Updated on May 13 with more information about Seha’s plan.

Recent remarks made by the acting CEO of Qatar’s new universal healthcare scheme Seha have prompted questions about whether the requirements to use the insurance are changing.

According to stories published this week in a number of English- and Arabic-language newspapers, including the Peninsula and Al Sharq, Dr. Faleh Hussain apparently said patients would soon need a referral from a primary care doctor before seeing a consultant or specialist.

This would mean that hospitals and clinics would require patients covered by the new scheme – which currently applies to all Qataris – to visit a primary healthcare center or family doctor before seeing a consultant.

Al Sharq reported, as translated into English:

“Speaking about the transfer system that is currently in place, which demands the patient to obtain a transfer request from the medical center or primary care provider before going to a specialist physician, Dr Faleh said that the health insurance plan was the primary reason behind imposing the transfer system.”

In addition, the Qatar Tribune stated that the measure would be introduced “in the coming months,” and that it would be “strictly implemented.”

However, a Seha spokesman said that no big changes would be implemented any time soon, though a referral system will likely be put in place in the future.

In a statement sent to Doha News, he clarified:

“The National Health Insurance Company confirms that Seha members are free to visit specialists and physicians at any of the health service provider within the Seha network.

However, it should be noted that instituting a gatekeeping system whereby referrals are required from a primary health care physician is a key tenet of the National Health Strategy, and will be implemented at a future date. In the meantime, only those requiring physiotherapy will need a referral from a general practitioner or specialist to receive treatment at one of Seha’s health services providers.”

In demand

The Seha scheme, which was rolled out to all Qatari nationals at the end of April, provides free care for basic health needs at most of the country’s major hospitals and medical clinics.

The introduction of a referral process, even if just for physiotherapy, represents a significant shift in the service provided under the scheme.

Previously, patients were advised to make an appointment with any doctor they wished to see at more than a pre-approved dozen hospitals and healthcare centers, and to present their Qatar ID prior to the appointment to confirm their entitlement to coverage.

Officials have previously said that Seha would be rolled out in five stages, with expats being covered by 2015.

Under the new healthcare law passed last year, the government will pay for the healthcare needs of its citizens, while employers will be required to cover insurance premiums for foreigners.

So far, the coverage appears to have been well-received. Officials have said that around 11,500 Qataris used the scheme in the first week of May, a significant increase from the 30,000 Qatari women in total who used Seha during the first phase, between July and December last year.

Currently, four public and three private hospitals, nine private clinics and six branches of Magrabi opticians are included in the scheme, and several more providers have applied to be signed up.

Dental care is expected to be added to the plan next month, but cosmetic procedures will not be covered.

Primary care expansion plans

The introduction of a mandatory referral for physiotherapy sessions coincides with a new campaign to educate people about the services provided by government-funded Primary Healthcare Corporation (PHCC) centers, which was launched yesterday.

There are currently 21 such centers around the country, with two more (in Al Karaana and Al Ghwairya) due to open this year, and five more scheduled to come online in 2015.

Among other things, the clinics offer dentistry, pregnancy check-ups, vaccinations and laboratory tests.

However, some patients have complained about long waiting times and unfriendly staff. Responding to these issues, Mariam Yaseen, Executive Director of Public Relations at the PHCC, told the Peninsula:

“We often hold training sessions for our staff to provide best service for patients. They have been instructed to respond to patients in the right way.”

She added that long waiting times were usually due to the high volume of patients attending clinics.  According to official statistics, the clinic in Abu Hamour, for example, reported 60,000 more visitors in 2012 than in 2011.

Thoughts?