{
  "abstract": "Background\n\nEmployer mandates are a central mechanism for expanding universal health coverage (UHC). In Oman, the Dhamani platform a national digital health-insurance system mandates private-sector coverage under Capital Market Authority Resolution 78/2019. Full national rollout commenced in 2025, creating an urgent need for pre-implementation employer-readiness evidence.Objective\n\nTo describe formal employer health-insurance provision rates across Omani private-sector firms, to identify firm structural factors independently associated with provision, and to assess whether organisational resource capacity mediates the firm size-provision relationship.Methods\n\nCross-sectional employer survey (n = 222) conducted prior to full Dhamani enforcement, using stratified purposive sampling by firm size and sector. Multivariable logistic regression (Hosmer-Lemeshow calibration, ROC AUC discrimination, VIF multicollinearity checks, Box-Tidwell linearity test, Firth penalized sensitivity analysis) and bootstrapped mediation analysis (5,000 resamples; bias-corrected 95% CI as primary inferential result) were used.Results\n\nFormal provision was 36.5% overall (95% CI: 30.2-43.1%), ranging from 10.8% among micro-enterprises to 81.0% among large firms (Cramér's V = 0.573, p < 0.001). Organisational resource capacity was the strongest independent predictor (AOR = 31.51, 95% CI: 11.82-84.01, p < 0.001). The bootstrapped indirect effect of firm size on provision through capacity was 0.413 (bias-corrected 95% CI: 0.189-0.687), representing 30.3% of the total association. Model discrimination was good (ROC AUC = 0.88, 95% CI: 0.83-0.93) and calibration was acceptable (Hosmer-Lemeshow p = 0.45). A post-stratification weighted estimate adjusting for micro-enterprise oversampling was 21.9% (95% CI: 17.0-26.8%). The most common barriers among non-insuring firms were absence of a legal mandate (51.8%) and high premium costs (49.6%).Conclusions\n\nFirm size and organisational resource capacity are strongly associated with formal health-insurance provision. Phased Dhamani enrollment targeting large firms first, premium subsidies, and administrative support for micro- and small enterprises are the evidence-indicated policy responses.",
  "abstract_shown": true,
  "affiliations": [
    "University of Technology and Applied Sciences, Al Mussannah, Oman. Neetu.kwatra@utas.edu.om.",
    "University of Technology and Applied Sciences, Al Mussannah, Oman.",
    "Ministry of Health, Muscat, Oman."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Neetu Kwatra"
    },
    {
      "affs": [
        1
      ],
      "name": "Nihad Al Zadjali"
    },
    {
      "affs": [
        2
      ],
      "name": "Sultana Al Sabahi"
    },
    {
      "affs": [
        2
      ],
      "name": "Zuhair Al Sulti"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4tpkg3bf2mabp.bib",
  "cited_by": 0,
  "doi": "10.1186/s13561-026-00831-y",
  "fulltext_url": "https://europepmc.org/articles/PMC13681757",
  "id": "4tpkg3bf2mabp",
  "issns": [
    "2191-1991"
  ],
  "landing_url": "https://europepmc.org/article/MED/42900267",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "R5-920"
    ],
    [
      "openalex",
      "2003|Healthcare Systems and Reforms"
    ]
  ],
  "openalex": "W7170161175",
  "pdf_url": "https://europepmc.org/articles/PMC13681757?pdf=render",
  "pmcid": "PMC13681757",
  "pmid": "42900267",
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/4tpkg3bf2mabp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:42Z",
      "native_id": "MED:42900267",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42900267"
    },
    {
      "first_seen": "2026-10-30T13:45:35Z",
      "native_id": "79e51a628e814ed09a857f77c836a062",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s13561-026-00831-y"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:R5-920",
      "subfield": "general"
    }
  ],
  "title": "Firm structure, organisational capacity, and employer health insurance provision in Oman: a cross-sectional mediation study.",
  "title_text": "Firm structure, organisational capacity, and employer health insurance provision in Oman: a cross-sectional mediation study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:35Z",
  "url": "https://research.draconitic.com/paper/4tpkg3bf2mabp",
  "venue": "Health economics review",
  "versions": []
}