Table Of ContentHealthcare Development Strategies
in the Kingdom of Saudi Arabia
Healthcare Development Strategies
in the Kingdom of Saudi Arabia
Mohammed Hassan S. Mufti
M.D., F.R.C.S., M.S., A.B.M.M.
Consultant in Health Administration
Saudi Arabia
KLUWERACADEMIC PUBLISHERS
New York, Boston, Dordrecht,London, Moscow
eBookISBN: 0-306-47183-3
Print ISBN: 0-306-46314-8
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To my wife Afaf A. Aldakhil,
and to my children Maram, Mishal, Majed, and Mansour
with the greatest love and affection and
with appreciation for their support, encouragement, and patience
Foreword
This book is very timely at the present stage of development of the health care system in
the Kingdom of Saudi Arabia. Dr. Mufti has demonstrated, in a convincing manner, his
thorough knowledge and mastery of the health care delivery system and current issues
faced by it.
The book essentially asks and answers the question; now that we have all the human,
technical and physical resources in place, thanks to the strong and wise commitment of
the government, what roles do we have to play as planners, managers, and health care
providers, in sustaining the future viability and efficiency of the health care system.
I sincerely hope that health care provider agencies will read this book and reflect
seriously on the strategic issues raised and the policy actions recommended in it. Issues
discussed, such as the problem of coordination and integration ofactivities among health
care providers, are very timely and extremely pertinent in light of the fast evolving
economic and social environment in the Kingdom. Inefficiency, wasteful use of
resources, and needless redundancy of services should never be an excuse for promoting
the status quo.
At long last we have a health care system that we can justifiably be proud of. We must
continue to improve the quality of this system in an efficient manner. The problems we
face in doing this are not insurmountable. Overall, this book raises some major strategic
issues faced by our health care system and contributes significantly to the literature on the
provision of health care in the Kingdom. These policy issues and the recommended
policy actions will hopefully increase awareness, stimulate thinking, promote discussions,
and inspire necessary action.
Abdul-Wahab Bin Abdul-Salam Attar
Minister of Planning
Foreword
Healthcareisone of the main priorities inSaudi Arabia and the government has provided
several organizations for this purpose. The Ministry of Health is the main governmental
agency with overall responsibility for health policies and planning for the Kingdom. The
private sector receives substantial support from the government and, therefore, it is
steadily growing.
The support and guidance the health sector has received from His Majesty the Custodian
of the Two Holy Mosques King Fahd bin Abdulaziz, HRH Prince Abdullah Bin Abdul
Aziz, the Crown Prince and the Chief of the National Guard, and HRH Prince Sultan Bin
Abdul Aziz, the Second Premier and Minister of Defense and Aviation and General
Inspector, is unlimited. This support and guidance motivates us to provide high quality
preventive, curative and rehabilitative services.
Dr. Mohammed Mufti has written an interesting book: he has illustrated the healthcare
delivery system in the Kingdom and put forward strategic issues, which need to be
considered in the future. An appropriate prospective to assist healthcare planners and
executives is now available inone volume.
This book emphasizes the best utilization of resources, the financing of the health sector
and suggests contemporary solutions such as National Health Insurance, patient charges,
certificate of need and the important topic of Saudization.
Professor Ossama Shobokshi,
MBBS, M.D., CCST, PhD,FRCS (Hon)
Minister of Health
ix
Preface
The Saudi health system has made unprecedented progress within a short period of time.
The commitment to providing high quality health care to residents, and the huge
investment in health care by government and the private sector, have created a level of
health care infrastructures and other resources comparable with the highly developed
countries. This, and the general improvement in economic and social conditions, have, in
turn, led to some very dramatic improvements in the health status of the population.
As in the case with most health systems, a number of problems have arisen. While some
of the problems result from a worldwide phenomenon of escalating cost, population
explosion and technological innovations, a few of them stem from factors peculiar to our
health system--funding,organization, delivery, utilization, etc. This book discusses what
I consider the main strategic issues of the Saudi health system, and suggests I hope, some
ways of tackling the problems. Our health system has done very well so far. There is,
however, a growing awareness that, unless some drastic steps are taken in areas of our
delivery system where changes are indicated, the long-term sustainability of the system
may be in jeopardy.
Some of the strategic issues I have discussed in this book are already being addressed in
various quarters, while others are either largely ignored or are not taken seriously. My
personal belief, is that the 8 percent of Gross Domestic Product (GDP) spent on health
care in the Kingdom is more than adequate. The problem, as I see it, is one of efficiency
in delivery and use of services. I have, therefore, devoted a good portion of the book to
the discussion of cost-containment. Other strategic issues--contract management of public
facilities, coordination of activities of health sector agencies, long-term care, etc., are
discussed from the point of view of containing costs and increasing efficiency.
The status of health informatics in the Kingdom is discussed in depth. Advancement in
medical technology is seriously changing the way health care is delivered. Thanks to the
government’s readiness to support all efforts at improving quality, a good number of
health facilities have the latest medical equipment and are engaging in telemedicine and
other high-tech techniques for delivering care. Close cooperation among health facilities
in this area of high-tech medicine will be beneficial to all and significantly increase the
quality of care provided in the Kingdom.
The Author
Acknowledgements
I am deeply grateful to God for the energy and support bestowed on me during my life
and in the writing of this book. I am indebted to their excellencies Dr. Abdulwahab
Attar, Saudi Minister of Planning, and Professor Osama Shobokshi, Saudi Minister of
Health for their kindness in accepting to write a foreword.
I thank Dr. Willy De Geyndt for his wise feedback and advice. I also thank my
administrative assistant, Ms. Kathleen Banks, for her help as well as Ms. Suzanne
McLeesand Ms. Julie-Anne Graitge for their assistance in editing the book. Numerous
people in Saudi Arabia have supported this effort and have provided me with data, such
as the staff of the ministries of Health, Finance and Economy, Planning, Higher
Education, and of the medical departments of the National Guard, the Ministry of
Defense and Aviation, and the Ministry of Interior. I am very grateful for their assistance.
I also wish to acknowledge the assistance from staff of the World Bank and the World
Health Organization.
xiii
Contents
Page
Mapofthe Kingdom ofSaudi Arabia xix
Acronyms and Abbreviations xxi
Chapter1 Introduction
The Country andIts People 1
Government 2
Population 2
HistoryofHealth Care inthe Kingdom 3
OriginofMajor Health Providers 4
MinistryofHealth 4
SaudiRedCrescent Society 4
NationalGuard 4
Medical ServicesoftheArmedForces 4
Medical Services ofthe Ministry of Interior 5
The Five-Year Development Plans 5
Introduction to Subsequent Chapters 8
Chapter2 The Health Sector inSaudi Arabia
HealthPolicyEnvironment 9
Organization and Deliveryof Health Services 9
MinistryofHealth 9
Regionalization 10
MOHPrimary Health Centers 10
NationalGuardHealth Services 11
Medical Services Department ofthe Ministry of Defense 12
and Aviation
Medical Services Department ofthe Ministry of Interior 12
King Faisal Specialist Hospital andResearch Center 13
King Khalid Eye Specialist Hospital 13
University Hospitals 14
The General Organization for Social Insurance 14
SaudiRedCrescent Society 15
Other Government Health Providers 15
Private Sector 16
Contract Management ofPublic Hospitals 18
Evolution of Hospital Management 18
Chapter3 Achievements over the Last Twenty Years
Health Status ofSaudi Population 21
Human Resources 23
Physical Infrastructure 24
xv
Chapter4 Resources
Facilities 27
GrowthinHospitals and Hospital Beds bySector 27
Major Diagnostic Equipment by Sector 29
Health Centers and Polyclinics 30
Health Information System: Current Situation 31
Security Forces Hospital 33
Manpower 34
GrowthinManpowerbyNationality 34
Future Supply and Demand 36
SaudizationofManpower 37
ProgressinHealth Manpower Development 41
Closing the Resource Gap 42
Physician Assistants and Other Auxiliary Professionals 42
Saudi Council for Health Specialties 43
Chapter5 ExpendituresandFinancing
Trends in Healthcare Expenditures 44
Whythe Rising Expenditures? 45
Financing 48
Public Financing 49
Occupational Hazard Insurance 49
Private Sector Funding 49
Voluntary Insurance 51
Health Maintenance 51
Future Financing: National Health Insurance (NHI) 52
Brief Background onNHI 52
The Proposed NHIProgram 54
FirstPhase:NHIfor Non-Saudis 55
WhattoExpect 55
Future Financing: UserChargesinPublic Hospitals 57
Chapter6 StrategicIssuesandRecommendations
Contract Management of Public Facilities 61
Cost Effectiveness 61
Quality of Service 63
FutureofContract Management in Public Hospitals 64
Recommendations 65
Coordination of Activities byHealth Sector Agencies 66
Needfor Integration andCooperation 71
Recommendations 72
Cost Containment 73
Cost-Consciousness amongst Physicians 77
NHIand Cost Containment 78
Deductibles and Co-Payments 79
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