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Implications of Artificial Intelligence for the Health Insurance Sector

The United Arab Emirates (UAE) is one of the fastest growing economies in the world, and healthcare is one of the main areas of investment for the UAE government. The UAE has been investing significantly in cutting-edge healthcare technologies, such as artificial intelligence (AI), to enhance the patient experience and reduce operational costs. AI is expected to have a significant impact on the healthcare insurance market in the UAE, revolutionising the way insurance companies operate and transforming the way healthcare is delivered to patients.

Meeting Patient Needs
AI has the potential to revolutionise the way insurance companies operate by enabling them to better customise coverage to individual patient needs. AI algorithms can analyse health data collected from various sources, such as wearables, medical records and insurance claims data, to identify patterns and predict the likelihood of medical conditions. This can help insurance companies more accurately to calculate risks and tailor policies to individual patient needs.

For example, AI can be used to identify high-risk patients who are more likely to develop chronic conditions such as diabetes or heart disease. Insurance companies can then offer these patients more comprehensive coverage that includes preventative care, such as regular check-ups and health screenings to reduce the likelihood of developing these conditions. This can benefit both the patient and the insurer by reducing healthcare costs over time and delivering better outcomes.

Fraud Prevention and cost reduction

AI can help insurance companies to improve their fraud detection capabilities. Medical insurance fraud is a significant problem in the UAE and is estimated to cost insurers millions of dollars each year. UAE authorities estimate that approximately 5% of claims paid fall into this category and are pushing up the cost of insurance premiums by between 20% and 30%. AI algorithms can analyse large amounts of data to detect patterns and anomalies that may indicate fraudulent activity. This can help insurance companies more quickly and accurately to detect and prevent fraud, delivering significant savings.

The technology can also help to streamline the claims process and reduce administrative costs for insurance companies. Traditionally, claims processing can be a time-consuming and resource-intensive process, involving manual review of medical records and other paperwork. However, AI-powered systems can automate much of this process by analysing data and automatically processing claims. This can reduce the time and cost involved in claims processing, enabling insurance companies to provide faster and more efficient service to patients.

Prevention leading to better outcomes
AI can help to improve the quality of care for patients by enabling more accurate diagnoses and personalised treatment plans. AI can analyse large amounts of health data to identify patterns and trends that may not be immediately apparent to human doctors. This can enable doctors to diagnose conditions earlier and more accurately, and to develop more personalised treatment plans based on the patient's individual health profile. This can lead to better health outcomes for patients and reduce the need for more expensive and invasive treatments in the future.

Systems can also enable insurance companies more effectively to manage risk by analysing data from a wide range of sources. For example, AI can be used to analyse data from wearables and medical devices to monitor patient health in real-time and to detect early warning signs of potential health problems. This can enable insurance companies to intervene early and provide preventative care to reduce the risk of more serious complications in the future.

AI and the law
The use of AI in connection with health insurance raises various legal and ethical questions and there is no specific law in the UAE that directly addresses these in this context. Existing laws such as the UAE Health Data law, the Federal Data Protection Law and the DIFC Data Protection Law all deal with the privacy implications of its use, with the issue of data subject consent being front and centre of the use of AI by health insurance companies. Digital Dubai has also implemented non-binding guidelines to provide a degree of regulation and guidance on the ethical development and use of AI, together with an AI system ethics self-assessment tool which encourages the development and use of AI in a responsible manner, promoting innovation while delivering human benefit.

The potential impact of AI on the healthcare insurance market in the UAE is significant. AI has the potential to revolutionise the way insurance companies operate by enabling them more accurately to predict risks, detect fraud, streamline claims processing, and personalise coverage to individual patient needs. AI can also improve the quality of care for patients by enabling more accurate diagnoses, personalised treatment plans and early intervention to prevent more serious health problems from developing. As such, provided that developers are careful when navigating the applicable legal and regulatory requirements, AI is poised to become a key driver of innovation in the healthcare insurance market in the UAE.

This article was written by healthcare lawyer James Clarke, and focuses on Artificial Intelligence in the Health Insurance Sector in the United Arab Emirates.

BSA is a regional Law Firm in the Middle East with offices in the UAE, Oman and Saudi Arabia. As a full-service law firm our practice areas include litigation, arbitration and corporate services, including M&A, banking & finance, Intellectual Property, TMT, Fintech, employment and insurance. 

Published on 15 June, 2023.

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