The rapidly increasing population combined with continuing advancements in hi-tech medical technology and pharmaceutical innovations have started to put pressure on the financial and infrastructure capacity of the health care sector in Qatar. Pursuant to the goals set out in the Qatar National Vision 2030, the State of Qatar has been working to implement a social health insurance scheme (SHIS) to provide universal healthcare access by 2014 in order to strengthen the healthcare infrastructure of the country.

The Supreme Council of Health (SCH), the governmental entity responsible for the development and implementation of the SHIS, last month revealed initial details regarding the way in which the scheme will be implemented.  Currently the draft law that will implement the SHIS is under consideration with the Council of Ministers. 

Although the draft law has not been circulated for wider consultation, several key details have been released by the SCH through local newspapers and media statements.  According to these sources, the draft law provides that the government will pay the health insurance premiums for Qatari nationals while employers will be responsible for the premiums of their expatriate workers.  Once the draft law has been approved and comes into effect, the government plans to require all residents and visitors of Qatar the country to have insurance coverage by the end of 2014.

The SHIS will be mandatory for residents and will be linked to the processing and granting of residence permits for expatriates.  However the position with respect to the coverage of expatriates who are not sponsored by an employer remains unclear.  In preparation of the implementation of the draft law, the government has initiated the establishment of the National Health Insurance Company (NHIC) which will be wholly owned by the SCH.  The NHIC will have a seven member board of directors representing various ministries and other public and private entities.    

The NHIC will ultimately launch and regulate the SHIS by coordinating between insurance providers and the beneficiaries of the SHIS.  The scheme will be further supported by a third party administrator responsible for establishing a provider network and processing claims.  Currently the intention is for the SHIS to cover all public and private healthcare service providers in Qatar including primary, secondary and tertiary healthcare services.  Hospitals, clinics, polyclinics, as well as medical laboratories should also be included in the SHIS.  The tendering process for the third party administrator is expected to commence in the near future.

The SHIS will be rolled out through a series of five phases.  On 12 April 2012 the SCH announced that the pilot programme of the SHIS will be launched around November of this year, followed by additional phased programme rollouts to be completed by the end of 2014.  The pilot programme will initially provide cover to approximately 75,000 Qatari women aged 15 years and above.  Among the services to be covered by the programme are maternity, obstetrics and gynaecology with more services becoming available at a later date.  The application of the pilot programme has been deliberately limited in order to enable the SCH to micro-manage a small portion of the public healthcare population, allowing them to troubleshoot issues as they arise whilst simultaneously limiting the impact of such issues. 

The second stage of the SHIS is planned for July 2013 and will extend the scheme coverage to include all Qatari nationals and provide access to primary healthcare facilities and certain private sector participants.  In October 2013 the third stage will be implemented entitling all Qatari nationals to basic services from all healthcare providers in Qatar.  By May 2014 the fourth stage will extend coverage of all Qatari nationals under the SHIS to all services in the private sector and half of the services available on an out-patient basis.   

The final stage, earmarked for the end of 2014, will extend SHIS coverage to include all residents of Qatar with the majority of those covered eligible for the basic package of benefits of healthcare services at both primary and secondary levels.

The current intention is for private health insurance companies to operate under the NHIC as providers of supplementary health insurance services, whilst the NHIC will be the sole provider of the basic premium package.  It is also envisaged that Qatari nationals will be entitled to receive a more enhanced basic package compared to other residents.

In addition to providing health insurance coverage, the SHIS will use the premiums collected to fund the scheme with the goal of improving the quality and efficiency of healthcare services being offered in the country, and thereby potentially increasing the participation of the private healthcare sector in the scheme.

At this stage the SCH in conducting a comprehensive study in order to identify the overall costs associated with healthcare services in Qatar.  The findings of the study will aid in determining the applicable premium amounts for the SHIS.  Once the SHIS has been put in place, the draft enabling legislation may be reviewed subsequently and amended as necessary to reflect the development of the scheme.

Although the draft enabling law has generally been agreed, the SHIS will not formally commence until the legislation has been promulgated.  In the interim many residents (as well as stakeholders in the healthcare sector) anxiously await the roll out of the SHIS' first phase.  Whilst it is likely that there are quite a few challenges to face before the SHIS will be implemented effectively, it appears that Qatar is progressing the scheme at a pace that may well see its complete implementation prior to 2015. 

All Qatari Laws (save for those issued by the Qatar Financial Centre (QFC) to regulate its own business) are issued in Arabic and there are no official translations, therefore for the purposes of drafting this article we have used our own translation and interpreted the same in the context of Qatari regulation and current market practice.

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