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Series of steps
Al-Ibrahim Rehabilitation Center:
In order to spread insurance culture and awareness, especially the health of state employees, the Insurance Regulatory Authority organized an event at the Aleppo Chamber of Commerce entitled: Health insuranceIn the Syrian Arab Republic, Dr. Rafid Mohammed, Director General of the Authority, spoke about the reality of health insurance, its challenges, how to address them, the development of electronic fingerprinting, and the use of electronic payment systems to achieve the basic goal of establishing the right insurance culture and creating an integrated environment and a solid foundation that will allow citizens to get the healthcare they need and on schedule.
Many challenges
Dr. Mohammed spoke about the challenges facing health insurance in Syria, such as the coverage of policies not meeting the needs of the insured due to low financial limits, especially chronic medications, surgeries, etc., and the depletion of card balances. For example, the high price of chronic medication prescriptions, the abuse of medications by the insured, and the use of third-party medical insurance cards that lead to the inability to benefit when sick, in addition to the lack of medical insurance cards. It is clear what services are provided to the insured and the reasons for rejection, as well as some cases of mishandling by the management company.
Sanctions and controls on all parties have improved health care services
On the other hand, Dr. Mohammed pointed out the measures taken by the Administration to address these challenges, such as revising the structure of the State Employees Health Insurance Policy – the insurance coverage and allowances of the Administration, and focusing on the following costs: the factors that have the greatest impact and pain on employees (surgery, artificial substitutes, network and chronic medications, reducing the misuse of fees and cards by all parties, evaluating the performance of the management company and allocating health insurance contracts accordingly). Evaluation.
Dr. Mohammed pointed out that the adoption of medical rates that match the actual costs of service providers would help solve most of the problems and directed the management company to adopt an electronic application that allows the insured to check their balances, book appointments, search the medical network to find the nearest service provider, and find out the reasons for the denial of claims, pointing out that premiums are financed in various ways to serve state employees and emphasizing the commitment of insurance-affiliated hospitals to receive all payments to health insurance card holders at any time.
Electronic fingerprint
The Director of the Insurance Regulatory Authority spoke about the importance of the electronic fingerprint project and the positive role it plays for all parties in shortening the time for medical approval, protecting the rights and interests of service providers caused by late insertion, reducing the embarrassment faced by service providers due to the use of the card by someone other than the holder of the card, reducing the waste caused by issuing new cards or replacing lost cards, and linking medical files with the files of the insured. Fingerprints and national numbers have enabled easy transfer of contracts between insurance companies and management companies.
Unified Protocol
Dr. Mohammed expressed approval for the acceptance of all insured patients as well as military centers and hospitals, as a notification had been issued to the management company on the need to develop the necessary unified protocols and models for all companies with the Military Medical Services Department, indicating the mechanism for insurance packages in all links of the “Home for the Wounded” project to obtain health services.
Insurance Broker
Mohammed also said that the Insurance Regulatory Authority has not cancelled its contribution to enabling citizens to obtain loans from public banks through its intervention as an insurance broker or guarantor, but banks stopped issuing individual loans some time ago and when they reopen their doors to enable citizens to borrow again, the authorities will resume active intervention to strengthen bank financing and promote development.
Dr. Mohammed pointed out that the way in which the complaint culture was strengthened was positively reflected in the details of communication with the service providers, noting that a “WhatsApp” group had been created for all insurance officers of public entities and a “WhatsApp” sub-group had been established between the insurance officers of all entities and the insured persons with the aim of informing them of all amendments and establishing a complaint culture.
Negative Outlook
Dr. Mohammed Manjo, the head of the Aleppo Pharmacists Syndicate, noted that the negative perception of citizens towards service providers, especially pharmacists and doctors, seeing them as “thieves”, points to the need to build relationships in which all parties participate so that everyone can benefit from health services.
Manjoo pointed out the problems faced by pharmacists in installing fingerprint devices and the high cost of installation, and said that only some insurance companies in the city of Aleppo are committed to insurance services, and some of them have not yet adjusted the prices of medicines, but he did not deny that the weak of some service providers are compensating for their losses among citizens.
We are not opposites
The Director of the Insurance Authority responded by confirming that the Insurance Authority did not accuse pharmacists of violations, but that there were abuses and violations in the use of health insurance services by all parties, including the Insurance Authority, noting that the purpose of the mistakes was to strengthen the insurance culture and spread it in society, indicating that all parties that contribute to the improvement of health insurance services will be punished and controlled, noting that the Authority and service providers are partners and not opponents, and the goal is to accuse the Aleppo Pharmacists Union of not communicating with the insurance regulator and informing it of the negative impact: if the union cannot submit complaints and reports of violations, how can other parties or ordinary citizens do so?
T-Suhaib Amraya
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