The Emirates Insurance Federation emphasized that there are unnecessary medical practices and procedures, and the recipes for exaggerated drugs are a major reason for increasing the prices of health insurance premiums annually by more than 20%, and leads to the consumption of the entire ceiling of the amount allocated for insurance quickly, and raises the “tolerance rates” that the patient pays, as it negatively affects the economy and the insurance sector in the country.
Al -Ittihad stressed the importance of setting uniform standards for future treatment, and higher prices for prices, in addition to carrying out intense scrutiny on hospitals greater than what is currently in place, and monitoring them more, as well as granting certificates or classification to the bodies committed to “clean practices.”
Dealers had told «Emirates Today» that they paid large sums of money, as a percentage of tolerance, as a result of the multiplicity of medical procedures required by some hospitals, as well as their accusation of the necessity of laboratory examinations, which proves later to be important.
Medical practices
In detail, the head of the Health Insurance Committee in the Emirates Insurance Union, Abdul Mohsen Jaber, told «Emirates Today» that “there are hospitals and medical centers that do additional procedures that the patient does not need, such as multiple medical analyzes, or keeping the patient in the hospital without any reason for that, which carries large sums of money, as a percentage of participation in the treatment (the tolerance rates), and also affects the insurance sector and companies operating in it, and therefore the economy.”
He added: «This problem is although it is common in many countries, it has many negative effects in the patient himself, as a result of the long medical procedures, and giving it recipes for exaggerated medicines, and in long doses that it does not need, which leads to overcoming the ceiling of his coverage in a short time.
He continued: «There are also medical bodies that send an insurance coverage request that were not originally done, or only part of them have been made, or some procedures, or the materials that were not used, are considered abuse, and up to the extent of sending incorrect reports, which is a clear fraud.
Jaber said that “all of these practices are a big problem, and companies and economics incur huge sums, as it is the main reason for increasing the prices of health insurance premiums between 10 and 20% annually, and sometimes more.”
Controls and control
In response to a question about the controls and procedures taken to reduce these medical practices, Jaber said: “In terms of laws and controls, health bodies at the state level undertake procedures that reduce these practices, through tools in which the abuse of health insurance is discovered in addition to placing pricing and maximum limits for some medical procedures, as well as the annual evaluation of insurance companies, insurance brokers, medical demands management companies, and hospitals by bodies Health, as a condition for renewing licenses, takes into account the extent of the commitment of these entities, and the violation of the parties that offend or circumvent. ”
The head of the Health Insurance Committee in the Emirates Insurance Union said that the patient should also play a fundamental role to stop the abuse of health insurance, and said: “The patient has a basic role by asking and inquiring about the importance of the additional medical procedures that he does, and that he understands well his health, because he will participate in a percentage in the cost, and he can take another medical opinion in the event of doubt, and not sign the approval of procedures that doubt its importance, and finally, he can file a complaint Its health body. ”
Jaber stressed the importance of awareness among health insurance users, and not to implement everything that is required of them without understanding so that they are not subject to exploitation.
Suggestions for the phenomenon
Jaber called for the necessity of setting uniform standards for the future treatment, and higher prices for prices in addition to carrying out intense scrutiny on hospitals greater than what is currently in effect, as well as linking the renewal of the license to the absence of exaggerated cases of the use of health insurance cards.
Jaber expected that artificial intelligence would have a future role in monitoring medical authorities, in a way that reduces wrong practices and stops abuse.
He also suggested some solutions that could limit this phenomenon, such as granting certificates or classification to the bodies committed to “clean practices”, as well as conducting training and awareness workshops for medical authorities, and adopting preventive treatment that prevents future diseases.
40 %growth in the cost of the insured treatment bill within 5 years
Central Bank statistics show that the cost of treating the insured, which was paid by insurance companies in the form of “claims”, recorded during the year 2024 a value of 24.9 billion dirhams, while during the year 2023 it recorded a value of 20 billion dirhams.
The cost of treatment in 2022 recorded about 17.06 billion dirhams, and in 2021 about 15.61 billion dirhams, and in 2020, it was worth 14.91 billion dirhams.
According to the data, the claims paid by the insurance companies to hospitals witnessed a rate of 40% during the last five years, specifically from 2020 to the end of 2024, according to the latest data issued by the central bank.
Table of Contents
- 1. How do defensive medicine practices contribute to overdiagnosis and increased premiums?
- 2. Impact of Unneeded Medical Practices on Rising Health Insurance Premiums
- 3. The Overutilization Problem: A Core Driver of Healthcare Costs
- 4. What Constitutes an Unnecessary Medical Practice?
- 5. the Financial Chain Reaction: From Practice to Premium
- 6. The Role of Fee-for-service models
- 7. Impact on Different Types of Health Insurance
- 8. Real-World Example: The Case of Back Pain
- 9. benefits of Reducing Unnecessary Medical Practices
- 10. Practical Tips for Patients: Becoming an Informed Healthcare Consumer
The Overutilization Problem: A Core Driver of Healthcare Costs
Rising health insurance premiums are a significant concern for individuals and families. While many factors contribute to this increase, a critical, often overlooked element is the impact of unnecessary medical practices. These practices, ranging from excessive testing to inappropriate treatments, inflate healthcare spending and directly translate into higher costs for everyone. Understanding why these practices occur and how they affect your premiums is the first step towards advocating for a more sustainable healthcare system. This article will delve into the specifics, offering insights into healthcare costs, medical billing, and strategies for navigating the system.
What Constitutes an Unnecessary Medical Practice?
Defining “unnecessary” can be complex,but generally,it refers to medical services that don’t demonstrably improve health outcomes and may even pose risks. Here are some common examples:
Defensive Medicine: Physicians ordering tests and procedures primarily to avoid potential malpractice lawsuits, rather than for diagnostic necessity. This is a major contributor to overdiagnosis.
Redundant Testing: Repeating tests already performed, or ordering tests that provide little additional clinical value.
Brand-Name Drug Preference: Prescribing more expensive brand-name drugs when equally effective, lower-cost generic alternatives are available. This impacts prescription drug costs.
Unneeded Specialist Referrals: Referring patients to specialists without a clear medical justification.
Low-Value Imaging: Utilizing advanced imaging techniques (MRI, CT scans) when simpler, less expensive methods would suffice. This contributes to increased radiology costs.
Prolonged Antibiotic Use: Prescribing antibiotics for viral infections where they are ineffective,contributing to antibiotic resistance and unnecessary healthcare expenditure.
The link between unnecessary practices and health insurance costs is straightforward:
- Increased Healthcare Spending: Unnecessary procedures and tests add to the overall volume of healthcare services utilized.
- Higher Claims Costs: Insurance companies pay for these services, leading to increased claims costs.
- premium Adjustments: To cover these higher costs, insurance companies raise premiums for all policyholders.
- Reduced Affordability: Higher premiums make health coverage less affordable, potentially leading individuals to forgo necessary care or choose plans with higher deductibles.
This cycle perpetuates itself, creating a system where unnecessary care drives up costs, making care less accessible, and potentially leading to more unnecessary care as people delay preventative services.
The Role of Fee-for-service models
The traditional fee-for-service (FFS) healthcare model, where providers are paid for each service rendered, is frequently enough cited as a key driver of overutilization.This system incentivizes volume over value. Option payment models, such as value-based care, aim to address this by rewarding providers for quality of care and patient outcomes, rather than the quantity of services provided. Accountable Care Organizations (ACOs) are an example of this shift.
Impact on Different Types of Health Insurance
The impact of unnecessary practices isn’t uniform across all insurance plans:
HMO (Health Maintenance Organization): Generally, HMOs have more control over costs through gatekeeping (requiring referrals to specialists) and negotiated rates, potentially mitigating the impact of unnecessary care.
PPO (Preferred Provider Organization): PPOs offer more flexibility but frequently enough have higher premiums due to less cost control. Unnecessary care can substantially inflate these premiums.
High-Deductible Health Plans (HDHPs): While HDHPs have lower premiums, individuals bear a larger financial burden for healthcare costs. Unnecessary care can quickly deplete thier out-of-pocket funds.
Medicare & Medicaid: wasteful spending in these publicly funded programs represents a significant drain on taxpayer dollars. Efforts to reduce unnecessary care are crucial for the long-term sustainability of these programs.
Real-World Example: The Case of Back Pain
Back pain is a common ailment often subject to unnecessary interventions. studies have shown that many patients with acute back pain receive imaging (X-rays, MRIs) despite guidelines recommending against it unless there are “red flags” indicating a serious underlying condition. These unnecessary scans contribute to medical imaging costs and expose patients to radiation. Furthermore, they often lead to further unnecessary interventions, like spinal fusions, driving up costs significantly.
benefits of Reducing Unnecessary Medical Practices
Addressing the issue of unnecessary care offers numerous benefits:
Lower Health Insurance Premiums: Reduced healthcare spending translates directly into lower premiums for individuals and employers.
Improved Patient Safety: Avoiding unnecessary procedures minimizes the risk of complications and adverse events.
More Efficient Healthcare System: Resources are allocated to services that truly improve health outcomes.
Increased Access to Care: Lower costs make healthcare more affordable and accessible to a wider population.
* Reduced Financial Burden on Individuals & Families: Less out-of-pocket spending on unnecessary care.
Practical Tips for Patients: Becoming an Informed Healthcare Consumer
You can play an active role in reducing unnecessary care and controlling healthcare expenses:
- Ask questions: Don’t hesitate to ask
