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
