Thousands of Oman’s workers don’t have medical insurance. Now the government is taking action to ensure expats need not worry about crippling bills in the event of an accident or serious illness. Alvin Thomas reports.
Sitting in a doctor’s office and being told you have tested positive for hypothyroidism would be a matter of grave concern for anyone.
The condition is one in which your thyroid gland fails to produce enough important hormones.
But for patient Shyama* and her husband Murali*, both residents of Oman, the shock was beyond that of the illness itself.
They knew that their life was about to take a wild turn – and their concerns were proved right almost instantly.
Murali, a 32-year-old project engineer for a contracting agency in the Sultanate, and the breadwinner, knew he couldn’t afford to pay for the treatment for his wife’s condition.
His company didn’t offer health insurance either, which
meant he was liable for all medical expenses.
Murali and his wife had to make a tough decision: ditch the tests, pay the existing consultation bills, and head to India for further treatment.
The consultation and initial test charges at the private Omani hospital had already amounted to RO125 – a stretch for an engineer earning just RO550 per month.
Murali says: “No one wants to let their spouse down. And watching her take the bad news about her health was painful enough for me. But the nail in the coffin was when we knew we couldn’t afford the medical bills, and the constant medication that hypothyroidism demands.
“We just knew that we’d have to come up with a solution together. It was my wife who then suggested that she get the treatment done back home in India.”
To avoid a scenario in which the couple and their two children would be parted, Murali then approached his company for help.
However, his employers stressed the company policy of failing to provide any health insurance to any employee.
“There was only one thing left then; to send everyone back home for treatment while I stayed back for work,” says Murali.
At the time he spoke to Y, he had already sent his wife and two school-age children back to India.
The perils faced by expats
In reality, Murali and his family are among thousands of expats who don’t get health insurance in Oman.
While an accurate number of expats not covered under health insurance cannot be given, the Capital Market Authority (CMA)’s executive president, H.E. Abdullah bin Salim Al Salmi, said (in 2016) that only 10 per cent of expat workers in Oman were covered by healthcare insurance that year.
Rising cost of healthcare
That, coupled with the rising cost of medical services in Oman, is slowly burning holes in patients’ pockets.
The reasons for this rise are down to tougher ministry regulations that mandate a higher quality of services, and the application of advanced equipment and medicines for treatments.
Currently, private hospitals in Oman offer packages for health tests but these can sometimes cost more than RO90. Some hospitals are also known to charge anywhere between RO20 and RO50 for X-Ray screenings.
Even a sexually-transmitted infections/diseases test package can cost RO295, which can be a stretch for many residents.
Medical care facilities in Oman – as is the case with most GCC countries – are quite expensive when compared to those in Asian countries.
Dr Matlooba al Zadjali, a specialist cardiologist at the Royal Hospital, the National Heart Center, and the non-communicable diseases (NCD) department of the Ministry of Health, confirms this.
“Yes,” she says, “The price of medical care is quite high here but it depends on the quality of the service too. Unlike our neighbours in the Middle East, the healthcare sector in Oman is only slowly being privatised now.
“This is why we’re seeing the high costs. As the hospitals procure newer machines and invest money in the latest technologies to treat patients, the cost reflects on the bill too.”
But even then, she believes that the prices are lower than what patients pay in countries like the United Arab Emirates and Qatar.
“In most cases, the average bill of a patient would hover around the RO20 to RO40 mark. Cases where the bill will break RO100 in one sitting is rare unless the case is complicated.
“But it’s true that a lot of Omanis and expats are opting to avail themselves of health services from private hospitals, which are more expensive, as government hospitals can have long and tedious waiting periods – some of which can last up to a month to get a consultation.
“It’s a matter of health, and in such cases money isn’t a concern that is factored in. People would do the best they can to get a clean bill of health.
“The problem arises when someone cannot pay for their services. And that’s why a mandatory medical insurance system makes sense in Oman.
“But at the end of the day, an Omani – at least as a last resort – can always go to a government hospital for treatment. This cannot be said about an expat who will have to spend money from his salary for every sitting with a doctor.”
Currently 2,014,239 expats currently live in Oman (as per statistics released by the National Centre for Statistics and Information), from the which a considerable number of lives are put at risk due to private companies’ lax attitude to providing health cover to their migrant workers.
The dawn of a new era
However, things are slowly starting to change.
A newly-drafted law in Oman mandates that every worker – both Omanis and expats – in the country must be covered by health insurance by the companies that hire them.
This should come as a blessing for those who have been shelling out to meet medical bills.
And as per the statement by the Capital Market Authority (CMA) of Oman, the government body is currently drafting the final plans to roll out this scheme, after the Council of Ministers reached common ground about the plans to protect residents – both Omanis and expats.
Previously, only Omanis – irrespective of age, gender and disabilities – and government employees (including expats) were covered under the national health insurance scheme which allowed them to access services at public hospitals.
But no such option was in place for expats working for private companies.
In a statement, Oman’s Minister of Health, Mohammed bin Obaid Al Sa’eedi said: “CMA set an executive work plan as a milestone for the implementation of the health insurance scheme, the key of which is preparing a draft unified health insurance policy for employees of the private sector and their families, to ensure sound competition and to avoid any future irregularities by insurance companies to provide the customer with proper basic health cover.”
The policy is still under legal review at the CMA, and details of the “basic health cover” that Al Sa’eedi refers to is still under wraps. However, it is clear that private companies across the nation will now have to insure all their employees.
Experts working in various insurance agencies believe that the insurance will benefit those seeking facilities such as hospitalisation and inpatients (patients living in hospitals under treatment), but this has not yet been confirmed by the CMA.
The rollout of the insurance schemes could also take months. After the legal review, the CMA will be implementing the proposals over a period – and in phases.
In the first phase, it is expected that companies with more than 100 employees will be targeted, before which the law will slowly trickle down to smaller establishments.
In a statement the CMA said: “The policy is currently under legal review at the CMA. The body [believes] that the best mode of implementation is gradual execution. The next phase will only be after they ensure the success of implementation of the previous phases.
“The Capital Market Authority is continuing its endeavours, in collaboration with the relevant entities, to implement the decision of the Council of Ministers to apply the compulsory health insurance scheme for employees of the private sector, expatriates and visitors.”
“The decision aims to meet the needs of the employees of the private sector relating to coverage of basic health, so to limit the high costs that employers of the private sector will incur in view of the current economic situation, in addition to ensuring the provision of quality services by insurance companies and health care units to the insured.”
After implementation, even tourists will receive health insurance.
Sudheer N, the director of a leading petroleum engineering firm in Oman, says: “This move by the government is definitely something that we approve of. We’ve always followed a policy of providing our employees with some form of medical cover for the work they do.
“Of course, it wasn’t mandatory as such back then but several clients give preference to companies that offer health insurance to its employees. We’ve always taken care to provide them with basic coverage in private hospitals – which includes consultation, prescription medicine charges, and even physiotherapy.
But Sudheer then reveals that his company also provides the ‘Workman’s Compensation Insurance’, which entitles every employee in the company receives added pay along with their basic salary.
This insurance protects businesses against employee death, bodily injury, and illness arising from work-related exposures. In addition, the policy also provides coverage for accidental medical benefits in private hospitals and clinics, and repatriation expenses.
Such insurance would have protected one business owner (who declined to be named) from being liable for hospital fees after one of his workers died after an accident at home.
The owner says: “His family said he hadn’t been keeping too well with a nasal block. Before sleeping, he headed to the kitchen to prepare herbal tea.
“But, as luck had it, the pipe connecting the gas stove leaked, leaving the kitchen filled with LPG. He couldn’t detect the smell, and proceeded to light the stove.
“The explosion that resulted left him with third-degree burns. And by the fifth day, he passed away from the burns.
“Since medical or workman’s compensation insurance wasn’t provided, the family had to settle a bill of RO1200. But, owing to the economic condition of the family and our small company, the case was taken up by several social workers, who paid the bills in full.”
These are some of the aspects several insurance agents in Oman are hoping the new law will cover.
Social worker and insurance agent, P.M. Jabir says: “Daily, we see a lot of cases of migrants (expats) being hospitalised. It could be from illnesses or accidents. We usually find it very difficult to help them pay the bills.
“While good companies offer insurance to its employees, many sponsors in Oman don’t normally pay for cover. My estimation is that there are hundreds of medium- or small-scale companies that don’t make the commitment to provide this insurance.
“Normal medical expenses are paid off by the worker himself. But when the person is hospitalised, it becomes more difficult again. So, it’s up to the friends’ circles, social workers or other organisations that help them get the money.
“But with this insurance scheme, sponsors and companies will now be mandated to provide this cover – and we couldn’t be happier about it.”
Nevertheless, the uncertainty of when the schemes will be rolled out flanks much of the expat population in
Jabir has an answer. Even before the Government’s announcement, he’d been working on an affordable annual scheme with a leading insurance provider in Oman.
“I’ve been talking to many insurance companies about this for a while, but recently National Life Insurance & General Insurance came up with a new scheme in conjunction with the Indian Embassy in Oman.
Under this affordable insurance scheme – which Jabir was instrumental in setting up – individuals can access personal basic health insurance for as low as RO35. The insurance only takes care of services such as hospitalisation and inpatient, but Jabir says that the scheme is receiving “a good response”.
The social worker is grateful to the Oman government for undertaking efforts to help expats but also believes that Omanis will benefit from the scheme too.
“Omanis will benefit a lot from this new mandatory insurance scheme, as I have been in touch with a few (citizens) who will be happy to have access to private hospitals across the Sultanate.
“This will furthermore reduce the reliance of Omanis on government hospitals, which will in turn reduce the nation’s spending. In all, I am expecting this move to have a positive outcome.”
His words appear to have been borne out after a study conducted by the Business Times, a financial daily newspaper in Singapore. It found that per capita visits to health care centres in Oman are considered high due to the free public healthcare system.
Meanwhile, out-of-pocket health care expenditure in 2016 comprised just 5.8 per cent of total health expenditure.
However, recent figures show that annual expenditure in the healthcare sector is increasing.
As per a report published by Alpen Capital, an investment banking advisory firm, from an estimated US$3.2bn (RO1.23bn) in 2017, Oman’s healthcare expenditure is expected to grow at a compounded annual growth rate (CARG) of 9.1 per cent to US$4.2bn by 2022.
This can be attributed to the rapidly-rising population, the introduction of the health insurance scheme, and the rising costs of care.
A.R. Srinivasan, the CEO of Arabia Falcon Insurance, says the new mandatory insurance scheme would propel the health insurance sector as the “single largest premium that is on offer”.
He says: “We are still awaiting the rules and regulations on how this is going to be implemented; whether it will be a mandatory minimum policy like in the UAE.
“So, the insurance companies are in close touch with the insurance regulators, the capital market authorities, the Ministry of Health and the Oman Chamber of Commerce and Industry.”
But what does Murali think about the impending changes?
“I’m very happy about it,” he says.
“For my family and me, and others like us, it will take a lot of pressure off. Everyone should be able to give their families the help they need if something bad happens. It’s great the government is doing this.
“And if the scheme comes into place soon, I will definitely bring my wife back to Oman for treatment.
“Whatever is on offer would be an improvement from having no cover at all.”
* Names in this article have been changed to protect identities.