Regional profile – Saudi Arabia
Turning to the private sector


Middle East Health again visits the Kingdom of Saudi Arabia to speak to key people in the industry and review leading institutions. In the past year there has been considerable development in the field of health insurance and in the expansion of a number of leading private medical facilities. Callan Emery reports.



One of the first initiatives of King Abdul Aziz Bin Abdul Rahman Al-Saud, following the establishment Kingdom of Saudi Arabia in 1932, was to improve healthcare facilities in the country and to offer free medical care to citizens and the pilgrims who come to Saudi Arabia to visit the Islamic holy cities.

This was implemented by ensuring each administrative region in the kingdom set up its own medical facilities. Health in the country improved substantially and once-endemic diseases such as malaria and smallpox were virtually eradicated, the infant mortality rate was drastically reduced and life expectancy increased markedly. In 1970 the Government introduced the first of the five-year Development Plans.

It was on the basis of these plans that the Saudi healthcare system underwent dramatic improvement in both quality and number of healthcare facilities.

The continual upgrading of medical technology has run concurrent with the expansion of the healthcare services network. In a move to relieve the financial burden on the state for the provision of healthcare, a number of initiatives were introduced at this time to provide incentives to the private sector to develop healthcare facilities around the country.

The move was successful, particularly in cities such as Jeddah, whose population was growing fast and which sees a great number of pilgrims passing annually through the city on their way to the holy cities of Makkah and Madinah.

This is where now large hospital groups, such as Saudi German Hospitals Group, Dr S Fakeeh Hospital, Dr Bakhsh Hospital Group and Magrabi Hospital and Centres began as relatively modest operations. Overall, this has enabled Saudi Arabians to have access to a network of thousands of hospitals and clinics across the kingdom. They are no longer obligated to travel abroad to obtain specialised medical treatment.

Advanced surgical procedures such as open heart surgery and organ transplants are routinely performed in Saudi hospitals. Several Saudi hospitals rank with the best in the world and serve as models of healthcare to the Middle East, such as the enormous, superbly equipped and expertly staffed King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh which has accreditation from the highly regarded United Statesbased Joint Commission International (JCI).

KFSH also acts as a World Health Organisation (WHO) Collaborating Centre for Cancer Prevention and Control. As well as such hospitals serving as models for the Middle East, the kingdom is playing an increasingly influential role in the region as a number of entrepreneurial hospital developers, such as Sobhi Batterjee and Sulaiman Habib, expand their operations beyond the kingdom’s borders into countries such as Yemen, Egypt, the United Arab Emirates and Qatar.

Legal provisions

In March 1992 the Constitution of Saudi Arabia was adopted and promulgated by Crown Decree. According to the Constitution the State is to guarantee the rights of the citizen and his family in the event of emergency, disease, disability, and old age; it is to support the social security system and encourage legal and natural persons to contribute to charitable acts (Sec. 27). The State is to take charge of all aspects of health and ensure that healthcare is provided for all citizens (Sec. 31).

Health expenditure

The Kingdom of Saudi Arabia has invested heavily in healthcare. Facilities generally have been financed directly by the government through the establishment of hospitals and clinics and by generous incentive and support programmes to privatesector institutions. Nonetheless, budgetary constraints, the rapidly growing population and new medical technologies are causing the Government to rethink how healthcare will be financed. According to (2001) figures from the WHO, Government spent 4.6% of GDP on healthcare.

In the Middle East this compares with Lebanon’s 12.2%, the highest in the region, Jordan 9.5%, Iran 6.3%, Syria 5.4%, Egypt 3.9%, UAE 3.5% and Oman 3%. Government expenditure expressed as a percentage of total health expenditure is 74.6% (2001).

This has been fairly consistent since 1997 according to the WHO. This equates to US$375 spent on health per capita in 2001. Here Saudi Arabia is sixth in the region behind Qatar ($885), UAE ($849), Kuwait ($537), Bahrain ($500) and Lebanon ($500). Iran spends $350 on healthcare per capita and Oman $225. Egypt and Yemen are way down the list with $46 and $20 respectively. Health expenditure as a percentage of total government expenditure is 10% (WHO, 2001).

This is down from 11.5% in 1998. Private expenditure on health is 25.4% of total health expenditure (2001). This figure remained fairly constant in the five years prior to 2001.

Health insurance

In a renewed effort to free the State from some of the financial burden of providing free medical care to all nationals and foreign workers in the kingdom, the Shoura Council last year passed a law to implement mandatory health insurance for all foreign workers in the kingdom.

The motivation for this is to enable foreign workers to receive healthcare at private facilities and relieve financial pressure on government healthcare facilities where expatriate workers have traditionally been provided free medical care. After several delays the health minister Hamad bin Abdullah Al-Mani announced earlier this year a 1 June deadline for the first phase of the threephase mandatory health insurance initiative.

Phase one entails coverage of all foreign workers working in large companies (those with more than 500 employees) and public corporations. Foreign workers employed in small establishments will be covered in the second phase of the mandatory health insurance scheme. The third and final phase will cover the remaining foreign workers. Speaking to Wassim Khashoggi, chief executive officer of Waseel, a Riyadhbased IT company spearheading a digital revolution in the insurance industry in the kingdom, Middle East Health asked if the government had plans to make health insurance mandatory for nationals as well as expatriates?

“There has only been talk of having nationals covered by health insurance, but no formal plans have been made,” Khashoggi said, “However, the move to have expatriates covered will also effect Saudi nationals to some degree as some of these big companies have a large percentage of nationals as employees and they too will presumably be covered under any health insurance scheme provided by the companies. “The big push will come between phase two and three when the smaller companies will be required to have insurance.”

This will make up the bulk of the labour force, he pointed out. Phase-by-phase implementation will provide employers, medical institutions and insurers sufficient time to effectively put into operation their respective participation in the health insurance system. About 60 insurance companies have operated in the kingdom, but only one company National Cooperative Insurance Company (NCCI) is licensed. At the time of going to press the Government was expected to license a further 14 companies.

Key medical institutions

If the health of a nation can be determined by the easy access to and quality of healthcare available to its people then the kingdom of Saudi Arabia must surely rank among the best in the world. The state has spared no expense in providing free access to quality healthcare to all Saudi nationals, as well as pilgrims to the Islamic holy cities and foreign workers residing in the kingdom. Middle East Health visited the Kingdom of Saudi Arabia in April to speak to healthcare practitioners, review key medical institutions and catch up on progress made since our previous visit in May last year.

Although we only visited medical facilities in the Riyadh and Jeddah (the first and second cities) they are by no means the only major centres in the kingdom. Others include Dammam in the east, the Holy Cities of Makkah and Madinah. In the northwest is Tabouk, Hail in the north and Al- Ahsa in the southeast.

King Faisal Specialist Hospital and Research Centre

King Faisal laid the foundation stone for the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh in 1970, and in 1975 the hospital opened its doors with 120 beds. Today KFSH is the largest hospital in the Middle East. It is a 650-bed tertiary care hospital offering highly specialised treatment to the people of the kingdom.

The hospital also caries out medical research and educational programmes including postgraduate education training. For the past six years the hospital has been accredited by Joint Commission International (JCI) the prestigious United States hospital accreditation board. The hospital is large. Looking down one of the 450-metre corridors, your eyes struggle to make out the activity of doctors and nurses at the far end.

“Treatment is free except for cases that could be treated outside the hospital at other facilities,” Dr Qasim Al-Qasabi, chief executive director, told Middle East Health. “We take the complicated cases.” KFSH&RC now encompasses the King Fahd National Centre for Children’s Cancer and Research (KFNCCC&R) with 38 beds, as well as the second King Faisal Specialist Hospital and Research Centre in Jeddah with 400 tertiary care beds.

The hospital recently initiated a degree of privatisation that allows revenue to be generated and opens new avenues, enabling more flexibility in the delivery of healthcare. Areas of clinical excellence at KFSH include cardiovascular diseases, oncology, paediatric haematology and oncology, radiology, neurosciences, pathology and laboratory medicine, obstetrics and gynaecology, internal medicine, urology, surgery, liver transplant, kidney transplant, anaesthesiology, emergency medicine and orthopaedic surgery.

The hospital also has a well established scientific research centre with programmes for: biological and medical research; genetic research, cyclotron and pharmaceutical research; biostatistics, epidemiology and scientific computing; comparative medicine; and biomedical physics. The hospital also has some of the most advanced equipment in the kingdom including MRI, CT and PET scanners in the Radiology Department. A new state-ofthe- art PET-CT scanner was being installed during out visit in April. “We will be getting a stateof- the-art 64-slice CT scanner later this year,” Dr Yusuf Al Qadhi, chief of radiology, told Middle East Health. On the long list of stateof- the-art equipment are two Varian Linear Accelerators for Radiation Therapy – two of only a handful in the Middle East.

Education

An important aspect of KFSH&RC is it’s role in educating physicians. According to a report released by the hospital, 23,308 new physicians will be required by the kingdom by 2020 if it is to maintain its current ratio of 17.7 doctors for every 10,000 people. KRSH&RC has formed a partnership with the King Faisal Foundation to develop an educational facility to help keep this ratio. Under the supervision of the Academic and Training Affairs various educational programmes are run, including Residency and Fellowship training and Continuous Medical Education. There is also a scholarship programme and various support facilities.

Journal

KFSH&RC publishes the bimonthly multidisciplinary medical journal Annals of Saudi Medicine. According to the KFSH website the Annals publishes “original articles, case reports, letters to the editor, editorials, special communications, commentaries, and review articles, dealing with aspects of clinical, academic or investigative medicine or research. Emphasis is placed on matters relating to medicine in Saudi Arabia in particular, and the Middle East in general, though articles are welcome from anywhere in the world.”

For more information visit: www.kfshrc.edu.sa
 

                                  
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