1. Funding and Reimbursement
– Planning healthcare
Abu Dhabi Healthcare system

2. History
• The restructuring of Abu Dhabi healthcare system
started with the formation of HAAD and SEHA
• Prior to 2007, government owned healthcare facilities
in the Emirate of Abu Dhabi were managed by the
General Authority for Health Services (GAHS)
• In 2007, the Government of Abu Dhabi issued
specific laws (Emirati Decrees) concerning the
restructuring of healthcare provision in the Emirate.
This resulted in the creation of SEHA and Health
Authority-Abu Dhabi (HAAD)

3. Process
• HAAD is the regulator, Daman the
leading insurer/payer and SEHA
the leading service provider

4. Abu Dhabi health Insurance market
Universal healthcare coverage is
mandatory, serviced by different
insurance plans
 Health Insurance is mandatory
 In 2011, Daman has 28.6% market
share of insured members in Abu
Dhabi

5. Insurance levels
o Thiqa Insurance Plan for nationals – exclusive
to Daman, paid by government, Daman does not
underwrite risk
o Basic Insurance Plan for lower income expats –
exclusive to Daman, subsidized by government,
Daman takes limited risk
o Enhanced Insurance Plan for higher income
expats – no exclusivity to Daman and insurance
companies take complete underwriting risk,
premiums paid mostly by employers

6. Coverage

7. Increasing demand
• Compulsory health insurance law
mandated universal coverage by 2007
and expanded coverage for Nationals
to include private sector providers
• Health insurance makes healthcare
more affordable for over 800,000 blue
collar expats
• Supply constraint was eased by
allowing Nationals free access to
private providers

8. Increasing supply
• Healthcare consumption is typically
supply constrained; new private
sector players may have induced
demand
• Number of private hospital beds has
strongly increased

9. Issues for Nationals
• Limited patient contribution by
nationals
• Unlike non-GCC countries, Abu
Dhabi nationals are responsible for
only minor co-payments at selected
facilities (private sector pharmacies
and dentists) leading to moral hazard
• Free healthcare system leads to
overtreatment – unnecessary
procedures

10. Increased demand
• High per capita income coupled with
sedentary lifestyle and dietary
pattern has increased the incidence
of obesity

11. No. 1 for Diabetes in
GCC

12. Bed capacity
• SEHA is dominant player although
the private sector is actively growing

13. Inpatient care
• The public sector (SEHA) is the
leading provider for inpatient care
and this is expected to continue in
the near to mid-term

14. Outpatient care
• The private sector has focused on
providing high margin outpatient
care

15. SEHA
• Abu Dhabi Health Services Company,
Public Joint Stock Company was
established in 2007
• SEHA became the vehicle to own and
operate all of the public health facilities
• SEHA’s strategy must align with HAAD
and Abu Dhabi Government
• Over 16,500 employees 12 hospitals,
2,369 beds
• 57 ambulatory and primary care centres
• Comprehensive, integrated health system

16. SEHA aims to:-
• Customers and Community Stakeholders
- Manage Patients and Stakeholders Expectations effectively
• Financial
- Manage financial performance to achieve efficiency and
competitiveness
• Service, Quality and Operational Efficiency
- Provide Integrated high quality and Patient Centered Services
- Deliver superior operational execution
• Learning , Growth and Infrastructure
- Establish SEHA among the UAE employers of choice
- Develop National Leadership and support Emiratization
- Develop infrastructure to achieve world class standards
- Promote Research & Education

17. Funding
• Insurance payments and government
subsidy are the main sources of funding
• 40% - Daman and other insurance plus
direct payments from patients
• 20% - Government mandates such as
medical education
• 40% - Government subsidy
• The goal is to have ZERO government
subsidy by 2015 / 2016

18. SEHA output 2011
• Performed 5.2 million1 outpatient visits and
admissions
• Delivered 18,298 babies
• Performed over 39,000 surgeries
• Patient satisfaction of 88.2%
• Improved clinical outcomes
• Reduced waiting times; improved access
• JCI Accreditations and ISO Re-Certifications
• Improved financial sustainability (increase net
patient revenue, 5.9%3 ahead of budget)

19. Plans
• Total construction project cost in
excess of AED 20 billion (USD 5.4
billion)

20. Plans cont.

21. Amalgimation

22. Role of Healthcare in
2030 Economic

23. SEHA
• …. and Abu Dhabi healthcare
system vision states the need for a
“predominantly private” provision
…

24. Task
• In twos or threes look growth in
healthcare in respect of:-
1. Supply of health services?
2. Why demand is increasing?
3. Where is growth?
4. How will services be funded?
5. What is the role of SEHA?