Transcript Health care system i..

Health Care System in
Saudi Arabia: An
Overview
• The government of Saudi Arabia has given high
priority to the development of health care services
@ all levels: primary, secondary & tertiary.
• As a consequence, the health of the Saudi
population & health services have improved greatly
in terms of quantity & quality.
• According to the World Health Organization (WHO),
the Saudi health care system is ranked 26th among
190 of the world’s health systems.
• Brief overview of health services development:
• Health services in Saudi Arabia have ↑’d &
improved significantly during recent decades.
• The first public health department was established
in Mecca in 1925 based on a royal decree from
King Abdulaziz : Responsible for sponsoring &
monitoring free h/c for the population & pilgrims
through establishing a # of hospitals & dispensaries.
• The MOH (Ministry of Health) was established in
1950 under another royal decree.
• 20 years later, the 5-year development plans were
introduced by the government to improve all
sectors of the nation, including the Saudi health
care (h/c) system.
• Since then, substantial improvements in h/c have
been achieved in KSA.
• Current structure of health services:
• Currently the MOH is the major government
provider & financer of h/c services in KSA.
• Total of 415 hospitals (58,126 beds) in Saudi Arabia
according to 2010 statistics.
Contributing factors to the significant improvements
in health indicators:
 The advancement in health services
Improved & more accessible public education
Increased health awareness among the community
Better life conditions
Despite the multiplicity of h/c service providers,
there is NO coordination or clear communication
channels among them >>> *waste of resources &
*duplication of effort
To overcome this & to provide the population
with affordable, organized, & comprehensive h/c
>>> In 2002 the Council of Health Services,
headed by the Minister of Health & including
representatives of other government & private
health sectors, was established .
• The aim of this Council: To develop a policy for
coordination & integration among all h/c services
authorities in KSA.
• However, significant progress has yet to be
achieved in this area.
• Public health care system (MOH):
• According to the Saudi constitution, the
government provides all citizens & expatriates
working within the public sector with full & free
access to all public h/c services.
• The Responsibilities of MOH:
 Managing, planning & formulating health policies
 Supervising health programs
 Monitoring health services in the private sector
 Advising other government agencies & the private
sector on ways to achieve the government’s health
objectives.
• The MOH supervises 20 regional directoratesgeneral of health affairs in various parts of the
country.
• Each regional health directorate has a # of hospitals
& health sectors & every health sector supervises a
number of PHC centers.
 The role of these 20 directorates includes:
Implementing policies, plans & program of MOH
 Managing & supporting MOH health services
 Supervising & organizing private sector services
 Coordinating with other government agencies &
other relevant bodies
• Levels of Health Care Services:
• Primary, Secondary & Tertiary.
• PHC centers supply 1˚ care services, both preventive
& curative >>> referring cases that require more
advanced care to public hospitals ( 2˚ level of care),
>>> cases that need more complex levels of care are
transferred to central or specialized hospitals ( 3˚
level of h/c).
• Transition to PHC services:
• In 1980, a ministerial decree was issued to
establish PHC centers which aimed to focus on the
8 elements of the PHC approach:
 Educating the population about prevailing health
problems & the methods of preventing &
controlling them;
 Provision of adequate supply of safe water & basic
sanitation;
Promotion of food supply and proper nutrition;
 Provision of comprehensive maternal & child h/c;
Immunization of children against major
communicable diseases;
 Prevention & control of locally endemic diseases;
 Appropriate treatment of common diseases &
injuries;
 Provision of essential drugs
Transition to PHC services
Levels of health care services
Tertiary
health care
Secondary
Health care
Primary
Health care (PHC)
• Health services in the pilgrimage (hajj)
season:
• Health care services in the hajj season provide free
of charge preventive & curative care for all
pilgrims, irrespective of their nationality.
Preventive care includes:
health education programs, vaccination &
chemoprophylaxis for all pilgrims via quarantine
services @ airports & land ports.
 The provision of emergency & curative services:
takes place through a network of h/c facilities.
• E.g., in 2009 : 2.3 million pilgrims:
• There were 21 hospitals,(of which 7 seasonal),
• A total of 3408 beds & 176 beds for emergency
admissions.
• 157 PHC centers,(of which 119 seasonal)
• On average, each PHC center treated 4734 pilgrims.
• The total workforce recruited to work in these
facilities during 2009 was 17,886
• On average, each physician treated about 612
pilgrims, while each nurse treated about 372.
• These free of charge services for all pilgrims >>>>
considerable pressure on the h/c budget.
• One suggestion: to introduce a seasonal health
insurance for all international pilgrims
• Challenges for h/c reform:
1. Health workforce,
2. Financing & expenditure,
3. Changing patterns of diseases,
4. Accessibility to h/c services,
5. Introducing the cooperative health
insurance scheme,
6. Privatization of public hospitals,
7. Utilization of electronic health (e-health)
strategies & the development of a national
system for health information.
• Challenges for h/c reform:
1. Health workforce:
 Shortage of local h/c professionals i.e., physicians,
nurses & pharmacists.
 The majority are expatriates >>> high rate of turnover
& instability in the workforce
 The budget for training & scholarships has ↑’d &
many MOH employees have a chance to pursue their
studies abroad which could:
1. Improve the skills of current employees
2. Raise the quality of health care
3. ↓ rate of turnover among h/c professionals
However, such efforts may not be enough to solve the
challenges.
• Challenges for h/c reform:
• More medical colleges & training programs need to
be established around the country.
• New laws & regulations to develop & reorganize
medical human resources by the MOH are urgently
required.
2. Reorganization & Restructuring of the MOH:
 The public health sector is overwhelmingly
financed, operated, controlled, supervised &
managed by the MOH.
 Serious & well-planned steps should be taken to
separate these multiple roles.
 Possible solutions include:
 Giving more authority to the regional directorates
 Applying the cooperative health insurance scheme
 Encouraging the privatization of public hospitals.
3. Decentralization of Health Services & Autonomy of
Hospitals:
• To meet ↑’ing pressure on the MOH, more autonomy
has been given to the regional directorates in: planning,
recruitment of professional staff, formulating
agreements with health services providers (operating
companies) & some limited financial discretion
• MOH standardized an autonomous hospital system for
31 public hospitals >>>> expected to:
Raise the efficiency of their performance in both
medical & managerial functions,
 Achieve financial & administrative flexibility
 Apply quality insurance programs
 Simplify the contractual process with qualified h/c
professionals
Decentralization of Health Services & Autonomy of
Hospitals:
• Giving more autonomy to hospitals >>>> will:
*Help the transition to full privatization of public
hospitals in KSA.
*It gives public hospitals more experience in the
management of their budgets, h/c quality
& workforce.
4. Health Insurance in Saudi Arabia
• Funding h/c care services is a central challenge
faced by the MOH
• The Council for Cooperative Health Insurance was
established by the government in 1999 .
• The main role of this Council is to: introduce,
regulate & supervise a health insurance strategy for
the Saudi h/c market to meet the growing
population demands for h/c & to ensure the quality
of services provided.
• The implementation of a cooperative health
insurance scheme was planned over 3 stages:
1) First stage:
Was applied for non-Saudis & Saudis in the private
sector, in which their employers pay for health cover
costs.
2) Second stage:
To be applied for Saudis & non-Saudis working in the
government sector.
The government will pay the cooperative health
insurance costs for them.
3) Final stage:
Will be applied to all other employees & other
groups , i.e., pilgrims .
• Only the first stage has been implemented to
date
• The government is now working systematically to
apply the remaining 2 stages
5) Privatization of public hospitals:
• Steps to implement a privatization strategy have
been initiated >>>> a # of public hospitals are
likely to be sold or rented to private firms over
the next few years.
• Expected advantages of hospitals privatization
Assist in speeding up decision-making,
 Reducing the government’s annual expenditure
on h/c,
Producing new financial sources for the MOH,
Improving h/c services .
Expected disadvantages of hospitals privatization:
Privatized hospitals will focus on attracting
patients, even those who may not require
hospital-level care.
People with health coverage may prefer to access
big hospitals directly instead of via PHC centers
or community hospitals.
Private companies are likely to focus their
activities within cities & larger communities.
Public hospitals will not be able to absorb
enough of the h/c market compared with private
companies, unless they upgrade @ all levels.
• If the government does not apply adequate
control over the h/c market >>> expenditure on
h/c may ↑ dramatically as a result of higher
pricing & profit-seeking behavior
6) Accessibility to Health Services:
 The current MOH statistics indicate that there is a
maldistribution of h/c services & h/c professionals
across geographical areas.
 Many do not have access to h/c facilities, esp. those
living in remote areas.
• In order to improve accessibility to health care
services:
1) A strategy for the redistribution of h/c services,
should be adopted by the MOH.
2) The MOH should coordinate with other sectors, i.e.
transport, water & power companies & social security
services in order to develop services for people with
the greatest needs in deprived areas .
7) Patterns of diseases:
• The change in disease patterns:
communicable  noncommunicable diseases in KSA
>>>challenge that needs > attention from the MOH.
There is an alarming ↑ in the prevalence of chronic
diseases (DM, HTN, & heart diseases, CA, genetic blood
disorders & childhood obesity).
 Tx of such diseases is costly & may even be ineffective.
 Early prevention is the most effective way to ↓ the
prevalence of chronic diseases & costs & difficulties
associated with Tx in the later stages of disease.
8) Promotion & Prevention Programs for Crises:
• Practical plans & procedures should be developed &
implemented to meet national crises in KSA, i.e.,
wars, earthquakes, fires & explosions @ petroleum
factories.
• Caring for people affected by road accidents
consumes a significant proportion of the MOH
budget; (in 2002 about SR 652.5 million),which
could be used to develop the h/c system & improve
services.
• Plans to manage such issues need to be
comprehensive & well-coordinated among the
related sectors in order to be achievable.
9) e-Health & National Health Information
Systems
• There is underutilization of electronic h/c
systems in KSA.
• Implementation of e-health & electronic
information systems has already started in many
hospitals & organizations (i.e. KFSH&RC &
university hospitals,…)
• However, these systems are not connected to
each other or to other private or specialized
health organizations.
A high level of coordination among different h/c
providers & with other sectors is needed  to
enhance the use of e-health strategies & to launch
a comprehensive national system for health
information.
• New strategy for health care services:
• To meet the challenges of the Saudi h/c system & to
improve the quality of h/c services  the MOH has
set a national strategy for h/c services that was
approved by the Council of Ministers in April 2009.
• A 20-year timeframe is expected for achieving the
objectives of this strategy.
• This National Strategy focuses on:
 Diversifying funding sources;
 Developing information systems;
 Developing the human workforce;
 Activating the supervision & monitoring role of the
MOH over h/c services;
 Encouraging the private sector to take its position
in providing h/c services;
 Improving the quality of preventive, curative &
rehabilitative care;
 Distributing h/c services equally to all regions.
In order to address these challenges &
continue to improve the status of the Saudi
h/c system>>> the MOH & other related
sectors should coordinate their efforts to
implement & ensure the success of the new
h/c strategy.