Health insurance: 90-day plan to evaluate hospitals before renewal

In a strategic move aimed at enhancing the efficiency of the private healthcare sector, the Council of Cooperative Health Insurance (CCHI) announced the adoption of an advanced monitoring mechanism called the “90-Day Journey.” This mandatory timeline involves evaluating healthcare providers three months prior to the facility's official accreditation renewal date. This initiative is designed to ensure that healthcare institutions adhere to the highest standards of quality and efficiency within the “Daman” (Cooperative Health Insurance) program.

The context of health transformation and Vision 2030

These new measures align with the goals of the Kingdom’s Vision 2030 and the Health Sector Transformation Program, which aims to restructure healthcare services to be more comprehensive and effective. The role of the Council of Cooperative Health Insurance is no longer limited to financial and administrative regulation; it has expanded to include promoting “value-based healthcare,” a global model that focuses on the quality of medical outcomes and improved patient health relative to cost, rather than the traditional focus on the quantity of services provided.

Details of the evaluation trip: Three crucial stops

The council explained that the new mechanism divides the period preceding renewal into three precise and well-defined time phases:

• The first month (self-assessment and leadership): The journey begins by obligating the facility to appoint a “assurance ambassador,” who must be the facility’s chief executive, to take over the leadership and direct supervision of the self-assessment processes and the submission of compliance documents, reflecting the council’s seriousness in linking quality to the highest administrative level in the hospital.
• The second month (field monitoring): The process shifts from office procedures to field operations, where a team of council assessors conducts scheduled and rigorous inspection visits. These visits aim to monitor operational realities and issue detailed reports that reveal strengths and weaknesses in technical and administrative performance.
• The third month (classification and deduction): This is the decision-making stage, where the council issues its final classification of the facility based on the previous data, accompanied by binding corrective plans that must be implemented before approval of accreditation renewal.

The importance of the “guarantee ambassador” and the expected impact

The council linked the success of this system to the extent to which the "Guarantee Ambassador" actively submits documentation proving the resolution of issues and the implementation of treatment plans. This approach carries significant implications for sector governance, placing hospital administrations under direct legal and ethical responsibility to improve performance.

This system is expected to contribute to cleaning up the market from non-compliant facilities and promoting positive competition among service providers, which will positively impact the end beneficiary (the patient) by providing them with safe, transparent, and sustainable health services that meet global standards.