Health Insurance & Purchasing of Healthcare Services

The challenges faced by the target group in this initiative are:

Citizens and expatriates not covered by the Council of Cooperative Health Insurance system face several challenges in accessing health care, including: 
  • Poor quality of health services provided in public hospitals
  • Long waiting times in public hospitals
  • Lack of treatment options in the desired hospitals
  • Rising cost of health care due to several reasons, including: 
    • High life expectancy rates at birth and an increase in the proportion of population groups over the age of 65, leading to an increased demand for health Care services. 
    • Lack of effective preventive care services, as preventive care is a long-term strategy to improve public health and reduce disease burden.
    • Continuous development of modern medical techniques. 
    • Ongoing changes in the determinants/ risk factors of communicable and non-communicable diseases, such as: environmental, genetic factors, behaviours, lifestyle,  the social and economic status, and health policies. They all can lead to growing prevalence of diseases, especially non-communicable diseases (e.g. diabetes, cardiovascular disease).
The challenges faced by the health care financing system in the kingdom are:
  • Financial Sustainability:
    • 73% of the health care system in the Kingdom is funded from government revenues.
    • Escalating health care costs while government revenues are unable to pursue this trend on the long term. 
  • Cost Efficiency:
    • Benchmarking shows a decrease in production and utilization rates as MoH's data indicate: 
    • Low productivity, and the lack of geographically are well-distributed human resources.
    • Low occupancy rate of hospital beds compared to other countries.
    • Disparity in hospitalization costs  between MoH’s hospitals and other government sectors providing health services.  
  • Quality of Health Services:
    • Disparity in health care services provided by government hospitals compared to other providers. 
    • Lack of transparency and limited documented information about patients, health practices and costs.
  • Weak regulatory capacity and policy enforcement:
    • Currently, the payment mechanism for hospitals is a dedicated legacy budget that is not linked to results, and does not produce any incentives to provide effective and high-quality health services. 
    • The current Saudi health system is significantly fragmented, leaving various regulatory bodies with restricted, often overlapped, jurisdiction and authority. Another impediment is centralization of health functions in one entity, without any differentiation between the regulatory body’s functions, purchaser and service providers in some cases. For instance, MoH may buy a service from a certain provider, while offering the same service for the private sector.  

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Last Update 15 August 2018 08:46 AM
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