Firm structure, organisational capacity, and employer health insurance provision in Oman: a cross-sectional mediation study.
- 1University of Technology and Applied Sciences, Al Mussannah, Oman. [email protected].
- 2University of Technology and Applied Sciences, Al Mussannah, Oman.
- 3Ministry of Health, Muscat, Oman.
Abstract
Background
Employer 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
To 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
Cross-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
Formal 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
Firm 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.
Related
- Maternal critical care infrastructure and organisational preparedness in Türkiye: a national analysis of the MaCriCare cross-sectional survey
- Associations between early antidepressant exposure, affective states, and subjective sleep quality among euthymic depressive-onset bipolar patients: a cross-sectional parallel mediation analysis
- Association between physical activity and quality of life among breast cancer survivors in China: a cross-sectional mediation analysis
- Analysis of the subject-object effects and chain mediation of psychosocial factors in couples during late pregnancy on depression: a cross-sectional study of pregnant women and their spouses
- Knowledge, Attitude, and Practices Regarding Dental Insurance among Dental Professionals in Bengaluru City: A Cross-sectional Survey
BibTeX
@article{kwatra2026firm,
title = {{Firm structure, organisational capacity, and employer health insurance provision in Oman: a cross-sectional mediation study.}},
author = {Neetu Kwatra and Nihad Al Zadjali and Sultana Al Sabahi and Zuhair Al Sulti},
journal = {Health economics review},
year = {2026},
month = jul,
doi = {10.1186/s13561-026-00831-y},
url = {https://europepmc.org/article/MED/42900267},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Firm structure, organisational capacity, and employer health insurance provision in Oman: a cross-sectional mediation study.
AU - Neetu Kwatra
AU - Nihad Al Zadjali
AU - Sultana Al Sabahi
AU - Zuhair Al Sulti
PY - 2026
DA - 2026/07/01
JO - Health economics review
DO - 10.1186/s13561-026-00831-y
UR - https://europepmc.org/article/MED/42900267
AB - Background Employer 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 To 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 Cross-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 Formal 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 Firm 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.
SN - 2191-1991
ER -