ABU DHABI // The healthcare system is creaking under the stress of hospital visits by members of the Thiqa health insurance scheme. Thiqa members, all of whom are UAE nationals, each made an average of 14 outpatient visits last year. Expatriates with enhanced insurance averaged 4.6 visits, and those with basic coverage – the minimum required by law – made 3.1. The figures compare with 2.8 visits a year in Sweden, 4.9 in the UK and 6.2 in Australia. Health chiefs attribute the high numbers to unnecessary visits for prescription renewal; to several services offered only to Thiqa members, such as preventive medicine, the Weqaya cardiovascular screening programme, dentistry and pre-marital screening; and to a shortage of primary healthcare administered by general practitioners. "If we normalise a little bit it’s still higher than nine visits a year, which excludes all the additional good services offered for nationals that are aimed to be preventive," said Dr Mahmoud Ramadan Abu Raddaha, head of the government prices and product benefits section at Haad, the Health Authority–Abu Dhabi. "This tells us there are still too many visits happening compared with the rest of world." The authority, which published the number of outpatient claims in its annual report for 2011, aims to address patterns of use, including an education plan for Thiqa members if it is deemed necessary, Dr Abu Raddaha said. Doctors said the number of visits was abnormally high because health insurance was a relatively new concept and there was no culture of primary care by GPs. "Most people think that having this insurance card gives them the liberty to see the doctor," said Dr Taha Ibrahim, director of Al Noor Hospital. "If you compare the system to the western countries, like the US and Canada – anybody having insurance cannot access the consultant or specialist level without having a referral from a general practitioner." This, however, would be difficult to implement. "You cannot tell a UAE citizen they cannot access their cardiologist unless it comes through the GP," Dr Ibrahim said. "Besides that, if you adopt that system … it also carries a risk of delayed care." That there is no required co-payment for most Thiqa services is another factor, Dr Ibrahim said, because members feel no financial impact from multiple visits. The best solution is an educational approach, which is the responsibility of the health authority, and of insurance companies and healthcare providers. "Therefore these unnecessary visits to the emergency room and to the doctor are not there." Daman, the national insurance company that provides Thiqa as well as private insurance that covers nearly a third of the market, said there was increased use across the board. Dr Sven Rohte, Daman’s chief commercial officer, attributed it to a lack of understanding of how insurance should be used. "The majority of claims are just simple, and really conditions which actually are not ultimately worth a visit to the doctor," he said. Patients also do not trust their healthcare professionals. "If they go to a doctor and he says you suffer from this, or even if the doctor tells you there is nothing, you go to five others to confirm." Increased visits have a ripple effect on the industry, Dr Rohte said. Overuse contributes to cost inflation, about 15 to 20 per cent a year. The acceptable rate given population demand and growth should be about 10 per cent. Premium costs are then affected, which are passed to employers, who may choose to provide fewer services. Thiqa is fully subsidised by the Government. Haad hopes to extend the duration of repeat prescriptions from six months to one year, which would reduce hospital visits, and Daman has launched several educational initiatives, including disease-management programmes and sessions with human resources departments. It has also launched an online database where members can track their transactions. "We've discussed this with the employers who pay the premiums, and they feel the individual member doesn't feel the responsibility," Dr Rohte said. "They get a piece of plastic that takes you wherever you want. It's like a free shopping card."