Oman’s Private Firms and Health Insurance: What Drives Coverage?

Oman’s private companies are beginning to adopt a new digital health‑insurance system called Dhamani. The system is required by a capital‑market rule issued in 2019. Full implementation started in 2025, so researchers needed to know how ready employers were before the change. A survey of 222 firms was carried out using a method that picks firms by size and sector. The study aimed to see how many firms already offered insurance, what factors mattered, and whether a firm’s resources explained the link between size and coverage.

The overall rate of formal insurance provision was 36.5 percent, with a confidence interval that ranged from 30.2 to 43.1. Very small firms offered insurance in only about 11 percent of cases, while large firms did so in roughly 81 percent of cases. The analysis showed that a firm’s organisational resource capacity was the strongest independent predictor, with an adjusted odds ratio of about 31.5. The indirect effect of firm size on coverage through this capacity accounted for about 30 percent of the total relationship.

The statistical model performed well, with an ROC AUC of 0.88 and a Hosmer‑Lemeshow p‑value of 0.45, indicating good discrimination and acceptable calibration. After adjusting for the fact that micro‑enterprises were over‑sampled, the weighted estimate of coverage dropped to 21.9 percent (95 % CI 17.0‑6.8). When firms said they did not provide insurance, the most common reasons were the lack of a legal requirement (about 52 percent) and the high cost of premiums (about 50 percent).

The findings suggest that a step‑by‑step rollout focusing first on larger firms could ease the transition. Offering subsidies for premiums may help smaller companies join the system. Policymakers can use these results to design support programs that raise organisational capacity and lower cost barriers, ensuring broader coverage as Dhamani expands.