MENA Medical Device Reimbursement & Health Insurance: Saudi CHI, UAE Daman, Turkey SGK & Regional Systems (2026)

Why Reimbursement Understanding Is the Missing Link in MENA Market Access

Most medical device manufacturers entering the MENA region focus on regulatory registration — securing SFDA MDMA, UAE EDE, or Turkey TITCK approval. But registration alone does not guarantee patient access. Understanding how devices are reimbursed — which insurance systems pay, at what rates, through which procurement channels, and under what coding structures — is what separates commercially successful market entries from those that secure a registration certificate but never achieve meaningful sales.

The MENA region presents a particularly complex reimbursement landscape. Unlike the EU (where DRG systems are relatively standardized) or the US (where CMS coverage decisions set a national floor), MENA countries operate fundamentally different healthcare financing models:

• Saudi Arabia is transitioning from fee-for-service to value-based care using AR-DRG and the NPHIES platform
• The UAE has mandatory private health insurance with different systems per emirate (Daman/Thiqa in Abu Dhabi, DHA in Dubai)
• Turkey uses SGK SUT codes with centralized DMO procurement that can create price gaps between reimbursement and purchase prices
• Israel operates a national Health Basket updated annually through cost-benefit analysis
• Egypt is rolling out a universal health insurance system governorate by governorate through 2032

This guide provides the first comprehensive, country-by-country breakdown of medical device reimbursement across these five key MENA markets, with specific data on coding systems, payment mechanisms, co-payment structures, and practical market access strategies.

Saudi Arabia: Value-Based Healthcare Transformation Under Vision 2030

Healthcare Financing Structure

Saudi Arabia's healthcare system is undergoing its most fundamental restructuring since the introduction of cooperative health insurance. The Council of Health Insurance (CHI) — formerly the Council of Cooperative Health Insurance — regulates the mandatory health insurance market, overseeing both cooperative health insurance companies and health insurance claims management companies. Saudi Arabia's medical device reimbursement market generated $4.72 billion in revenue in 2024 and is projected to reach $7.92 billion by 2030, growing at a 9% CAGR (Grand View Research).

The system operates through multiple interconnected platforms:

Component	Entity	Function
Insurance regulator	Council of Health Insurance (CHI)	Supervises insurance companies, sets policy
Claims platform	NPHIES	Electronic health information exchange, eClaims
Procurement	NUPCO	Centralized government procurement of devices
Coding system	AR-DRG v9.0	Inpatient case-based payment classification
Billing system	Saudi Billing System (SBS)	Standardized code set for all CHI participants
Health records	Sehhaty app	Patient-facing national health platform

NPHIES and AR-DRG Implementation

The National Platform for Health Information Exchange System (NPHIES), launched in 2021, is the backbone of Saudi Arabia's digital health insurance ecosystem. It integrates electronic health records, claims processing, and insurance verification across the entire system. NPHIES facilitates:

1. Eligibility verification — real-time confirmation of insurance coverage
2. Pre-authorization — prior approval for specified procedures and devices
3. Clinical coding — ICD-10-AM, ACHI, and AR-DRG code assignment
4. eClaims submission — electronic claim processing to insurance payers
5. Claim adjudication — review for accuracy, medical necessity, and policy compliance
6. Payment and remittance — Explanation of Benefits (EOB) issuance

Saudi Arabia adopted the Australian Refined Diagnosis-Related Group (AR-DRG) version 9.0 as its inpatient classification and payment system, transitioning from pure fee-for-service to case-based payments. The AR-DRG system classifies hospital admissions into clinically meaningful groups with expected resource consumption, enabling standardized reimbursement across providers. DRG version 9.0 is currently used for reporting all admitted care encounters, including inpatient and daycare services.

Value-Based Healthcare Roadmap

The CHI published a Value-Based Health Care (VBHC) White Paper outlining a phased transition:

• Phase 1 (completed): Introduced patient classification systems, data standards, clinical coding systems (ICD-10-AM, ACHI, AR-DRG), and NPHIES with Minimum Data Set (MDS) standards
• Phase 2 (in progress): Identifying and segmenting the CHI population, measuring clinical outcomes through NPHIES data, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs)
• Phase 3 (planned): Quantifying the financial value of rendered services, generating relative resource weights, and benchmarking
• Phase 4 (planned): Launching bundled payment models capitalizing on the data infrastructure

The CHI's 100 million insurance transactions milestone has significantly propelled the Kingdom toward full AR-DRG implementation. In July 2024, the SFDA issued its first Economic Evaluation Studies (EES) guidelines, with phased implementation through July 2025, requiring cost-effectiveness evidence for pharmaceutical pricing — a framework likely to extend to high-cost medical devices.

Mandatory Health Insurance and Coverage

All private-sector employers in Saudi Arabia are legally required to provide CHI-compliant health insurance for employees and dependents. Key requirements include:

• Insurance validity is checked in real-time during issuance or renewal of residency permits (Iqama)
• Insurance companies must be licensed by the Insurance Authority and accredited by CHI
• Employers cannot deduct insurance premiums from employee salaries — the cost must be fully borne by the sponsor
• Strict timelines for claim approvals and reimbursements are enforced

Premium ranges reflect the market's stratification:

Coverage Level	Annual Premium Range (SAR)	Approximate USD
Local CHI-compliant plan	1,800 – 5,000	$480 – $1,333
Mid-tier plan	5,000 – 12,000	$1,333 – $3,200
International IPMI plan	12,000 – 25,000+	$3,200 – $6,666+
Policy aggregate limit (standard)	500,000 – 1,000,000	$133,333 – $266,667

Co-insurance levels range from 0% to 20%, capped per visit.

NUPCO Government Procurement

For devices sold to government hospitals, NUPCO (National Unified Procurement Company) serves as the centralized procurement body. NUPCO's annual procurement exceeds SAR 25 billion across 400+ public healthcare facilities, with the government tender market valued at SAR 21 billion. NUPCO manages the procurement of medicines, devices, and medical supplies for all MOH hospitals and health centers through framework agreement tenders.

Key procurement realities in 2026:

• Localization enforcement: NUPCO is rejecting foreign bids when local alternatives exist, enforcing the "Made in Saudi" prioritization
• Digital marketplace: Launched in Q1 2025 for private clinics and SMEs
• AI-powered demand forecasting: Deployed for predictive inventory management
• Insurance integration: Connected to NPHIES for claims processing

Implications for Device Manufacturers

For medical device companies targeting Saudi Arabia:

1. Dual-channel strategy: Government sales require NUPCO tender participation; private-sector sales require insurance coverage through CHI-accredited payers
2. Coding alignment: Ensure your devices map to AR-DRG codes and SBS billing categories — uncoded devices face reimbursement barriers
3. Evidence generation: The VBHC transition means value-based evidence (clinical outcomes, cost-effectiveness) is increasingly required
4. Local presence: "Made in Saudi" prioritization in NUPCO tenders makes local manufacturing or assembly commercially advantageous

UAE: Mandatory Multi-Tier Insurance Across Emirates

Healthcare Financing Structure

The UAE operates a mandatory health insurance system, but implementation differs across emirates:

• Abu Dhabi: The Thiqa program (administered by Daman) provides comprehensive coverage for UAE nationals, while expatriates receive employer-mandated private insurance
• Dubai: The Dubai Health Insurance Law mandates employer-provided insurance, with the Dubai Health Authority (DHA) overseeing the system
• Northern Emirates: As of January 1, 2025, a new Basic Health Insurance Scheme extends mandatory coverage to private-sector employees and domestic workers across Sharjah, Ajman, Fujairah, Ras Al Khaimah, and Umm Al Quwain

The complexity of the UAE market is amplified by the fact that more than 60 insurance companies serve a population of approximately 9.3 million, each maintaining separate formularies and coverage decisions. Each emirate has its own formulary drawn by separate pharmacy and therapeutics committees, and the overall process of allocating reimbursement codes is not streamlined — with inconsistency among payers and providers in approving and reimbursing new technologies. For device manufacturers, this fragmentation means navigating multiple parallel insurance ecosystems rather than a single national pathway.

The GCC health insurance market wrote gross premiums of approximately $18–19 billion in 2023, with the UAE and Saudi Arabia accounting for over 80% of total gross written premiums. Health insurance represents 45–50% of total insurance GWP in the GCC, growing at a CAGR of 10–15%.

Abu Dhabi: Daman and Thiqa

Daman (National Health Insurance Company), owned by Abu Dhabi Developmental Holding Company (PureHealth Group), is the UAE's largest health insurer and the sole administrator of the Thiqa program for UAE nationals.

Plan	Population	Coverage	Key Features
Thiqa	UAE nationals (Abu Dhabi)	Comprehensive	Government-subsidized, full medical coverage, no out-of-pocket for most services, nationwide network
Thiqa Top-Up	Thiqa members	Supplementary	Up to AED 20 million annual limit, elective procedures, worldwide coverage
Individual/Family	Expatriates	Variable	Inpatient, outpatient, maternity, emergency
Flexi Health	Budget-conscious	Basic	Abu Dhabi network clinics, in-network hospital emergency
Essential Benefits	Low-income workers	Basic minimum	Employer-mandated minimum coverage

For UAE nationals under Thiqa, many services are fully covered with no out-of-pocket costs. The program provides access to a large network of public and private healthcare providers.

Northern Emirates Basic Plan (2025)

Effective January 1, 2025, the Ministry of Human Resources and Emiratisation introduced the Basic Health Insurance Scheme for private-sector employees and domestic workers in the five Northern Emirates:

Feature	Details
Annual premium	AED 320 (~$87) per year
Medication co-payment	30%, capped at AED 1,500 annually
Outpatient co-payment	25%, maximum AED 100 per visit
No co-payment	Follow-up visits for same condition within 7 days
Network	7 hospitals, 46 clinics, 45 pharmacies
Purchase channels	Dubai Insurance, accredited companies, Insurance Pool website

This scheme is a prerequisite for issuing or renewing residency permits, creating a significant new market for medical devices consumed in primary and secondary care settings.

Daman Published Rates and Reimbursement

Daman maintains published rate schedules for both network and non-network services. Examples of reimbursement rates for hospital services:

Service Category	Rate (AED)
Operating room — minor surgery	500
Operating room — first hour	1,600
Operating room — additional 30 min	450
Catheterization lab	1,600
Delivery room	1,300
Day stay — medical case	578
Day stay — surgical case	1,700
ICU per diem (days 4–8)	1,250
Short stay per diem	375

Market Access Strategy for the UAE

For medical device manufacturers:

1. Emirate-specific approach: Registration with EDE is national, but reimbursement pathways differ by emirate — Abu Dhabi (Daman/DOH), Dubai (DHA), and Northern Emirates (basic scheme)
2. Insurance coding: Work with insurers to ensure your device has appropriate coverage categories in their benefit schedules
3. Free zone advantages: 100% foreign ownership in DHCC (Dubai Healthcare City) and other free zones simplifies commercial presence
4. Daman coverage inclusion: Securing coverage under Daman's largest-in-UAE network provides access to the widest patient population

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Turkey: SGK SUT Codes and Dual-Price Procurement

Healthcare Financing Structure

Turkey's healthcare system is primarily funded through the Social Security Institution (SGK), which provides universal health coverage. Medical device reimbursement is governed by the Health Implementation Communiqué (SUT), which defines covered services, procedures, and devices through specific SUT codes.

The system involves two separate but interconnected pricing mechanisms:

1. SGK reimbursement prices — set through the SUT by the Reimbursement Commission
2. DMO procurement prices — set by the State Supply Office (DMO) through centralized e-procurement for public and university hospitals

This dual-price structure creates a critical tension: when DMO purchase prices exceed SGK reimbursement levels, hospitals face a funding gap that can limit device adoption.

SUT Code System and Barcode Matching

SUT codes are the backbone of Turkey's medical device reimbursement system. Each medical procedure, treatment, and device is assigned a specific code used for:

• Billing health services to SGK
• Determining reimbursement levels
• Standardizing care classification across healthcare institutions

A critical requirement is SUT Code–Barcode Matching — a mandatory process that associates each medical device's barcode with its corresponding SUT code. Products without SUT code or barcode matching cannot be purchased by hospitals and health institutions and cannot participate in the SGK reimbursement system. Device manufacturers, importers, and distributors must complete this matching process to achieve market access. Incorrect or incomplete applications can delay or prevent inclusion in the reimbursement system entirely.

The Reimbursement Commission periodically updates the SUT. Key recent changes include:

• May 2024 SUT update: Three new MedTech field codes introduced (FAST Ultrasonography, transcutaneous pacemaker application, critical patient bed and follow-up in emergency department), with reimbursement fee increases of 5% to 100% depending on device category
• January 2026 update: New medical device codes added, clearer committee approval rules for high-risk cardiovascular and orthopedic implants, updates across Annex-2, Annex-3, and Annex-4 impacting cardiology, gastroenterology, orthopedics, spine, and dental procedures
• December 2025: SGK announced an additional 110 billion TL funding for reimbursed health services, with targeted increases for the most critical services

Pricing and Procurement

Turkey's Ministry of Health Pricing Commission and SGK jointly manage medical device pricing. For a medical device to receive reimbursement, the manufacturer must apply to SGK for listing on the SUT reimbursement list. The Medical and Economic Evaluation Committee (TEDK) reviews submissions, evaluating clinical and cost-effectiveness data. TEDK's decisions are submitted to the Reimbursement Committee, and upon final approval, devices are included in the reimbursement list and published in the Official Gazette. Unlike pharmaceuticals, medical device prices are not individually regulated — instead, the SUT defines a maximum reimbursement price for each device category.

Turkey also uses reference pricing against a basket of EU countries and applies a fixed Euro conversion value (periodically adjusted) for translating EU prices into TRY for reimbursement and price caps. Alternative reimbursement agreements — discounts, price-volume deals, portfolio and value-based agreements — have been available since 2016 for high-budget-impact and innovative therapies.

In January 2026, SGK updated its euro-based price list for foreign-origin medicines and medical devices, with pricing effective from January 17, 2026. Products not produced domestically or facing supply shortages continue to be reimbursed under health insurance at approved euro-based prices.

Market Access Strategy for Turkey

1. SUT code registration: Ensure your device has an applicable SUT code — without one, public hospital reimbursement is not available
2. DMO tender participation: For public hospital sales, registration in DMO's Health Market e-procurement system is essential
3. Local manufacturing: Domestic production receives pricing preferences and avoids euro-based pricing volatility
4. Price gap navigation: Monitor the spread between DMO procurement and SGK reimbursement prices to identify commercially viable product categories
5. Invoice compliance: The updated Technical Guide on Invoices for Medicines and Medical Devices (effective October 1, 2025 for distributors, October 1, 2026 for pharmacies) introduces new e-invoice requirements with GTIN, batch number, and serialization data

Israel: The Health Basket System

National Health Insurance Framework

Israel's healthcare system is governed by the National Health Insurance Law of 1994, which provides universal coverage through four non-profit health maintenance organizations (HMOs): Clalit, Maccabi, Meuhedet, and Leumit. Every resident must enroll in one of these HMOs, which provide an identical basic Health Services Basket (Sal HaBriut).

The Health Basket defines the full range of medical services, medications, equipment, and devices to which all insured individuals are entitled. The basket is updated annually through a structured process:

• A public committee evaluates candidate technologies based on clinical benefit and cost-effectiveness
• The committee completes its work toward the end of each calendar year
• The government formally approves the list, effective from the start of the following year
• Implementation by HMOs may take several months, but coverage is applied retroactively

2026 Health Basket Update

In March 2026, the Israeli government approved the latest Health Basket expansion:

Metric	Value
Items added	650 medicines and technologies
Total cost	86.45 million NIS (~$23.5 million)
Beneficiaries	~107,000 people
Annual budgetary addition	~9–10 billion NIS (all adjustments combined)
Technological adjustment	~0.5 billion NIS for new technologies
Cost-of-living adjustment	~1.1 billion NIS

Notable 2026 basket additions include weight-loss medication for adolescents aged 12–18, advanced cholesterol-lowering drugs for secondary prevention, expanded pulmonary rehabilitation eligibility, and new treatments across multiple therapeutic areas.

Pricing and Reimbursement for Devices

Medical device prices in Israel are not controlled — unlike pharmaceuticals, there is no mandatory price regulation. However, inclusion in the Health Basket provides state-subsidized distribution through HMOs. The pathway for device manufacturers:

1. Regulatory registration with the Ministry of Health (AMAR) is prerequisite
2. Health Basket application to the public committee with clinical and economic evidence
3. Cost-benefit analysis comparing the device against existing alternatives
4. Government approval following committee recommendations
5. HMO distribution through the four health funds

For devices not in the Health Basket, patients may request individual reimbursement consideration by healthcare providers, who evaluate medical necessity, lack of alternatives, and clinical justification on a case-by-case basis.

HMOs also offer complementary insurance (Section 10 of NHIL) covering services beyond the basic basket, including medical equipment, limited medications, transplants abroad, and private physician choice.

Egypt: Universal Health Insurance System Rollout

UHIA Framework and Timeline

Egypt is implementing the Universal Health Insurance System (UHIS) under Law No. 2 of 2018, mandating coverage for all citizens in a phased rollout through 2032. The system is managed by the Universal Health Insurance Authority (UHIA), which serves as the single payer.

Phase	Governorates	Status
Phase 1	Port Said, Ismailia, Suez, South Sinai, Luxor, Aswan	Operational since 2018
Phase 2–6	Remaining governorates	Progressive rollout through 2032

Egypt's health budget reached 245 billion EGP in fiscal year 2025–26, though this represents only about 1.1% of GDP — below the constitutional mandate of 3%. The broader National Health Strategy 2024–2030 targets 85% insurance coverage by 2026/27 and renovation of 520 healthcare facilities.

Pricing and Reimbursement Mechanism

UHIA finalized its sixth edition of the service price list effective January 1, 2026, covering 3,476 medical services. Pricing uses two methodologies:

• Cost-Plus Method (63.2% of services): Calculating 14 different cost elements for each service
• Market Comparison (36.7% of services): Benchmarking against 13 major medical entities across public, private, and military sectors

Co-payment structures under UHIS:

Service	Co-Payment
Home visit by doctor	EGP 100
Medications	10% (max EGP 1,000; reaching 15% by year 10)
Chronic disease medications	No co-payment
Cancer treatment	No co-payment
Radiology and imaging	10% (max EGP 750 per episode)
Internal medicine (non-chronic)	5% (max EGP 300 per visit)

All co-payment lump sums increase by 7% annually, including adjustments tied to the national minimum wage.

Drug Formulary and Technology Assessment

The UHIA Drug Formulary was updated in October 2025, adding 59 new generic names to bring the total to 4,796 medications. The Egyptian Authority for Unified Procurement (UPA) is developing HTA capabilities, with a pharmaceutical value dossier submission template for companies to submit economic and clinical evidence. When UHIA becomes the single payer, UPA and UHIA will collaborate:

• UPA conducts cost-effectiveness assessments
• UHIA analyzes budget impact based on covered population
• A scientific committee of health economists and clinical researchers reviews evaluations
• HTA recommendations guide price negotiations for procurement and reimbursement

Market Access Strategy for Egypt

1. UHIA registration pathway: As the system expands, inclusion in UHIA's formulary and price list becomes the primary route to patient access
2. UPA value dossier: Prepare health economics submissions for the HTA process
3. Phase-timed entry: Target governorates already enrolled in UHIS (Phase 1) for initial market penetration
4. Private sector bridge: The large private hospital sector (1,100+ hospitals) provides an immediate commercial channel while UHIS scales
5. Local manufacturing opportunity: Egypt imports approximately 90% of its medical devices, creating incentives for local production

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Regional Comparison: Reimbursement at a Glance

Feature	Saudi Arabia	UAE	Turkey	Israel	Egypt
Insurance model	Mandatory private + government	Mandatory private (per emirate)	Universal SGK	Universal (4 HMOs)	UHIS rollout (2018–2032)
Primary payer	CHI / NUPCO	Daman / DHA / insurers	SGK	HMOs + state	UHIA
Coding system	AR-DRG v9.0, SBS	CPT-based	SUT codes	Not standardized nationally	UHIA price list (3,476 services)
Claims platform	NPHIES	Various (ISAHD, iPROMeS)	SGK electronic	HMO internal	Developing
Device reimbursement market	$4.72B (2024) → $7.92B (2030)	Part of $18–19B GCC premiums	110B TL additional funding (2025)	86.45M NIS basket addition (2026)	245B EGP health budget (2025–26)
VBHC adoption	Advanced (AR-DRG, bundled payments)	Early stage	Growing openness	Cost-benefit for basket	HTA capability building
Key challenge	NUPCO localization requirements	Fragmented by emirate	SGK-DMO price gap	Annual budget constraints for basket	Slow rollout, low GDP allocation

Strategic Recommendations for Device Manufacturers

1. Build Reimbursement Evidence, Not Just Regulatory Dossiers

The trend across MENA is unmistakable: payers want evidence of value, not just safety and efficacy. Saudi Arabia's EES guidelines, Israel's cost-benefit basket analysis, Turkey's structured SUT code updates, and Egypt's emerging HTA framework all demand clinical outcomes data and cost-effectiveness evidence. Device manufacturers should invest in HEOR (Health Economics and Outcomes Research) capabilities for the region.

2. Navigate the Dual-Channel Reality

Most MENA markets have separate government procurement and private insurance channels. In Saudi Arabia, NUPCO and CHI operate different purchasing mechanisms. In Turkey, DMO and SGK create a dual-price structure. Manufacturers need pricing and distribution strategies that account for both channels without undermining either.

3. Prioritize Coding and Classification

Ensure your devices are mapped to the relevant coding systems — AR-DRG in Saudi Arabia, SUT codes in Turkey, CPT codes in the UAE, and the UHIA price list in Egypt. Devices without appropriate codes face reimbursement barriers regardless of regulatory approval status.

4. Plan for Localization

Saudi Arabia's NUPCO is enforcing "Made in Saudi" preferences in tenders. Turkey favors domestically produced devices in its pricing framework. Egypt imports 90% of its devices and offers incentives for local manufacturing. Localization strategies — from full manufacturing to final assembly or packaging — increasingly determine commercial success.

5. Time Market Entry to Insurance Expansion

Egypt's UHIS rollout creates windows of opportunity as each governorate phase activates. The UAE's Northern Emirates basic insurance scheme (effective January 2025) opens a new market segment. Saudi Arabia's VBHC Phase 2–3 implementation will redefine device valuation. Aligning market entry with these expansion milestones maximizes early-mover advantage.

Key Takeaways

• Saudi Arabia's medical device reimbursement market is the region's largest at $4.72B, transitioning to AR-DRG value-based payments through NPHIES
• UAE mandatory insurance now covers all seven emirates, with the Northern Emirates basic plan (AED 320/year) creating new demand
• Turkey's dual SGK/DMO pricing structure requires careful navigation of the reimbursement-procurement price gap
• Israel's Health Basket system updates annually through rigorous cost-benefit analysis — 650 items added in 2026 at 86.45M NIS
• Egypt's UHIS is expanding governorate by governorate through 2032, with 3,476 services priced and 4,796 medications covered
• Across all MENA markets, evidence of clinical value and cost-effectiveness is becoming essential for reimbursement