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Enaya under review
The most expensive services under Enaya, the luxury health insurance package that covers 90,000 government employees in Dubai, are being reviewed, said Mona Ali Sultan, Assistant Director, Health Funding Department. The change is expected to be implemented next year.
Hello world!!Officials said that the DHA’s strict check on providers has had positive results with some reporting miscalculated claims themselves. “Some people complained about the pressure the authority was putting on providers,” said Dr Yousuf. “But as a result of the pressure we applied, many clinics have come forward claiming their mistakes; they realised this is serious responsibility.” The authority is in the process of taking legal action against a couple of providers. Dr Yousuf said that misuse of public money was not acceptable.
Malpractice is mostly reported in dental practice, said Dr Mona. “This service is expensive and the billing claims may be higher than in other specialities but we keep checks and balances according to set benchmarks,” she explained.
Another form of malpractice, said Dr Yousuf was pushing patients deliberately into investigations and therapies that were not required. “Many also claim for procedures they haven’t done and this is akin to theft of government money,” he added.
To prevent misuse, the government recently introduced a 20 per cent co-insurance for Enaya users. “Employees got disappointed when co-insurance was introduced but on the other hand they have full access to DHA facilities free of charge,” said Dr Yousuf.
“When there is a co-insurance, people will start to look after that money because they pay a percentage of it,” he said. However, if they do not want to pay, they can utilise the DHA’s Primary Health Care services, he said.
Enaya is the only programme that does not rule out pre-existing conditions such as diabetes or heart disease/chronic conditions. It also covers optical, dental and preventive procedures in DHA while employees can also avail of an annual health screening.
It is a partnership between the Department of Finance, Government of Dubai and Human Resource Department, DHA. “The government HR department is in the final stages of making a law that will spell out penalties and address misuse,” said Dr Yousuf. We also refer many complaints relating to physicians non-compliance and abuse to our colleagues in Health Regulation to look into their professional licensing when necessary, he added.
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