Yazed AlRuthia, PharmD, PhD, Professor of Health Economics and Outcomes Research; Bander Balkhi, PharmD, PhD, Professor of Health Economics and Outcomes Research, King Saud University, Riyadh, Saudi Arabia
As the Kingdom of Saudi Arabia strives to reduce its economy’s dependence on oil revenue, diversify its economy, and improve public spending efficiency, a comprehensive transformation is needed to take place across all sectors of the economy, including healthcare. According to the Saudi governance law, all citizens are entitled to comprehensive healthcare coverage. However, there was a significant variation in access and quality of healthcare received by Saudi citizens over the past few decades, mainly due to the fragmented nature of the public healthcare system and centralization of most tertiary health services in the main cities. As the country launched its new economic vision 2030, drastic changes must be implemented in the public and private healthcare sectors to address the mounting challenges facing the country’s healthcare system with regard to both financing and delivery. Therefore, the government has launched its Health Sector Transformation Program with four main objectives: facilitating access to healthcare services, improving the quality and efficiency, promoting the prevention of health risks, and enhancing traffic safety.
The Health Sector Transformation program aims to improve the quality of health services by encouraging the privatization of different health entities affiliated with the Saudi Ministry of Health (MOH) by establishing 21 health clusters where each cluster is responsible for delivering healthcare services to the citizens in designated geographic locations through its affiliated healthcare institutions. These clusters will be reimbursed based on the volume of health services delivered, complexity, and quality of care by the Center for National Health Insurance (CNHI), a newly founded and responsible body for reimbursing healthcare services in the public sector in order to ensure the provision of patient-centered care and create value-based rather than volume-based incentives for different healthcare entities, a value-based center was established. Additionally, public-private partnerships (PPPs) are encouraged through numerous initiatives and regulations set forth by the National Center for Privatization & PPP, a governmental body established in 2017 to facilitate the privatization of all public sectors in the Kingdom. The outsourcing dialysis program is one of the PPP initiatives that was implemented to reduce the administrative burden on the public health sector and improve the adequacy and quality of dialysis care for patients in Saudi Arabia.
Additionally, reforms were made in the private health insurance sector through the Council of Health Insurance (CHI) to improve the access and quality of health services to employees working in the private sector and their dependents. According to Saudi regulations, private-sector employers must provide health insurance for their employees and dependents. The CHI has recently updated its Essential Benefits Package (EBP) to enhance the effectiveness and efficiency of health services for private health insurance beneficiaries in the Kingdom. Today, about 37% of citizens and legal residents are covered by private health insurance, according to the latest estimates by the General Authority for Statistics in Saudi Arabia. With these changes, the Saudi MOH will play the role of regulator of corporate payers and providers rather than the leading healthcare provider.
Finally, the ongoing healthcare reforms to create a comprehensive, high-performing, and integrated health system to incentivize networks of healthcare providers to invest in preventive and proactive care, emphasizing collaboration, improved health outcomes, preventive measures, and efficiency in healthcare services delivery, are steps in the right direction.
However, caution must be exercised through different regulatory measures to ensure equitable access to healthcare and improved quality of care while minimizing the risk of a high rate of inflation in the cost of healthcare services and increased out-of-pocket expenditures.