Title : Saudi health care system and other country

Student name : Faisal saleh alrasheed

Student number : 439050279

Doctor : Ahmed Youssef

Abstract:
Background: Saudi Arabia has invested heavily in its health care system by
establishing health care infrastructures to improve health of the nation.
However, it remains to be seen whether it is ef cient and effective in providing
health care services needed. Primary health care, which is the basis of
universal health coverage, needs to be assessed on its performance,
challenges and future opportunities to serve the Saudi Arabian population.

Introduction:
In spite of substantial improvements in the Saudi Arabian health services
sector in the past few decades, the country is facing critical challenges in its
primary health care system. These challenges include increased demand
because of rapid population growth, high costs of health care services,
inequitable access, concerns about the quality and safety of care, a growing
burden of chronic diseases, a less than effective electronic health system
(eHealth), poor cooperation and coordination between other sectors of care,
and a highly centralized structure . The government has developed and
implemented a number of initiatives which include the Strategic Plan of the
Ministry of Health 2010–2020 to effectively tackle these challenges . These
initiatives resulted in the replacement of seven ministers of health in just one
year, which indicates the serious administrative and practical dif culties in
tackling these challenges in the health care system.
Most review papers in Saudi Arabia have focused on hospital-based medical
services and have neglected primary health care services, which are the rst
point of access to health care in the Saudi Arabian health care system. The
primary health care sector provides essential health care services to Saudi
Arabians and to expatriates working in the public sector. No reform of the
Saudi Arabian health care system can be complete without rst considering
the primary health care services at the heart of the health care system.
This narrative review aimed to explore the challenges facing the Saudi
Arabian health care system with a focus on primary health care services. It
further discusses and analyses the barriers to and drivers of health sector
reforms, including the effect of demographic and economic factors on the
health care system. The review also recommends mechanisms for effective
reform of primary health care services as the nucleus of overall health care
system.
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Health insurance in Saudi Arabia:

Funding health care services is a central challenge faced by the MOH. Since
the total expenditure on public health services comes from the government
and the services are free-of-charge, this lead to considerable cost pressure
on the government, particularly in view of the rapid growth in the population,
the high price of new technology and the growing awareness about health
and disease among the community. To meet the growing population demands
for health care and to ensure the quality of services provided, the Council for
Cooperative Health Insurance was established by the government in 1999 .
The main role of this Council is to introduce, regulate and supervise a health
insurance strategy for the Saudi health care market.
The implementation of a cooperative health insurance scheme was planned
over 3 stages. In the rst stage, the cooperative health insurance was applied
for non-Saudis and Saudis in the private sector, in which their employers
have to pay for health cover costs. In the second stage, the cooperative
health insurance is to be applied for Saudis and non-Saudis working in the
government sector. The government will pay the cooperative health insurance
costs for this category of employee. In the nal stage, the cooperative health
insurance will be applied to other groups, such as pilgrims . Only the rst
stage has been implemented to date, with the cooperative health insurance
being implemented gradually in a 3-phase programme to employees of the
private sector and their dependants . The rst phase covered companies with
500 or more employees, while the second phase applied to employers with
more than 100 workers. The third phase included employees of all companies
in Saudi Arabia as well as domestic workers . The government is now working
systematically to apply the remaining 2 stages—for employees in the
government sector and for pilgrims—before they privatize the state-owned
health care facilities. No information is available yet regarding the cooperative
health insurance scheme for the population of Saudi Arabia other than
employees and expatriates.
While the market for cooperative health insurance in Saudi Arabia started with
only 1 company in 2004, it currently involves about 25 companies. The
introduction of the scheme is intended to decrease the nancial burden on
Saudi Arabia due to the costs associated with providing health services free-
of-charge. It will also give people more opportunity to choose the health
services they require. The real challenge for policy-makers in Saudi Arabia is
to introduce a comprehensive, fair, and affordable service for the whole
population. Clearly lessons can be learned from the experiences of other
countries, including the advantages and disadvantages of different schemes.
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Privatization of public hospitals:

Privatization of public hospitals has been seen by policy-makers and

researchers as the best way to reform the Saudi health care system [38,39].
Steps to implement a privatization strategy have been initiated and related
regulation has been passed by the government. As a result, a number of
public hospitals are likely to be sold or rented to private rms over the next
few years . Privatization of hospitals is expected to bring a number of
advantages to the government and to the nation. It is hoped that privatization
will assist in speeding up decision-making, reducing the government’s annual
expenditure on health care, producing new nancial sources for the MOH and
improving health care services .
On the other hand, privatization may affect the current integrated system
between hospitals and PHC facilities. As hospitals become privatized, they
will focus on attracting patients, even those who may not require hospital-
level care. Moreover, people with health cover may prefer to access big
hospitals directly instead of via PHC centres or community hospitals.
Additionally, private hospitals will have incentives to shift non-refundable
costs back to the public PHC. Such practices will place nancial burdens on
the government.
A further drawback of privatization is that the traditional state/public hospitals
will not be able to absorb enough of the health care market compared with
private companies, unless they upgrade at all levels (e.g. management,
infrastructure and workforce) before starting to privatize . In the move to
privatization, private companies are likely to focus their activities within cities
and larger communities, leaving people in rural areas at a disadvantage. The
government should set regulations that protect the rights of rural communities
and provide them with fair and equitable health care services.
Finally, if the government does not apply adequate control over the health
care market, expenditure on health care may increase dramatically as a result
of higher pricing and pro t-seeking behaviour.

Accessibility to health services:

Optimizing the accessibility of health care services requires equity in the

distribution of health care facilities throughout the nation and equity of access
to health professionals, including transport to services and providers.
Accessibility is also affected by the level of cooperation between related
sectors . The current MOH statistics indicate that there is a maldistribution of
health care services and health professionals across geographical areas .
People experience long waiting lists for many health care services and
facilities . Additionally, there is a dearth of services for disadvantaged groups
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such as the elderly, adolescents and people with special needs such as
disability, particularly in rural areas [39]. Finally, many people do not have the
ability to access health care facilities, particularly those living in border and
remote areas.
In order to improve accessibility to health care services in all parts of the
country, a holistic strategy for the redistribution of health care services,
involving PHC centres, general hospitals, central and specialist hospitals as
well as the health professionals, should be adopted by the MOH. The MOH
should also liaise with other sectors such transport, water and power
companies and social security services in order to develop services in
deprived areas and to care for people with the greatest needs.

Patterns of diseases:

The change in disease patterns from communicable to noncommunicable

diseases in Saudi Arabia is another challenge that needs more attention from
the MOH . There has been an alarming increase in the prevalence of chronic
diseases, such as diabetes, hypertension, and heart diseases, cancer,
genetic blood disorders and childhood obesity . Treatment of chronic
diseases is costly and may even be ineffective . For example, the annual cost
for treatment of diabetes mellitus in Saudi Arabia was estimated to be 7 billion
Saudi riyal (SR) (US$ 1.87 billion) . Early prevention is the most effective way
to reduce the prevalence of chronic diseases and the costs and dif culties
associated with treatment in the later stages of disease. Any projected
reforms in the health care system must involve plans to address this change
in emphasize.

Promotion and prevention programmes for crises:

Development and implementation of practical plans and procedures to meet

national crises in Saudi Arabia, such as wars, earthquakes and res and
explosions at petroleum factories, are a further important need. Road traf c
accidents, for example, killed more than 39 000 and injured about 290 000
people between 1995 and 2004 . According to WHO, road traf c accidents
are now the highest cause of death, injury and disability in adult males aged
16 to 36 years in Saudi Arabia . Caring for people affected by road accidents
consumes a signi cant proportion of the MOH budget; for example, the cost
of treating injured people during 2002 was estimated to be SR 652.5 million
(US$ 174 million) . These funds could be used to develop the health system
and improve services. Plans to manage issues of this kind need to be
comprehensive and well-coordinated among the related sectors in order to be
achievable.
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e-health and national health information systems:

There is increasing concern about the underutilization of electronic health

systems in Saudi Arabia. Implementation of e-health and electronic
information systems has already started in a number of hospitals and
organizations such as the King Faisal specialist hospital and research centre,
national guard health affairs, medical services of the army forces and
university hospitals. While uptake of e-health systems is moving slowly in
MOH institutions, there are a number of information systems operating in the
regional directorates and in central hospitals. Unfortunately, these information
systems are not connected to each other or to other private or specialized
health organizations.
To develop e-health services in the public sector, a budget of SR 4 billion
(US$ 1.1 billion) was allocated by the MOH to run a 4-year development
programme (2008–11) . Additionally, a series of conferences on e-health have
been held by the Saudi Association for Health Information to emphasize the
importance of e-health in enhancing the quality of health care delivery and to
explore the necessary strategies, policies, applications and infrastructure.
More coordination among different health care providers is needed in order to
enhance the use of e-health strategies and to launch a comprehensive
national system for health information. A high level of coordination must be
achieved with other related sectors to provide the required infrastructure such
as internet and phone services.

New strategy for health care services:

To meet the challenges of the Saudi health care system and to improve the
quality of health care services, the MOH has set a national strategy for health
care services. This strategy was approved by the Council of Ministers in April
2009. It focuses on diversifying funding sources; developing information
systems; developing the human workforce; activating the supervision and
monitoring role of the MOH over health services; encouraging the private
sector to take its position in providing health services; improving the quality of
preventive, curative and rehabilitative care; and distributing health care
services equally to all regions.
The national strategy for health care services is to be implemented by the
MOH in cooperation with other health care providers and it will be supervised
by the Council of Health Services. A 20-year timeframe for achieving the
objectives of this strategy has been identi ed .
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 Conclusion:

As a result of the continued attention to and support from the government,

Saudi health services have advanced greatly over recent years in all levels of
health services: primary, secondary and tertiary. As a consequence, the
health of the Saudi population has improved markedly. The MOH has
introduced many reforms to its services, with substantial emphasis on PHC.
Despite these achievements, health services, and in particular public sector
health services, are still facing many challenges. These include: human
resource development; separation of the MOH’s multiple roles ( nancing,
provision, control and supervision of health care delivery); diversifying
nancial sources; implementing the cooperative health insurance,
privatization of public hospitals, effective management of chronic diseases;
development of practical policies for national crises; establishment of an
ef cient national health information system and the introduction of e-health. In
order to address these challenges and continue to improve the status of the
Saudi health care system, the MOH and other related sectors should
coordinate their efforts to implement and ensure the success of the new
health care strategy.
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 U.s. health care system
INTRODUCTION:

The U.S. health care system is the subject of much polarizing debate. At one
extreme are those who argue that Americans have the “best health care
system in the world”, pointing to the freely available medical technology and
state-of-the-art facilities that have become so highly symbolic of the system.
At the other extreme are those who berate the American system as being
fragmented and inef cient, pointing to the fact that America spends more on
health care than any other country in the world yet still suffers from massive
uninsurance, uneven quality, and administrative waste.
Understanding the debate between these two diametrically opposed
viewpoints requires a basic understanding of the structure of the U.S. health
care system. This primer will explain the organization and nancing of the
system, as well as place the U.S. health care system in a greater international
context.

ORGANIZATION OF U.S. HEALTH CARE SYSTEM:

As with all other countries, there are both private and public insurers in the
U.S. health care system. What is unique about the U.S. system in the world is
the dominance of the private element over the public element.
In 2003, 62% of non-elderly Americans received private employer-sponsored
insurance, and 5% purchased insurance on the private non group (individual)
market. 15% were enrolled in public insurance programs like Medicaid, and
18% were uninsured. Elderly individuals aged 65 or over are almost uniformly
enrolled in Medicare

Public Health Insurance:

• Medicare2
Basics: Medicare is a federal program that covers individuals aged 65 and
over, as well as some disabled individuals.
Administration: Medicare is a single-payer program administered by the
government; single-payer refers to the idea that there is only one entity (the
government) performing the insurance function of reimbursement.
Financing: Medicare is nanced by federal income taxes, a payroll tax
shared
by employers and employees, and individual enrollee premiums (for parts B
and D).
Bene ts: Medicare Part A covers hospital services, Medicare Part B covers
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 physician services, and Medicare Part D offers a prescription drug bene t.
[Medicare Part C refers to Medicare Advantage – HMO’s that administer
Medicare bene ts].

There are many gaps in Medicare coverage, including incomplete coverage

for skilled nursing facilities, incomplete preventive care coverage, and no
coverage for dental, hearing, or vision care. Because of this, the vast majority
of enrollees obtain supplemental insurance. Overall, seniors pay about 22%
of their income for health care costs despite their Medicare coverage.

•• Other public systems4

o S-CHIP: The State Children’s Health Insurance Program (S-CHIP) was
designed in 1997 to cover children whose families make too much money to
qualify for Medicaid but make too little to purchase private health insurance.
S-CHIP and Medicaid often share similar administrative and nancing
structures.
o VA: The Veteran’s Administration is a federally administered program for
veterans of the military. Health care is delivered in government-owned VA

hospitals and clinics. The VA is funded by taxpayer dollars and generally

offers extremely affordable (if not free) care to veterans.

Private Health Insurance

• Employer-sponsored insurance4
o Basics: Employer-sponsored insurance represents the main way in which
Americans receive health insurance. Employers provide health insurance as
part of the bene ts package for employees.
o Administration: Insurance plans are administered by private companies,
both
for-pro t (e.g. Aetna, Cigna) and non-for-pro t (e.g. Blue Cross/Blue Shield).
A special case is represented by companies that are “self-insured” –
that is, they pay for all health care costs incurred by employees directly. In
this case, the company contracts with a third party to administer the health
insurance plan. Self-insured companies tend to be larger companies such as
General Motors.
o Financing: Employer-sponsored insurance is nanced both through
employers (who usually pay the majority of the premium) and employees
(who pay the remainder of the premium). In 2005, the annual private
employer-sponsored insurance premiums averaged $4,024 for single
coverage and $10,880 for a family of four.5
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 o Bene ts: Bene ts vary widely with the speci c health insurance plan.
Some plans cover prescription drugs, while others do not. The degree of cost-
sharing (co-pays and deductibles) varies considerably.

Resources in the health sector (human, physical)

• In 2002, the United States had 2.3 practicing physicians per 1000
population, below the OECD average of 2.9 per 1000 population.
• There were 7.9 nurses per 1000 population in the United States in 2002,
below the OECD average of 8.2 per 1000 population.
• The number of acute care hospital beds in the United States in 2003 was
2.8 per 1000 population, below the OECD average of 4.1 beds per 1000
population.

Health status and risk factors

Most OECD countries have enjoyed large gains in life expectancy over the
past 40 years. In the United States, life expectancy at birth increased by 7.3
years between 1960 and 2002, which is less than the increase of 14 years in
life expectancy in Japan, or of 8.4 years in Canada. In 2002/3, life expectancy
in the United States stood at 77.2 years, below the OECD average of 77.8
years. Japan, Iceland, Spain, Switzerland and Australia were among the top 5
countries registering the highest life expectancy among
OECD countries.

Infant mortality rates in the United States have fallen greatly over the past few
decades, but not as much as in most other OECD countries. In 2002, the
infant mortality rate in the U.S. was 7 deaths per 1,000 live births, above the
OECD average of 6.1. Among OECD countries, infant mortality is the lowest
in Japan and in the Nordic countries (Iceland, Sweden, Finland and Norway),
which all have infant mortality rates below 3.5 deaths per 1,000 live births.
In the United States, the proportion of smokers among adults has fallen from
33.5% in 1980 to 17.5% in 2003, the lowest rate among OECD countries
along with Canada and Sweden. In the United States, the obesity rate among
adults (30.6% in 2002) is the highest in OECD countries, followed by Mexico
(24.2% in 2000) and the United Kingdom (23% in 2003)
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