About Allied Doctors

Allied Doctors is a Third Party Administrator Company. Established in June 2000 to administer medical policies for Insurance Companies or Self-Funded schemes. The Company is owned by Dr. Mohsen M. Helmy one of the pioneers of medical insurance business in the Arab world.

Presently, the Company has the largest adherent's numbers in Egypt, around 100,000 participants either as group or individually insured. Also we entered the field of self-funded schemes for large corporations as The National Societe Generale Bank (NSGB) , The Blom Bank of Egypt, Ernst & Young and Minapharm.

Allied Doctors has developed medical and financial auditing software that is able to manage and audit electronically the medical schemes. Currently we manage 100 clinics in Egypt's 29 governorates.

Allied Doctors medical team is formed by 250 field doctors, 11 medical supervisors, 6 Information Technology experts, 20 Auditors and 13 among office managers. Our financial Auditing firm is Ernst & Young which can provide a detailed financial structure of the Company.
As a service company, Our paid capital is 1,000,000 LE and our due-diligence is worth around 30,000,000 LE.

Mission and Vision

The main objectives can be summarized for the auditing system and the financial and medical departments for healthcare systems as follows:

  • Providing a complete procedural medical manual to act as a comprehensive guide to the physician in the treatment process to ensure the quality of the process and therapeutic compliance to the specifications of the medical world.
  • Full control of the medical services provided, to ascertain the rate of appropriate services for diagnosis and making sure that no exchanging or transferring any redundant services and unsolicited scientifically.
    Full control of the prices of medical services and make sure they conform to the contracted price lists.
  • Full control of the overall cost of medical services.
    Ability to issue all analytical reports to evaluate the performance of doctors and service providers, and reports of price preference to all service providers.
  • Ability to issue payment orders and checks very accurately in a short time (currently being reviewed invoices entirely by 45.000 bills within 10 days).
    The practicality of applying scientific therapeutic strategy for all medical diagnoses and issuing reports to evaluate the therapeutic efficiency of this strategy periodically. And through the achievement of these goals, ensuring the level of medical service performed within Allied Doctors clinics or within the hospitals and the contractor and to ensure the stability of this level, as well as the ability to issue payment orders for the service providers accurately and quickly which reflects on the performance of service providers and their dealings with the participant.

Medical History Registry:

The ability of registering the full medical history for the participant making it available Securely Online for the patient through username and password Or to the treating doctor during the medical checkup, which would positively identify the optimal course of treatment for the patient, which means securing a high level of health care management of the participants on the basis of accurate science. As well as the ability of accessing statistical data for finite precision on the health status of employees or subscribers, which represents significant support of administrative decisions on the health and also the ability to provide counseling and advice to the department regarding the health of employees and how to improve it.


Organization Chart

                   COB

DR Mohsen Mostafa Helmy

 

Exec. Manager

IT Director

Medical Director

Financial Director

Mr.Hamdy Abbas

Eng.Aysam Salah

Dr.Sherfi Etreby

Mr.Mohamed Gouda

Board Member

Board Member

Board Member

Board Member

Word of Chairman

Health Insurance Present and Future Views

The deterioration in the medical services of the National Insurance Organization has imposed the hopeful changes included in the President's Election Program. We have been calling for years for the necessity of taking scientific, administrative and financial steps to reform the healthcare insurance services that became inappropriate for the vast majority of its adherents.
We are going to determine some areas of deficiency in an attempt to finding practical solutions for them.

First: The Primary Care Services:

They mean the treatment services at the level of: General practitioner or family physician, specialist, out patient pharmacy, laboratory centers, radiography, physical therapy, endoscopies, etc.) it is also called the treatment outside hospitals.
This coverage costs about 50% of the total treatment expenses. There are several problems facing offering the primary care services (outside hospitals) and at all levels:

1-The General Practitioner or The Family Physician:
He is supposed to be capable of diagnosing and treating most of the cases and he should refer to the specialist or consultant anything that exceeds his capabilities and scientific training. In fact, the matter is completely different, as the General Practitioner is considered incapable of taking any medical decision and he should always resort to transferring patients to a more superior level such as a specialist or consultant. This is considered one of the common mistakes, as the general practitioner in the civilized countries is considered the most efficient physician and the most able for diagnosing and treating his captive registered population, due to his full knowledge of their medical and treatment history and he is the only one who has a complete medical file for his patients. But is this our reality? "Absolutely NOT", there is a great deficiency in training and preparing this important element in the medical services system and the officials should find the appropriate training and vocational programs.

2-The Specialist or Consultant:
The out-patient problems are supposed to end at this level of scientific training and practical experiences. It is supposed that he is able to reach the initial diagnosis based upon the patient's complaint and an accurate clinical examination. But is this our reality? "Absolutely NOT", in most of the developed world, there are medical protocols followed by the specialist to reach the correct diagnosis, following specified protocols concerning each diagnosis dealt with. After confirming the diagnosis, the determined treatment pertained in these protocols is executed. And during our experience that has been extended for more than twenty years in the Health Insurance field and introducing the group healthcare management, we did not find anyone following protocols with defined framework and there is a lot of financial waste as a result of useless investigations.
3- The medical prescription:
This is a very exciting subject!!!!!! Regardless of its content, are we completely aware of what happens at the pharmacy level? We are sure that many of the pharmacy owners deal with the insured persons with the utmost vocational honesty and they dispense what is included in the referral note (prescription) accurately, But, there are also lots of pharmacies that deal on the basis of the in-kind and financial alternatives and this is apparent to everyone and announced most of the times. In my point of view, this crime is one of the main reasons for the inferiority of the medical services in Egypt, as it has exhausted the medical budgets over the years, and accordingly depleted the financial resources dedicated for the development and progress of the healthcare, therefore it could not cope with the greed and avarice of medicine thieves. This is also included under the item of "Personal Gain Culture" disregarding the "Social Benefits".
4- The treatment inside the hospitals:
Concerning the Health Insurance Organization hospitals, few are qualified to offer the medical care that ensures the best qualified teams, modern equipment, sterilization and methods of comfortable accommodation which are necessary and an integral part of the medical treatment. Since these medical establishments are not able to offer the service for the numbers that the new system wishes to cover, many of the insured population will resort to the private sector hospitals !!, In this case, there will be another type of illegal benefiting from medical services. We should go back to what is called "Treatment Protocols" where a group of investigatory and medico-surgical procedures appropriate to each case are included. But Is this is our reality? "Absolutely not", we as medical schemes administrators, we handle over a thousand hospital invoices per month. I must say some of these invoices can be considered as "a disgrace to the medical society". The medically insured patient is never aware of the details of his hospital bill, that he never sees anyway, and if he was to pay his expenses, or part of it, he would have thoroughly revised his medical invoices and never agreed to the medical nonsense performed by many private hospitals that consider the insured patient as a financial prize in the form of a facts-ignoring patient. Please, Include this under the Item of" Personal Gains Culture" disregarding the social benefit.
Secondly: Medical Systems" Management:
The actual administrative reality of the Health Insurance Organization is sorrowful, and here, we should find excuses for those who are responsible for managing the scheme; if we made a flashback remembering the project start-up and the few participants numbers (few thousands) which increased until it included more than fifty million beneficiaries, we find that the administrative discipline and logic did not cope with the additional burdens with the great increase of the insured numbers. Those who are responsible for the project should have realized the uselessness of the manual system for supervising and reviewing the medical services and they should have resorted to the systems and information technology as the western world did when it offered similar group schemes.
Statistically, about 3% of the number of beneficiaries will visit daily the out-patient clinics, as a result, there will be medical invoices estimated at more than one Million invoices daily spread all-over Egypt Governorates. Also, statistically, about 6% will have an in-patient services annually, meaning, three million hospital invoices annually, spread also all-over Egypt Governorates. Can the technical revision, medical performance assessment, and financial auditing of the price-lists contracted possible to be made manually, accurately and quickly?? Of Course not, But those who are responsible for developing the new system realized this administrative deficiency and they are undertaking the use of the great scientific progress in systems and information technology fields which 'facilitates and saves lots of effort, time and human resources involved in the supervision of this scheme.

Thirdly: Laws:
We have mentioned a lot "the personal benefit culture" Is there a solution? Yes, of course!, the beginning of the solution is education and starting from the first educational stages and in "Sociology" lessons, the Health Insurance is simply taught to consolidate the concept of how to deal with the collective systems and the duties that should be undertaken by the individual and his rights in a good quality medical service that he should not abandon. And this is the law of inserting the discipline as an educational subject. There is another law which is not less important which is "Criminalizing the illegal benefits from the medical services" and it is a law which prohibits the aforementioned such as the insured persons behavior, doctors, pharmacists and hospitals from illegal practices at the purpose of profiting from the medical system without scientifically justified grounds. I leave for the responsible judiciary authorities the right of writing the law draft and its applications, including restrictions and provisions so as to be submitted to the people assembly. We , as Allied Doctors Medical Systems administrators, has created a modern model of group Health Insurance management with the use of a state of the art information technology solutions that has enabled us, through the years , to acquire a leadership position in such a complicated field.
In Brief, we welcome the serious steps taken for reforming this vital sector and we are looking forward to reach the integration of a comprehensive administrative system for the management of the future Health Insurance umbrella with a defined coverage plan, not forgetting to issue the necessary laws that can protect this important industry.
Finally, It is only fair to criticize the society as we criticized those who are responsible for providing the medical schemes, as it is obvious that there is a destructive culture based upon the individual gains and uncaring for the financial and human resources invested in this vital sector.

Chairman
Dr. Mohsen Mostafa Helmy



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