Program Evaluation: Daman Health Insurance Company
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PROGRAM EVALUATION OF THE NATIONAL HEALTH INSURER OF THE UNITED ARAB EMIRATES, DAMAN
Table of Contents
Abstract:…………………………………………………………………… 4Keywords:………………………………………………………………… 5
Introduction:……………………………………………………………… 6
Purpose of the report: ……………………………… ……………………..8
Overall evaluation…………………………………………………………..9
Methodology……………………………………………………………….11
Hypothesis…………………………………………………………12
Program design and theory………………………………………13
Discussion…………………………………………………………14
Design goals………………………………………………………………16
Conclusion and recommendation………………………………………….16
References…………………………………………………………………..18
Appendices…………………………………………………………………19
Abstract
Program evaluation will help comprehend and increase the use and benefit of a product to consumers or clients. It will reduce costs and improve service delivery mechanisms. In addition, it will facilitate management to conceptualize what the organization objectives are, how to fulfill the goals and the techniques to apply in determining if goals have been fulfilled or not. The aim of evaluation is to determine the quality of services offered by scrutinizing what works and what doesn’t and from this assessment decide what to perpetuate doing and what to change. The objective of performing a project evaluation on the National health insurance of the emirates is to outline the advantages of health insurance cards as well as determine the individuals’ points of view towards this insurance company.
Health cards entitle Emiratis to subsidized medical care and treatment in any public, government governed health insurance company.in UAE, employers and visitors who will prologue their stay to more than two weeks need to be ascertained a residency status. With a residency status come health standards and regulation such as banning anyone with Aids, TB or hepatitis from residing in the UAE. Failure to embrace the recommendation results to deportation or and detention. Health cards are applied for by submitting paperwork to hospitals or filling application forms available in the ministry of health. On submission, one must have the receipts of payment, two passport photos and a completed medical test for. All the details have to be filled in Arabic.it is important for every individual to have a health card.
The program evaluation methodology used in my research was process and summative evaluation. Process evaluation is conducted to identify areas in the existing program in my case Daman health insurance. Summative individual Evaluation is an evaluation conducted by an individual or a team with no substantial connections with the evaluand, its designers, or its implementers and without any participation and without any participation in the evaluation process of organizational or program staff. I collected my data from relevant internet sites, questionnaires and interviews both online and face to face. I collected my data via audio recording, reading and note taking and stored it in recorded and note form.
KEYWORDS
Evaluand –Is the element evaluation for example a company program, policy, project, service or the organization itself. An evaluee is the personnel working under the evaluand being evaluated.
Client –a person commissioned and paying for evaluation services. This term is also used to refer to patients or customers.
Insurance – This is a promise, which is made by one party especially companies to their employees, for compensation regarding future losses and unexpected multiple realities but at a certain amount of money.
Insured- This defines the person, group, or property for which an insurance policy is has been issued to.
Cover- This term is used to refer to the type of insurance an individual applies for. There are different covers, which can be chosen depending on an individual’s financial capabilities.
The emiratization approach was initially initiated to uphold the Emirati identity especially in the workforce. It merely relies on the United Arab Emirates’ nationals who are willing to work or have the desire to work.
Emirati- is an individual possessing an Arab ethnic background particularly those Arabs originating from the United Arab Emirates.
Introduction
Daman is the national health insurance company of the United Arab Emirates, which is located in Abu Dhabi, Dubai. The corporation was established in September 26, 2005. It did not commence immediately until May 2006. The company boasts of a staff base of over approximately 1000 workers. It offers a wide range of health insurance policies and benefits amid wide geographical coverage. The company has become United Arab Emirates’ first specialized National Health Insurance Company. The section will provide of the benefits and convenience of the insurance card initiatives and its advantages to the stakeholders.
A health insurance has many benefits to an individual. It entails payment of a certain amount of money to a plan chosen. Each plan is different from the other in terms of the broad medical options entailed. An insurance premium includes the group insurance plan and an individualized insurance plan. The group insurance plan through an individual’s employment company normally offers the best coverage for the money. Individual health insurance plans offer alternatives for persons who do not have right to use to their employment corporation’s group plan (Frost, 2010).
An insurance card initiative aims at protecting the client from financial constraints especially in cases where one requires urgent medical attention. The extent, at which the patient stays in the hospital together with the hospital bills, accumulate altogether thereby giving one a hard time especially when it comes to payment using cash. A health insurance card is vital because it covers the essential medical invoices that have accumulated. In so doing, it gives you the satisfaction required without worries at all.
When it comes to medical care, a health insurance offers one the comprehensive cover. In most cases when an individual goes for a health appointment, majority of the health providers and consultant doctors require full payment of their services. If one does not have an insurance cover, paying for such services at times becomes difficult. With an insurance cover, you can have unlimited access to the doctor in case of health problems and without any money being paid up front.
In most cases, acquiring medicines may be difficult if the financial implications are considered. A majority of new drugs that have no imitation tend to be quite expensive. The advantage of having a health insurance is that they contain a free drug prescription policy, which lower the amount of money ought to be paid while purchasing such drugs. People without medical insurance have to pay the full amount of money in order to purchase the drugs while people with medical cover paid a small amount or in some cases, they do not pay anything.
One of the major roles Daman played as a leader in the MENA area is the enhancement of the level of quality of health care services rendered. Women who are under the Daman health insurance scheme enjoy a great deal from the company’s services. Daman as the national health insurer has ensured that all babies whose parents are under the Daman medical cover policy enjoy the unlimited services being offered (“UAE Interact”, 2011). The only requirement is the enrollment of the newborn baby into the mother’s insurance scheme. This move is to ensure the babies acquire the best medical care facilities just like the parents.
Daman has become the first of its kind to offer a large specialized and comprehensive health insurance policy to the nation’s visitors (“UAE Interact”, 2008). It has issued about twelve thousand visitor plans since late July 2008. This was after a law allowing it being initiated in line with the Ministerial Decision No. 322/2008. This decision affects all participants who are planning to apply for a visit to the United Arab Emirates (“UAE Interact”, 2008). An insured member is entitled to share a room in case of an inpatient emergency treatment, which is completely covered. Since date, the company has grown to have the highest market share of above 85% in Abu Dhabi (“UAE Interact”, 2008).
The study also aimed to determine the consumer satisfaction through interviews and questionnaires. Health insurance card initiatives have been beneficial to the majority of the population all over the world. These programs help the local and non-local people in the United Arab Emirates. This section will also deal with a synopsis of the health insurance card initiative in United Arab Emirates and the various policies and process undertaken by the Government.
Purpose of the report
In previous years, the purpose of program evaluation was solely to show whether a program was effective or not but today, program evaluating measures effectiveness as well as ensure perpetual quality improvements. The main aim and purpose of this study is to identify the useful, advantages of health insurance card; in other words, determine the individuals’ points of view towards this insurance company. According to the previous information, we hope to provide people with reliable information from the experiences of life and then introduce data that can be considered as beneficial one to others. This research paper will find out whether this health insurance card meets its objectives and goals or not. This report samples the evidence I collected my research. The evidence I collected indicates the impact of Daman health insurance cards to stakeholders, sponsors, clients, volunteers, employees and community at large. This information will be useful in determining what works and what needs to be changed or replaced; health needs of Emiratis and forecast the worth of health insurance. This report will also help compare different health insurance companies in UAE, highlight my study hypothesis and the outcomes and show the cost benefits of the research.
Overall Evaluation
The overall evaluation of the paper will be based on the actual mission and vision of the DAMAN Company. Damans visions, values, mission and goals are:
Goal:
Daman aims at being a leading health insurer in the MENA region by helping Health Care Providers achieve high quality standards of medical services delivered to patients (Agamy, 2009)
Vision:
Daman Insured Members have a free and easy access to a comprehensive Network of Healthcare Providers, which offer high quality of medical services at reasonable cost.
Provision of a long term necessity of medical insurance coverage to its citizens, protect its financial sector by attracting the best regional professionals in the insurance business and incorporate the best customer service in the region as well (Agamy, 2009).
Mission:
Building-up a professional Network Team that is capable of developing and maintaining an integrated network of public and private healthcare providers at a reasonable cost and providing continuous support to improve the quality of medical services by implementing appropriate management techniques (Agamy, 2009).
Values:
-High performance to meet customer satisfaction and professional friendly behaviors that ensure targets are reached on time
-Perpetual innovation and creativity reinforced by the ability to take risks
-Emphasis on consumer wants and concerns in a professional way.
-Contributing to societal health by being an example to other companies through adhering to work ethics and integrity.
-Being honest reliable and confident in relaying integral services to the public. There is good will in Daman.
The outcomes of the results indicated Daman health insurance company should needs to adjust some of its operation.as much as the information is relevant and informative to the company, implementing the required changes requires perpetual monitoring of improvements requires.in addition, the changes are expensive to manipulate and are unique to Daman insurance hence may not be compatible to other health insurance company’s.
Methodology
The section will list the method to be followed in the course of the paper to evaluate this program. The data collection techniques used were interviewing, questionnaires both open and closed ended as well as secondary information sources like the internet, newsletters periodicals and journals. The program evaluation methodology I adapted was process evaluation. From this technique I was able to track quality, number and nature of population the program supports, a description of how the services are offered, quality of services provided and implementation evaluation. I attained information to perform my process evaluation from secondary sources like websites and book. I also applied summative evaluation. Summative evaluation evaluates programs that are underway or completed. Daman health insurance was established in September 23rd 2005 and commenced operations in May 2006 and has operated since then rendering it a complete program.
The tools I used in summative evaluating are changes in attitudes, knowledge and behavior, number of people served, cost efficiency and of the program, changes in policies and impact assessments.in order to measure the changes in attitude, I had to conduct interviews at intervals for the purpose of comparison. I collected both qualitative and quantitative data via audio recording, reading and note taking and stored it in recorded and note form.it is important to choose evaluation that will encourage voluntary participation, use multiple approaches, address real community issues, utilize a participatory process as much as possible and allow for flexibility.
The relevant stakeholders included Daman clients from whom I gained information regarding consumer satisfaction, my sponsors who funded my research, and fellow colleagues undertaking similar project with which we shared interest. Persons interested in the program were I and my doctor who issued the assignment to me. Stakeholders are vital to program evaluation as the evaluating cannot be done in seclusion. The evaluation information I gathered was important in stressing the importance of health insurance to individuals. The information will also inform the potential clients on the services offered by domain as well as offer employment opportunities to job seekers.
Based on the finances I use to travel to the Daman headquarters to seek audience with the Chief Executive Officer as well as the clients thus the research was very costly. In addition, I encountered unresponsive respondents, which was a major setback due to the limited time. I also experienced dramatic weather changes that affected my health negatively. I also felt that the research was involving and the time stipulated was little. However, my research was a success because I managed to accomplish my purpose for the study.
HYPOTHESIS
The purpose of evaluating Daman health insurance was to:
To collect evidence on the effectiveness of a Daman health insurance
To be accountable to my and Daman’s stakeholders, sponsors, clients and community.
To identify ways to improve a program:
Determining services that are good, those that need to be eradicated or replaced assessing the needs of Emiratis and Daman members
To sensitize Emiratis on importance of health cards.
To compare Daman with other health insurance companies.
To assess the profitability and income analysis of Daman.
To check the accuracy of my research hypothesis
PROGRAM DESIGN AND THEORY
The research design was longitudinal as opposed to cross sectional because I obtained the information at different locations and at different times. My appointment with Daman’s Chief Executive Officer was on a different day from the day I conducted the customer’s online interview. All this was done within the stipulated time allocated for the project. There was a day I interviewed Daman clients face to face, a visit to their offices and a different day to conduct the online interviews and a different day to read press news about the organization and a separate day to read the periodic Daman newsletters
Discussion
Based on the data I collected Daman health insurance is currently the largest UAE health insurance Daman has a clientele base of about 2,240,000 persons and increase from 253,000 in 2006(Rohte, 2012). The program targets to provide insurance covers to persons of all ages and genders. Some of the company’s services are specific but not limited. Quantity of services offered is high. There are covers for newborns, young adults and expectant mothers.in addition, all visitors of Dubai residing there for more than two months are supposed to get a health insurance. Services offered include medical covers, billings, funds and benefits. The shares of Daman are 80% Abu Dhabi government and 20% MunichRe (Rohte, 2012).
How services are provided
Forms of compensation or claims can be filled via the internet or dropped in any of Daman branches countrywide. There are 35 branches and service points across the UAE. The Daman staff is highly qualified and with many years of experience. There are 430 claims processors at Daman. Daman is in partnership with MunichRe, Assist America and Europe Assist (Rohte, 2012).
Numbers
On average, 1,600,000 Daman insurance members process claims at Daman every month. There are 430 staff with specialty in claim processing (Rohte, 2012).In case of inquiries the company operates a twenty-four hour, seven days a week customer care service. About 40, 000 calls are received in the contact center each month (Rohte, 2012). Daman customer care services offer consultation, guidance and counseling as well as listen and address customer problems. To acquire a medical cover, individuals visit any of the branch offices and fill in the details required. Those in need of health cards must have the receipt of payment, passports and a medical form bearing test results from a credited hospital or doctor. Over 190,000 membership cards are printed every month (Rohte, 2012). The health card is easy to apply and it only takes a few days if not weeks to be processed.
Quality of services
Based on my interviews with Daman insurance clients, the quality of service offered there is above average (Rohte, 2012)
Changes in attitudes, awareness or deeds;
Emiratis attitudes towards insuring their health has improved over the years. More and more people are number of persons applying for health insurance within the institutions have progressed from recent years.my results also indicate that the population is more aware of the health insurance and its benefit(Rohte, 2012).
Number of people served;
About 68,000 customer’s visit Daman branches every month whereas 156,000 members are enrolled every month in Daman retail and corporate branches (Rohte, 2012).
Cost-benefit analysis;
In the year 2011, Daman insurance company had a net profit of 4% (Rohte, 2012)
Cost-effectiveness analysis;
Ninety nine percent of interviewed customer of Daman was content with the amount fee charged to support services like medical text or getting a health card. On average, the clients were content with the premium charges in the year 2011.
Achievements
Daman received the Corporate Social Responsibility Award by the insurance industry four times since (2008-2011) and also chosen as the Health Insurer of the Year five times by the insurance industry from 2007-2012.
Currently, Higher Colleges of Technology (HCT) is joining with Daman the national health insurer to embark on a project to establish a new institute of health economics by name Daman Institute for Health Economics(‘HCT Partners with Daman to develop new cadre of health insurance professionals,2012)
Based on my research statistics, the company needs to improve on the relationship management of its 360 degree policy, underwriting guidelines, service schemes and pricing, inflation in the medical forecast, value added services, stock and bond optimization, provider management, rate debates, medical charges and preventing fraud (Rohte, 2012).
DESIGN GOALS
At the end of my research, I had managed to gather all necessary information I hoped to acquire. I fully utilized all equipment’s for example a voice recorder rendered to me. I was able to skillfully spend the finances set aside for the research and completed my research on time.
Conclusion and recommendation
My research was successful. I was able to assemble the outcomes, which would encourage non-members of Daman health insurance Company to join and impart the existing customers with knowledge regarding the services rendered by the company .I was also able to offer information about the company’s readiness to form partnership with willing parties that have concrete and worthwhile proposals.
In the process of my research, I encountered several setbacks including unresponsive participation, cost implications, adverse language barriers, which required one to have a translator and the harsh reception received from various departments within the company.
In my own opinion, I would highly recommend citizens to acquire health cover with Daman as it is ranked the United Arab Emirates chief health insurer and in addition the company is service oriented as opposed to other profit-oriented private insurance companies.
To ensure an effective evaluation, one must capitalize in planning, sum up materials analysis with summative pretest adequately use fellow students and volunteers and internal resources.
REFERENCES
‘Daman Asset Management Funds continue to outperform benchmarks’ (2010) Retrieved November 21, 2012, from http://www.ameinfo.com/news/Company_News/D/Daman_Asset_Management/Daman (n.d.). Retrieved November 21, 2012, from http://www.damanhealth.aeDaman (n.d.). Retrieved November 21, 2012, from http://www.damanhealth.ae/eDamanApp/en/home/index.html?version=R110.12.12‘HCT Partners with Daman to develop new cadre of health insurance professionals’ (2012). Retrieved November 21, 2012, from http://www.ameinfo.com/hct-partners-daman-develop-cadre-health-316607Agamy, M. E. (2009). Daman Evaluation Standards- Initiative to Give Quality Health Care. Retrieved November 24, 2012, from http://www.google.co.ke/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CDEQFjAA&url=http%3A%2F%2Fwww.damanhealth.ae%2FeDamanApp%2Fen%2FPDF%2FEventsCampaigns%2FRegionalConference_Ezzat.pdf&ei=AS2xULb7GIinrAfVo4DACw&usg=AFQjCNFNMbxO9uqB9eflSffgzf3jyAFt3QFrost, S. (2010). Importance of Health Care Insurance. Retrieved November 24, 2012, from http://www.livestrong.com/article/127278-importance-health-care-insurance/UAE Interact. (2008). DNRD unveils the new ‘Traveller Health Insurance Policy’ for visitors to the UAE. Retrieved November 24, 2012, from http://www.uaeinteract.com/docs/DNRD_unveils_the_new_Traveller_Health_Insurance_Policy_for_visitors_to_the_UAE/31537.htmUAE Interact. (2011). Newborns are now automatically covered under Daman’s Enhanced Plans. Retrieved November 24, 2012, from http://www.uaeinteract.com/
Rohte. S. (2012)6th Middle East Healthcare: Insurance Conference Dubai. Retrieved November 24,2012 from http://www.google.co.ke/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&ved=0CEQQFjAD&url=http%3A%2F%2Fwww.damanhealth.ae%2FeDamanApp%2Fen%2FPDF%2FWhitepaper%2F121007_Daman_Success_Factors.pdf&ei=TqexUIOfL62b1AW624DwCA&usg=AFQjCNGtj4AnOHjcDElwdv8zZFJM8wn_HgAPPENDICES
1. PROFIT CHARACTERISTICS
27717753581402466975358140172402535814019431003581401200150358140030023001840
103822521082053340021082002000
280
442912541402042100504140203638550393700326707539370280180
NRP Loading insurance claimsOPEX profit
premiums
• NRP raised by 1% to 20 AED resulting to 11% profit
• admin loading increased by 1% to 3 AED resulting to (2%) profit • OPEX decreased 1% to 2.8 AED triggering a (2%) profit
• claims lowered by 1% to 18.4 AED initiating a 10% profit
2. EXPERIENCE
Number Experience
68,000 clients who stopover Daman branches every month
35 outlets and service centers clients can seek services across the UAE
298 staff attending to clients in Daman branches and corporate offices
156,000 Average number of members registered every month in Daman retail and corporate outlets
1,600,000 claims administered by Daman every month
430 claims processing employees working at Daman
5,100,000 AED average sum of individual re-imbursements unconfined each month
81,000 Requests of sanction approvals acknowledged each month
190,000 Number of membership cards processed each month
40,000 Number of calls per month received by the daman contact center
98 % Rate of customer problems and concerns resolved with the first call.
4 Total times Daman was honored with the Corporate Social Responsibility Award by the insurance industry. From 2008-2011
5 Number of times Daman was elected by the insurance industry as the ‘Health Insurer of the Year’. From. From 2007- 2012
3. SERVICES OFFERED
NATURE EXPLANATION/TYPE
Billing A billing rule defines the minimum requirements to make a claim for a Daman beneficiary in terms of regularity and duration Billing rules exist for Long Term Care, General Ophthalmological Services, Injections, Infusions and Hydrations, Nebulization, Obstetrical Ultrasounds, Cardiac Catheterization and Coronary Angiography, Vaccination Administration and Wound Care Management.
Medical coverage Coverage of treatment of Common Cold, treatment and prevention of Flu, Vitiligo & Other Dyschromias, Strabismus Surgery, Strabismus Surgery, Hemodialysis, LASIK, Obesity & Morbid Obesity, Allergy Tests & Desensitization, Acne, Alopecia, Nocturnal Enuresis, polycystic Ovarian Disease, Antenatal Care & Screening, Daycare Procedures, Keratoconus, Echocardiography, Septoplasty
Pharmaceutical coverage Coverage in Neurobion, Growth Hormone, Montelukast, Statins, Clopidogrel, Proton Pump Inhibitors and Anti-Tumor Necrosis Factor Alpha.
Products Coverage of Hepatitis B and C, breast Reconstruction Post-Mastectomy, Dental Coverage of Orthodontic, General Examination, Orthodontic Specific Examination, Dental Examination and Dental Radiographs,
4.INTERVIEW QUESTIONNARE
1.Rate the services of daman insurance company
[poor][ good][ very good][ average] [ above average][Excellent].
2. Since the first time you experienced daman, has your knowledge on the services they offer intensified?
[yes][no]
3. Ask to make changes on the current services offered, what would you change?
4. Would you refer other persons to daman or other insurance companies?
5. What is your general view on the premium rates of daman?
6. Do you own a health card? [yes] [no]
7. Describe to me how your encounter with the daman staff was.
4.MEMBERSHIP DEPLOYMENT JULY 2006-2011
KEY:
Basic-
•Monthly total salary package less than or equal to 5,000 AED housing included.
•a Daman only service with 600 AED annual premiums.
• Abu Dhabi government is the only risk carrier
Cover is fully reinsured until 2016
Enhanced:
•wide range of benefits and territorial coverage restrictions
• Daman is the risk carrier while MunichRe reinsures
Thiqa:
•particularly for UAE Nationals
•Abu Dhabi Department of Finance is the only risk carrier
