Saudi Arabian health-care challenges

Saudi Arabia has many health-care challenges. The population is growing — in 1975 there were 7.3 million people compared with 24.6 million in 2005, approximately six million of who are expatriates.

The majority of the Saudi population is young, with 40% of the population aged younger than 15 years. Only 3.5% of Saudis are aged 65 years or older.  

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Disease patterns are changing from communicable to non-communicable, and chronic disease rates are expected to rise. Childhood obesity rates are rising — in 2008 the obesity rate was 33%. This increase in obesity will further burden the system with chronic disease patients that will require intensive health care. 

Ahmed told me there is also an increase in health-care disparities in Saudi Arabia, and this will require more intensive primary care. Another challenge the kingdom faces is an annual influx of approximately five million pilgrims and visitors to the Holy Mosque in Makkah. Saudi Arabia provides free health care to these travelers, which places additional demands on the health-care system.

Finally, Saudi Arabia relies heavily on medical expatriates to deliver health care. Currently only 17% of health care providers in Saudi are nationals. Medical expatriates that do work in Saudi Arabia stay for approximately two to three years, creating a lack of continuity that further burdens the system. PAs may aid in addressing these new challenges.

Health insurance

There are major changes occurring in the health care system. Currently health insurance coverage in Saudi Arabia is free to all Saudi nationals, but not expatriates.

Health-care coverage in Saudi Arabia is a mixed system that utilizes both private and public entities. The Ministry of Health is mostly responsible for the health of Saudis, but many receive health care from private hospitals. The ministry of health provides 60% of the health care to Saudi’s and expatriates, and 20% to 21% of people receive healthcare through the National Guard and Red Crescent Society. The remaining get health care from private institutions.

The system of control is somewhat splintered. Although the Ministry of Health is responsible for providing health care for all Saudis, the department does not have authority over university teaching hospitals and military hospitals, which means that the system is not fully unified.

In 2005 Saudi Arabia introduced cooperative health insurance, which was an attempt to control health-care costs and offer all residents (Saudis and non Saudis alike) access to health insurance.

Currently, all Saudi nationals have access to free health care. This new program would among other things, rein in costs by cost sharing with citizens, force employers of nonresidents to offer insurance to their employees, and create a health-insurance plan for pilgrims. 

The program will be done in three stages, and the last stage will be privatization of hospitals as a means of controlling health-care costs.

Currently, the Ministry of Health has a network of health centers that are community based and are located throughout the kingdom, where they deliver primary health care and serve as gatekeepers to secondary and tertiary care.

The two systems are well integrated, and people needing more advanced care have access to hospital care; although, there is a growing wait time to be seen in such facilities.

The introduction of this new plan will have a cost savings effect and offer non-Saudis insurance coverage, but it could also have a negative impact on the access of rural populations to hospital care.

If hospitals will function with a financial incentive it is thought that small rural isolated hospitals might be forced to close, because many of these will be costly to manage and generating a profit could be difficult.