

“The new rates list has been established using the 2011 codes sets, the upgrade of the coding system from codes’ sets 2008 to 2011 was very critical to support billing and payment of new healthcare technology and services that became available after 2008” AbuRaddaha added.

The final report of KPMG Lower Gulf Limited, the independent consultant commissioned by HAAD to conduct an independent assessment of the methodology and process used in setting HAAD’s Mandatory Tariff V2012, stated that “The new mandatory tariff pricing methodology is a right step towards ensuring reliable excellence in healthcare within the Emirate of Abu Dhabi”