Question

Which policies would you like to introduce into the health system in Saudi Arabia but which are likely to face major feasibility problem?

Answer 1

Ans) Saudi Arabia will need to consider both components in any future policy changes. Analysis of the systems showed that there is little to support the use of predominantly funded healthcare models based on the experiences of Saudi Arabia and the UK.

- These models do have some advantage in that
they provide equitable access to healthcare which is free at the point-of-delivery. However, they are associated with high levels of expenditure. It would also seem that the ra-
tioning which is necessary creates a situation in which richer citizens choose to access private care available, which may then reduce the equity in the system.

- At the opposite end of the spectrum is the predominantly privately owned and funded approach adopted in the USA.

- Evidence suggests that while this approach would theoretically be most efficient, in reality it is still associated with huge government costs, due to problems with maintaining access for those in disadvantaged groups. There is also a risk that those who are less risk-averse will not take out insurance if not mandated and will then suffer financial hardship or receive poorer quality care at a later stage.

- The Australian social insurance model
seems to be associated with high quality care, which would suggest there may be some promise for the model.

- The mainadvantage is that insurance membership is mandated, with those in employment and their employers contributing most of the cost. There remains an issue of moral hazard with this approach which could see large amounts of money being
required to maintain the disadvantaged population. The only system which seems to overcome this problem is that of Singapore, which adopts a PPP approach. This would therefore seem to be the model which would allow KSA to maintain the highest level of healthcare quality while also reducing
healthcare costs.

- However, more in-depth analysis may be
required of this system to understand how it would translate to the context of KSA.

- In particular, care needs to be taken
in any system which is selected for adoption so as to reduce the risk of undoing the gains in national healthcare which have been achieved in the recent past.

- For example thereneeds to be care to retain high levels of access to primary health, particularly for children, to retain the high levels of vaccination currently observed and prevent communicable disease spread.

On the basis of the findings, the following recommendations are made:
• Healthcare reform: It is clear that the current model of Saudi Arabian healthcare is not sustainable in the future and reform of the system is necessary.
• Research: Further in-depth analysis of the Singaporean healthcare system would be useful to understanding how this would apply in the context of KSA.
• Health insurance model vs. pure privatisation:
The health insurance model which has been proposed for the KSA would seem to be preferential to the pure privatisation model adopted in the USA.

- Steps may need to be taken to reduce the risk of moral hazard as a means to curbing government spending that may still be associated with this model.