Healthcare in Saudi Arabia

Pharmacy In Health Care SystemPHCL 411

Course ContentsOverview of the Health care systemsProfessional, Economic and Public Aspects of Health Care SystemPharmacy and Health Care SystemMedication Use and Distribution SystemThe Structure of Health Care System in Saudi ArabiaThe Organization of Health Care System in Saudi ArabiaFinance and Regulation of Health Care System in Saudi ArabiaAccreditation of Health Care System in Saudi ArabiaThe Role of Insurance and Private Sector in Health Care System in Saudi ArabiaGroup Project Presentation

health care system

According to the World Health Organization (WHO) , the Saudi health care system is ranked 26th among 190 of the worlds health systemsIt comes before many other international health care systems Canada (ranked 30), Australia (32), New Zealand (41), and other systems in the region such as the United Arab Emirates (27), Qatar (44) and Kuwait (45)Despite these achievements, the Saudi health care system faces many challenges which require new strategies and policies by the Saudi Ministry of Health (MOH) as well as effective cooperation with other sectors.

Introduction to health care system Consist of a number of interrelated subsystems .

Each of these subsystems has a purpose which, if attained, aids the larger system in reaching its overall goals.

For examples the healthcare systems of U.S.A, Canada , Saudi Arabia,

Components of Healthcare Systems

Health care system in the United StatesHealth care in the United Statesis provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector .health insurance is now primarily provided by the government in the public sector, with 60-65%of healthcare provision and spending coming from programs such as Medicare ,Medicaid ,Tricare , the children's Health insurance program , and theveterans Health Administration

Health care system in the United StatesThe U.S census Bureaureported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009).According to theworld health organization (WHO), the United States spent more on health care per capita($7,146), and more on health care as percentage of itsGDP (15.2%), than any other nation in 2008.The United States had the fourth highest level of government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita: Monaco, Luxembourg, and Norway.

Health care system in the United StatesThe World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).

Thecommon wealth fund ranked the United States last in the quality of health care among similar countries,and notes U.S. care costs the mostComparison between Canadian and American Health Care systemCanadian health care system

United States health care system

Coverage: Universal and comprehensiveAccess: No financial BarriersPrivate insurance: SmallPayers model: singleCost control: High and CentralizedSystem capacity: High degree of control

Coverage: Mixed: Medicare and privateAccess: Financial BarriersPrivate insurance: LargePayers model: multipleCost control: Low and fragmentedSystem capacity: Low degree of control

Overview of Healthcare system in Saudi Arabia

Table of contentsIntroduction to health care systemAspects of health Determinants of healthComponents of Healthcare SystemHealth and System GoalsOverview of the Healthcare System in the Kingdom of Saudi ArabiaDemographic and economic patterns of Saudi Arabia

Table of contentsPharmaceutical CareLevels of health care Health insurance in Saudi ArabiaBrief overview of health services developmentHow do you become a Pharmacist in Saudi ArabiaRole of pharmacist in health care Comparative Health Care SystemsChallenges facing the current health systemElements of Saudi health system reform What Makes a Good Healthcare System

Introduction to health care systemWhat is health care system?A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. A health system needs to provide services that are responsive and financially fair, while treating people decently. (WHO)

Introduction to health care systemHealth is a complex and multidimensional issue. Many of the factors influencing over all health either not in the traditional domain of health care or are difficult to influence , e.g.: Water quality , diet , genetics , and consumption of tobacco & other.The most famous modern definition of health was created during a Preamble to the Constitution of the World Healthorganization adopted by the international health conference in new York

Introduction to health care systemAccording to World Health Organization's (WHO's) "health "is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.Historically, all the great advances in health have been caused by prevention of diseases.

Aspects to health

Most people accept that health can be divided into two broad aspects - physical andmental health.Physical health : For humans, physical health means a good body health, which is healthy because of regular physical activity (exercise), goodnutrition, and adequate rest.Physical health is defined as health relates to anything concerning our bodies as physical entities

Aspects to health

Mental health: Mental health refers to people's cognitive and emotional well-being. A person who enjoys good mental health does not have a mental disorder. According to WHO, mental health is"a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community".

Determinants of health

The health of individual people and their communities are affected by a wide range of contributory factors. People's good or bad health is determined by their environment and situationsWHO says that the following factors probably have a bigger impact on our health than access and use of health care services:1.Where we live 2.The state of our environment 3.Genetics 4.Our income

Determinants of health 5. Our education level 6 .Our relationship with friends and familyWHO says the main determinants to health are: Our economy and society("The social and economic environment"),Where we live, what is physically around us("The physical environment"), What we are and what we do("The person's individual characteristics and behaviors")

Components of Healthcare SystemHealth care system Consist of a number of interrelated subsystems .Each of these subsystems has a purpose which, if attained, aids the larger system in reaching its overall goals.For examples the healthcare systems of U.S.A, Canada , Saudi Arabia, and other countries

Elements of Healthcare SystemInputs ( human resources , material , technology , information , capital , .Outputs ( patient care , acceptable costs , training , other objectives ) .Process

Feedback

Outcome (improvement in infant mortality rate and life expectancy at birth

Overview of the Healthcare System in Saudi ArabiaThe Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors. The system offers universal healthcare coverage.The healthcare system has two tiers. One is a network of primary healthcare centers and clinics. The second tier is represented by the hospitals and specialized treatment facilities located in urban areas.

Overview of the Healthcare System in Saudi ArabiaIn 1970, there were 74 hospitals with 9,039 beds; by 2005, there were 350 hospitals with nearly 48,000 beds. The Ministry of Health operates 62% of the hospitals and 53% of the clinics and centers; the remaining facilities are operated by government agencies, including the Ministry of Defense, the National Guard, the Ministry of the Interior, and several other ministries, as well as by private entities

Overview of the Healthcare System in Saudi ArabiaThe breakdown of facilities is as follows:1) Ministry of Health Facilities These serve the general public and are located in both the large cities and the small towns throughout Saudi Arabia.2) Military Hospitals These serve members of the Saudi Arabia armed forces and members of their families, according to the branch of the military in which the individual serves.

Overview of the Healthcare System in Saudi ArabiaSaudi Arabian National Guard (SANG) SANG has four hospitals which provide care to the soldiers of the Saudi Arabian National Guard and their dependents:King Abdul-Aziz Medical City, Riyadh (650 beds, formerly the King Fahad National Guard Hospital);King Abdul-Aziz Medical City, Jeddah (350 beds, formerly the King Khalid National Guard Hospital);

Overview of the Healthcare System in Saudi ArabiaKing Abdul-Aziz Medical City Dammam (100 beds);The Saudi Arabian National Guard also operates clinics in Riyadh and Taif. Saudi Arabian Ministry of Defense and Aviation (MODA)It includes the Saudi Arabian Army, the Royal Saudi Naval Forces, the Royal Saudi Air Force and Royal Saudi Air DefenseRiyadh Military Hospital Al Kharj, Riyadh (1,000+ beds);

Overview of the Healthcare System in Saudi ArabiaPrince Sultan Cardiac Center, Riyadh (150+ beds);North West Armed Forces Hospital, Tabuk (350 beds);Ministry of the InteriorThis serves members the ministry of the interior, including the police and customs collectors.Security Forces Hospital, Riyadh (500 beds), serves the Ministry of Interior personnel.

Overview of the Healthcare System in Saudi ArabiaReferral HospitalsEvery citizen is eligible to go to the referral hospitals for specialized care. These facilities include:King Faisal Specialist Hospital & Research Centre-Riyadh Site (700 beds);King Faisal Specialist Hospital & Research Centre-Jeddah Site (250 beds);King Khalid Eye Specialist Hospital, Riyadh (360 beds);

Overview of the Healthcare System in Saudi ArabiaPrivate FacilitiesFor-Profit: Saudi German Hospital, Jeddah; Dr. Erfan & Bagedo Hospital, Jeddah; Al-Habib centers and Kingdom Hospital, RiyadhSaudi ARAMCO Hospital, Dhahran (480 beds); serves employees of the oil company Saudi ARAMCO, and their family membersSocial Insurance Hospital, Riyadh (GOSI) (300 beds)Royal Commission Hospitals, which

Demographic and economic patterns of Saudi Arabia

According to last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004The annual population growth rate for 2004 to 2010 was 3.2% per annumAccording to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050

Demography of Saudi Arabia

The last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004.The annual population growth rate for 2004 to 2010 was 3.2% per annum ,and the total fertility rate was 3.04Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.67.1% of the population are under the age of 30 years and about 37.2% are under 15 years;Demography of Saudi ArabiaThe population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women).

Overview of health services development

Health services in Saudi Arabia have increased and improved significantly during recent decades .The first public health department was established in Mecca in 1925 based on a royal decree from King Abdulaziz.This department was responsible for sponsoring and monitoring free health care for the population and pilgrims through establishing a number of hospitals and dispensaries.While it was an important first step in providing curative health services, the national income was not sufficient to achieve major advances in health careOverview of health services developmentThe majority of people continued to depend on traditional medicine and the incidence of epidemic diseases remained high among the population.The next crucial advance was the establishment of the MOH in 1950 under another royal decree.Twenty years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care system.Since then, substantial improvements in health care have been achieved in Saudi Arabia.

Current Structure of health system in Saudi Arabia

Currently the MOH is the major government provider and financer of health care services in Saudi Arabia, with a total of 244 hospitals (33 277 beds) and 2037 primary health care (PHC) centers .The Ministry of Health is responsible for the supervision of healthcare and hospitals in both the public and private sectors.The healthcare system has two tiers. One is a network of primary healthcare centers and clinics that provide preventive, prenatal, emergency, and basic services, as well as mobile clinics for remote rural areas.

Current Structure of health system in Saudi Arabia

The second tier is represented by the hospitals and specialized treatment facilities located in urban areas.In 1970, the first of the governments five-year plans to promote development in a variety of areas, including healthcare, was instituted.In healthcare, the plan only meant establishing the necessary infrastructure of hospitals, clinics, pharmacies, laboratories and research facilities, but hiring expatriate staff to work in the facilities and encouraging Saudis to pursue careers in the healthcare field.

Pharmaceutical Care

The principal goal of pharmaceutical care is to achieve positive outcomes from the use of medication that improves patients' quality of life. These outcomes include: cure of a disease; elimination or reduction of symptoms; arresting or slowing a disease process; prevention of disease; diagnosis of disease; desired alterations in physiological processes, all with minimum risk to patients.

Levels of health care PRIMARY HEALTH CARESECONDARY HEALTH CARETERIEARY HEALTH CARE>2000 Around 400

Brief overview of health services development

Health services in Saudi Arabia have increased and improved significantly during recent decadesThe first public health department was established in Mecca in 1925 based on a royal decree from King Abdul-AzizThis department was responsible for sponsoring and monitoring free health careThe next crucial advance was the establishment of the MOH in 1950 under another royal decree

Brief overview of health services developmentTwenty years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care systemSince then, substantial improvements in health care have been achieved in Saudi Arabia

Role of pharmacist in health care

Pharmacist are health professionals who practice the science of pharmacy The fundamental role of pharmacists is to distribute drugs that have been prescribed by a healthcare practitioner to patientsOne of the most important roles that pharmacists are currently taking on is one of pharmaceutical care. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and the management of each in order to improve the outcome for each individual patient. ROLE OF PHARMACIST IN GLOBAL HEALTH

Role of pharmacist in health care

Pharmacists should adequately inform patients and the general public about unwanted effects of medicines, and should monitor such unwanted effects and their consequences in collaboration with other health care professionals and the appropriate authoritiesRole in Health measurement

Role of pharmacist in health care

Role in Transmitted Diseases Pharmacist can educate people by giving information that explain disease, its transmission, risk reduction and prevention against disease. Patient counseling is one of the important role that a community Pharmacist can provide.Role in Epidemiology : Epidemiology is the study of the distribution and prevention of health related events in specific population

Role of pharmacist in health care

Role of pharmacist to Provide up-to-date information about New Guidelines, New Medications , News reports about medications Provide answers to patient questions before They are asked to medical staff , Drug-drug interactions, Drug-food interactions , Drug-disease interactions

Challenges facing the current health systemFinancialManpowerGeographicalPopulation:GrowthAgingDemandingChanges in Disease patterns (NCD) New medical technologies and new medications

Elements of Saudi health system reform

To Change the Role of MOH to be Responsible for:Primary Health Care Services Preventive medicine Standardization of medical practiceSupervision of health system Health system Support To Establish The National Organization of Hospitals To Establish The National Health Fund

What Makes a Good Healthcare SystemWHAT MAKES A GOOD HEALTHCARE SYSTEM

What Makes a Good Healthcare SystemThe University of Chicago established the first master's degree program in 1934. now it is the American College of Healthcare Executive (ACHE). About 60 graduate programs were accredited by the Accrediting Commission on Education for a professional Health Services Administration.Health Education : The objective of health education is to provide the individualized information necessary for patients to modify their behavior, all in an effort to live a healthier life. Pharmacists actively promote good health practices through their own personal example

What Makes a Good Healthcare System

United States master's degree programs have more than 25,000 graduates.Educational programs provide a generic education in health services, rather than hospital, management . Some offer specialty preparation in hospital, nursing facility, or ambulatory services management.The most common educational preparation for HSO managers is the master degree.

What Makes a Good Healthcare SystemThe didactic portion for accredited programs is two academic years; 4 Semesters. Most programs include field experiences of varying lengths. Many require a 1-year residency that allows application of the academic preparation under the guidance of an On-Site preceptor.The basic curriculum in accredited health services management graduate programs covers eight areas: -1. Assessment and understanding of health status of populations; determinants of health and illness; and factors influencing the use of health services.

What Makes a Good Healthcare System2 . Understanding of the organization, financing and delivery of health services, drawing on the social science disciplines ( economics, law, political science, physiology, sociology, and related disciplines).3 Understanding of, and development of skills in, economic, financial, policy, and quantitative analysis.4 Understanding of the values and ethical issue associated with the practice of health services administration, and the development of skills in ethical analysis

What Makes a Good Healthcare System5 Understanding of, and development of skills in, positioning organizations favourably in the environment and managing these organizations for continued effectiveness.6.Provision of opportunities for development of leadership potential including stimulating creativity, and interpersonal and communication skill development.7 Understanding of, and development of skills in, the management of human capital information resources.8 Understanding of, and development of skills in, evaluation methods to assess organisational performance and, in particular; methods to assure the quality of services provided.

What Makes a Good Healthcare System AS with the graduate programs, rapid growth in the number of undergraduate programs preparing health services management personnel occurred its the late 1960s and early 1970s.Master programs prepare graduates to become senior-level line or staff managers for pharmacy ; baccalaureate programs train middle-level supervisors or department managers.

Licensure, Certification, and Registration of Caregivers

Licensure, Certification, and Registration of CaregiversLicensure: a process performed by government that allows someone to engage in an occupation after finding that the applicant has achieved a certain minimum competency . Physicians and dentists are always licensed, for example .Registration: qualified individuals are listed on an official roster maintain by government or nongovernmental body (registered nurse)

CertificationA process by which a nongovernmental agency or association grants recognition to someone who meets its qualification (Nurses-midwives are certified for example).PhysiciansNonphysical Caregivers : Dentists, Physician Assistant, Pharmacists, Technologists, & other .

Professional ,Economic and Public Aspects of health Care System LIST OF CONTENTSIntroduction to health system Goals of health care system Professional aspects of health care system Economic aspect of health systemPublic aspect of health care systemChallenges for health care reform

Professional ,Economic and Public Aspects of health Care System Introduction to health system A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.A health system is broader than the (relatively) simple function of delivering clinical care, and should maximize its potential for prevention and the promotion of equity.Professional ,Economic and Public Aspects of health Care SystemIntroduction to health system A health system encompasses:the complex interaction and feedback occurring among global contexts, organizational capacities, inter-organizational relationships, institutional environments and population health.Strengthening health systems and making them more equitable have been recognized as key strategies for fighting poverty and fostering developmentProfessional ,Economic and Public Aspects of health Care SystemThe goals of health system according to the WHOGood health, responsiveness to the expectations of the population, fair financial contribution Progress towards them depends on how systems carry out four vital functions:provision of health care services, resource generation, financing, stewardship. Professional ,Economic and Public Aspects of health Care SystemOther dimensions for the evaluation of health systems include quality, efficiency, acceptability, equity.They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and chronic illness Also, continuity of health care is a major goal.Professional ,Economic and Public Aspects of health Care System Professional aspects of health care system In Saudi Arabia, many health professionals are expatriates of various nationalities.A gradual change has been observable, with increased numbers of Saudi nationals becoming qualified and taking up employment in the health sector.In 2002 figure of 15.6 physicians/10 000 populations compares favorably with the WHO minimum recommendation of 1 physician/10 000 populations for developing countries, and the WHO Eastern Mediterranean Region average of 9.4 physicians/10000 populationsProfessional ,Economic and Public Aspects of health Care System Professional aspects of health care system The annual large influx of pilgrims during the Haj season dramatically alters the health worker/population ratio as doctors, nurses, pharmacists and allied health personnel are drawn from the different parts of the country.The pilgrimage poses special problems, not only in terms of the number of people, but also the special health problems associated with this diverse group.Saudi Arabia provides the essential man power and other resources needed to manage Haj season safelyProfessional ,Economic and Public Aspects of health Care System Professional aspects of health care system The Saudi health system is unique in that medical consultations are overwhelmingly doctor patient encounters, unlike in other settings where there are different mixes of personnel.Examples of the latter include physicians, clinicians and nurse practitioners in the United States, physicians and barefoot doctors in China, and physicians and medical auxiliaries in most Asian and African countries.The burden of the Saudi approach can better be appreciated by the enormous workload of health centre physicians in some areas.

Professional ,Economic and Public Aspects of health Care System Professional aspects of health care system There are a number of health care centers of excellence, such as the King Faisal Specialist Hospital and Research Centre and the King Khalid Specialist Hospital for Eye Diseases in Riyadh.The military hospitals, university hospitals and some private hospitals also have state-of-the-art equipment and well-qualified personnel.There is an air ambulance service that provides prompt transfer of patients from one part of the country to the other to optimize care.This arrangement helps to minimize the need for overseas treatment.

Professional ,Economic and Public Aspects of health Care System key current human resource issues and concerns.The health worker/population ratio in Saudi Arabia has improved in the last 10 years to facilitate accessibility to health services.Increased number of health colleges and institutes, and increased training and scholarship budget allocation is aiming to provide the health services with different and qualified health specialties to cover the issue of shortage in health human recourses with expansion of Saudization of health jobs.Professional ,Economic and Public Aspects of health Care System Professional aspects of health care system Human Resource Training Institutions for HealthType of institution current planned

No of institutions capacity No of institutions capacity target year Medical school 10 1861 2 120 2013School of dentistry 4 373 2 74 2013 School of pharmacy 4 625 3 150 2012 Nursing schools 43 9813 8 1600 2010-15Paramedical colleges 4 1200 2 120 2012School of public health not applied Professional ,Economic and Public Aspects of health Care System Professional aspects of health care system Saudi Board for Health specialties with MOH cooperation is responsible for accreditation, and registration mechanisms for HR InstitutionsHuman resources policy and reforms over last 10 years Increase number of qualified health workers. Saudization, in the previous 7th five year plan reached 50.9% Increased number of health colleges and institutes. Issue of guidelines for policy and procedures aiming to raise the quality of health workProfessional ,Economic and Public Aspects of health Care System Economic aspect of health systemEconomics is concerned with the allocation of scarce resources among their competing uses, on the face of unlimited human wants.Among these wants are health care services for which we cannot use exactly the same Economic Principles we use for other goods and services; because they have special characteristics that make them different than the others. That is why a special branch of economics is developed to deal with them called Health Care Economics.

Professional ,Economic and Public Aspects of health Care System Economic aspect of health systemHealth Care Economics is a new branch of Economics concerned with how to apply the Economics Tools for heath care issues and explain its different aspects to make them more analyzable.It also offers measures to determine if a certain policy will increase or decrease the economic efficiency and the equitable distribution of health care services.Of course, economic analysis cannot help in all the concerns of health professionals and the general public in the area of health care services. Professional ,Economic and Public Aspects of health Care System Economic aspect of health systemThe particular problems suitable for economic analysis are those related to scarcity of resources. In this respect, economics can explain the most preferable choices of the society when its available resources are not enough to satisfy all its needs.That is usually the case in all societies because of the strong competition between the different needs of each society such as education, health care, security, defense, roads, .etc.

Professional ,Economic and Public Aspects of health Care System Economic aspect of health systemEconomics Tools:The most used two economics tools for the analysis of health care services are:The marginal analysis which deals with optimization problems.Supply and demand analysis which is used for predicting the new equilibrium situations.

Professional ,Economic and Public Aspects of health Care System Marginal analysis is used to assist people in allocating their scarce resources to maximize the benefit of the output produced.

Simply getting the most value for the resources used. Marginal analysis: The analysis of the benefits and costs of the marginal unit of a good or input.

Professional ,Economic and Public Aspects of health Care System DEMAND AND SUPPLY ANALYSIS1. The law of demand states that consumers will purchase more of a good at lower prices and less of a good at higher prices.2. The law of supply states that producers will sell less of a good at lower prices and more of a good at higher prices.3. Equilibrium exits when there is no reason for a situation to change.When equilibrium exits, the quantity people plan to buy is equal to the quantity that producers plan to sell.The laws of demand and supply cause the market to move to equilibrium.Professional ,Economic and Public Aspects of health Care System Economic aspect of health systemThe Assumptions of Health Care:There are many assumptions concerning health care that makes it different from other industries. The following are some examples:1. Consumers of health care services lack information concerning their health problems and how they should be treated.2. Uncertainty about the medical expenditures the patients or the government may have to pay.3. Uncertainty about the results of treatment.

Professional ,Economic and Public Aspects of health Care System Economic aspect of health system4. The double role played by the doctor as an agent for the patient and as a supplier of the medical service, at the same time5. The large number of non-profit medical firms which determine the prices of their services based upon their costs only.6. Barriers to entry in the medical profession and in certain tasks delivered by the different health professionals.7. The desire of the society to provide each of its individuals with the minimum level of health care.

Professional ,Economic and Public Aspects of health Care System Economic aspect of health systemTo sum up the forgoing discussion, health care economics benefits the health care sector in many ways, which are:1. It provides a background by which medical care issues could be analyzed2. Economics can be used in the traditional aspects such as predictions and planning which are required in any other sector or industryProfessional ,Economic and Public Aspects of health Care System Economic aspect of health system3. It enables the evaluation of the effects of medical legislations and regulations on the supply and demand in the four interrelated health care markets, which are:The final market for health care.The market for health care institutions. The market for health care manpower.The market for health care education with all its levels and types.

Professional ,Economic and Public Aspects of health Care System Economic aspect of health system4. Economics provide measures to evaluate health policies in order to achieve efficiency and equity in health care.5. Economics determine the costs and benefits of the different health care choices.

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemThe public health system once was thought of as comprising only official government public health agencies now is understood to include both other public-sector agencies (such as schools, Medicaid and environmental protection agencies, and land-use agencies) and private-sector organizations whose actions have significant consequences for the health of the public. The public health system includes the following four main components:Professional ,Economic and Public Aspects of health Care System Public aspects of health care system1-Mission Themissionof the public health system includes its goals at any point in time and how, at the conceptual level, these goals are operationalized. At the beginning of the 21st century, the mission of public health is to ensure conditions in which people can be healthy.2-Structure Thestructural capacityof the public health system is the cumulative resources and relationships necessary to carry out the important processes of public healthProfessional ,Economic and Public Aspects of health Care System Structural capacity includes the following elements:information resources, organizational resources, physical resources, human resources, fiscal resources.3-Process The practice of public health can be thought of in terms of the keyprocessesthrough which practitioners seek to identify, address, and prioritize community or population-wide health problems and resources and the outputs of these more fundamental processes, public healths interventions, policies, regulations, programs, and services. Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemThe processes of public health are those that identify and address health problems as well as the programs and services consistent with mandates and community priorities.4-Outcome The immediate and long-term changes experienced by individuals, families, communities, providers, and populations are the systemsoutcomes, the cumulative result of the interaction of the public health systems structural capacity and processes, given the macro context and the systems mission and purpose.

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemOutcomes can be used to provide information about the systems overall performance, including its efficiency, effectiveness, and ability to achieve equity between populations.

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemWhat Is Public Health QualityQuality in public health is the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy.

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemPublic Health Aims:The nine aims help guide public health practices across the entire system to ensure quality for increasing positive population health outcomes.1. Population-centered:Protecting and promoting healthy conditions and the health for the entire population2. Proactive:Formulating policies and sustainable practices in a timely manner, while mobilizing rapidly to address new and emerging threats and vulnerabilities

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemPublic Health Aims:3. Equitable:Working to achieve health equity4. Health promoting:Ensuring policies and strategies that advance safe practices by providers and the population and increase the probability of positive health behaviors and outcomes5. Risk reducing:Diminishing adverse environmental and social events by implementing policies and strategies to reduce the probability of preventable injuries and illness or negative outcomes

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemPublic Health Aims:6. Vigilant:Intensifying practices and enacting policies to support enhancements to surveillance activities7. Transparency:Ensuring openness in the delivery of services and practices with particular emphasis on valid, reliable, accessible, timely and meaningful data that is readily available to stakeholders, including the public8. Effective:Justifying investments by using evidence, science and best practices to achieve optimal results is areas of greatest need

Professional ,Economic and Public Aspects of health Care System Public aspects of health care systemPublic Health Aims:9. Efficient:Understanding costs and benefits of public health interventions and to facilitate the optimal use of resources to achieve desired outcomes

Challenges for Health Care ReformChallenges for health care reform1. Provide universal coverage.Enact systematic health care reform guaranteeing access to affordable health care for all individuals from the health care providers of their choice.2. Eliminate health disparities.Dedicate more resources to assuring health equity and eliminating the disparities that persist in vulnerable populations. Payment for preventive interventions should include psychosocial initiatives and innovative care models.Challenges for Health Care ReformChallenges for health care reform3. Focus health care resources on wellness, disease prevention and primary care. Promote a greater supply and usage of primary care professionals as defined by the Institute of Medicine, including certified nursemidwives (CNMs) and certified midwives (CMs).4. Improve care integration and coordination.Promote seamless consultation, collaboration and referral among providers and institutions to improve consumer access to health care services and to their personal health information.

Challenges for Health Care ReformChallenges for health care reform 5. Align payment systems with evidencebased practice and optimal outcomes rather than on maximizing billable interventions. Promote collection and transparent reporting of standardized performance measures by all providers and institutions.6. Improve womens access to high quality care.7. Recognize that women play a key role in the health of the family and they often access the health care system through their reproductive health care provider.Challenges for Health Care ReformChallenges for health care reform8. Preserve direct access to the full range of reproductive and primary care services for women of all ages from the providers of their choice.9. Improve quality and value by strategically expanding the use of CNMs and CMs as integral members of the health care team by ensuring licensed independent provider status, universal access to hospital privileges and equal payment for professional services in all 50states and US territories10. Educate more midwives by expanding funding for scholarships, clinical sites and loan repayment.Challenges for Health Care ReformChallenges for health care reform11. Expand funding for midwifery research, demonstration projects and collaborative training of midwives and physician residents.Provide incentives for innovative delivery models such as communitybased birth centers and group prenatal car12. Significantly improve maternal and infant health. Promote high quality, evidencebased maternity care emphasizing normal birth and the appropriate use of technology and medical interventions.Organization of health care system in Saudi Arabia Table of content Brief history of the health care system organization organizationCentral organizationRegional Health OrganizationPublic Health Care SystemPrivate Health Care SystemLevels of health care International health and health related organizations Brief history of the health care system As said before a public health department was established in 1925, by a Royal decree from King Abdel- Aziz Al-Saud, based in Makka AlMukrma, with branches in provinces, followed by establishment of dispensaries, hospitals, and laboratories.This was the beginning of emphasis on prevention and environmental health. The first school of nursing was opened in 1926, followed by the school of heath and emergences in 1927.In 1951, the Ministry of Health was established. From that date the health services expanded.Brief history of the health care system From 1970 to 1980, health services were predominantly curative as most health personnel had received their formative training in patient-oriented, hospital-based medical institutes.There was a general population expectation of curative care.This care was delivered through a network of hospitals and dispensaries, preventive care was delivered by health offices and to some extent through maternal and child health care centers

Brief history of the health care system Disease control activities, such as for malaria, tuberculosis, leprosy, schistosomiasis and leishmaniasis, were handled by vertical programs.Episodic outbreak control activities were managed through the health offices.In the early 1980s, the concept of primary health care (PHC) became popular, with the WHO slogan Health For All (HFA) gaining recognition.A ministerial decree in 1980, led to the establishment of the health centers, administratively integrating the existing dispensaries, health offices and maternal and child health (MCH) centers into one unit.Brief history of the health care system At the same time, health posts were upgraded to health centers, thus paving the way for the delivery of integrated health services, i.e. initiation of the PHC approach.there are 1848 PHC centers, and 200 hospitals run by Ministry of Health. The MOH budget increased from 2,8% of the total National budget in 1970 to 6,4% in 2004.http://www.moh.gov.sa/Ministry/OpenData/Pages/OpenDataLibrary.aspxThe Saudi health system was established by a Royal decree in 2002, aimed to insure the provision of comprehensive and integrate health care to all inhabitants in Saudi Arabia in an equitable, affordable and organized manner

Organization Saudi Arabia is a welfare state with health services right to every citizen . Ministry of Health (MOH) and about 20 other government agencies and the Private Health Sector .MOH is the most important providing 60% of hospital services, 50% of Health centers services. Private Sector employs 28% of physicians, 19% of nurses and provides 19% of all hospital services Central organization : Minister appointed by King for 4 years renewable. Two Deputy Ministers and four Assistant Deputy Ministers appointed by Council of Ministers at the recommendation of the Minister

Ministry of Health Organizational Chart

Organization Deputy Minister for Executive Affairs has two Assistants ( Preventive and Curative health services).Deputy Minister for Planning and Development has two Assistant ( Planning & Research and Manpower Development) There are several Directors General and Directors ( such as Nutrition, Primary Care, Laboratories, etc).Regional Health Organization: ( 20 offices) : 13 regions headed by Director General ( Riyadh, Makkah, Gassim, Assir, Gizan, Medina, North Border,Eastern Region, Hail, Tabuk, Baha, AlJouf, Najran ) 6 Director of Health Affairs ( Holy Capital ( Makkah City), or Director of Health Services in Provinces ( Jeddah,Taif, Hafr Al Batin, Al Ehssa, Bisha ) appointed by Minister of Health .

Organization PLANNING: CENTRAL (Ministry of Planning) in co-operation with MOH, every five years , currrent is the Eighth ( emphasis on PHC, Co-ordination, Manpower saudization and development ).FINANCE : government

Organization MINISTRY OF HEALTH BUDGET

YEAR

BUDGET BILLION SAR

SALARIES %

OPERATION AND MAINTENANCE

PROJECTS

1999/200012.851.4%46.12.52000/200113.852.842.34.92001/20022002/2003----Organization MINISTRY OF HEALTH BUDGET

Organization HEALTH MANPOWER Problems : mostly expatriate( non Saudis ) , gross mal-distribution of Saudi manpower ( mostly in big cities and in hospitals) Measures to solve manpower problem : Manpower Council Deputy Minister for Planning and Development ADM for health Manpower Development OrganizationsectorPhysician Nurses Hospitals MOH 49%55.5%60.8%

Other govt 22.8%25.8%20.0%Private 28.2%18.7%19.2%Per 1000 population 199310.422.827.0199817.133.423.3 Public Health Care SystemKey organizational changes over last 5 years in the public system, and consequences: There are 13 health regions, each led by a Regional Director General for Health Services, who is directly responsible to the Deputy Minister of Health for Executive Affairs and Deputy Minister for Planning and development.Each health regional general directorate supervises one or more of health provinces through provincial health directorate.Each provincial health directorate supervises and manages at least one general hospital and a number of health centers, and supervises private health sector.Public Health Care SystemThe policies, plans and programs of the MOH are implemented through this structure.The health directorates are reasonably autonomous in terms of staff recruitment and welfare, training, discipline, supervision and evaluation.However, some responsibilities are shared with the MOH when necessary.

Public Health Care SystemEach region has a dental centre that acts as a referral centre for the dental clinics attached to the health centers and hospitals.There are medical rehabilitation centers for speech and hearing therapy, accident injury repair and physiotherapy.there is at least one anti-smoking clinic in each health directorate for counseling, health education and rehabilitation.

Public Health Care SystemUnder other government sectors are grouped the health facilities of the military, National Guard, universities (and affiliated teaching hospitals), large multinational corporations such as Saudi Aramco oil company, and a number of specialist hospitals.The other government facilities carry out similar functions to those of the MOH with respect to ambulatory care and inpatient care.Public Health Care SystemPlanned organizational reforms in the public system:1. Administrative reforms including restructuring the MOH organization structure, policies procedure, and regulations.2. Implementation of the Saudi Health System.3. Implementation of the cooperative health insurance system.4.The Primary Health Care strengthening and expansion 5. Strengthening quality assurance in health care.6. Privatization and corporatization of some of MOH hospital.Levels of health carePrimary health care : Secondary health care : Tertiary health care :First contact of persons with the health system" This is usually in PHC units found near residence or work Secondary health care is referral care from PHC This takes place in hospitals Tertiary health care is specialized / rehabilitation care .ALMA ATA CONFERENCE :PHC is essential heath care made universally accessible to individuals and families through their full participation , by means acceptable to them at a cost that the country can afford and it forms an integral part of the national health system of which it is the nucleus and of the overall social and economic development"

Levels of health care

ORGANIZED BY W.H.O. AND U.N.C.E.F. IN 1978 IN ALMA ATA IN KAZAKHASTAN SOLOGAN " HEALTH FOR ALL BY YEAR 2000" HFA/2000 .COMPONENTS : 1- food/ nutrition2- Basic sanitation / Water supply 3- Health promotion4- Maternal and child health care5- Control of common diseases6- Immunization7- Treatment of common diseases and injuries8- Provision of essential drugs

The promotion and protection of the health of the people is essential to sustained economic and social development and contributes to a better quality of life and to world peace. Governments have a responsibility for the health of their people. Primary health care is the key to attaining this target as part of development in the spirit of social justice.

Levels of health care

Levels of health care

IMPORTANCE OF PHC : solves majority of health problems - cheap - convenient . near home or work suitable working hours - family record / socioeconomic data - hospitals will concentrate on secondary care

Levels of health care

MINIMUM GLOBAL INDICATORS FOR PHC PROGRAMMES: These are the minimum requirements for successful PHC programme) HFA received endorsement (approval) as policy by highest official level.( KING, PRESIDENT, COUNCIL OF MINISTERS) Formation, strengthening and actually functioning mechanisms for involving people in implementation of strategies ( PHC friendship societies and committees)At least 5 % of GNP (general national production) is spent on health Levels of health careA reasonable amount of the GNP is spent on primary health care. Resources are Equitably Distributed .( ACCORDING TO NEEDS) PHC is available to the whole population with at least within 15 minutes walking distance Adequate Sanitary Facilities ( refuse collection and disposal ) in home or vicinity ( near home )Immunization with DPT , MMR , BCG Primary Health Care (PHC) with at least 20 drugs within one hour walk.

Levels of health careTrained Attendants (Midwives) for pregnancy, delivery, infants health.Adequate Nutritional Status of Children: - At Least 90 % newborns have birth weight of 2.5 kg + and 90 % of children have within normal weight for age.Infant Mortality Rate Not Exceeding 50 / 1000 live births.Life Expectancy at birth Not Less than 60 years.

INTERNATIONAL HEALTH AND HEALTH RELATED ORGANIZATION Name Abbreviation Head quarter Activities World health organization W.H.OGeneva, Switzerland Health promotion ,health legislation , control of diseases United nations children fund U.N.I.C.E.FNew York , USA Child &mother health Food agriculture organization F.A.O

Rome,italy Food production nutrition United nations education scientific& cultural organization U.N.E.S.C.OParis , France Health education &training Private Health Care SystemModern, for-profit: The private health sector includes private hospitals, clinics, dispensaries and pharmacies. The facilities are mostly located in urban centers. The private sector has grown rapidly in recent years. Health services vary from basic medical care to highly organized specialist services.Traditional: There is a recently established traditional medicine department in MOH to supervise and control traditional medicine in the market.Key changes in private sector organization: MOH fully cooperates, and coordinates with the private health sector, either directly or through the medical units in chambers of commerce and industry in the kingdom.Private Health Care SystemPublic/private interactions (Institutional), Participation in joint committees.Plays a major role in cooperative health insurance system. Privatization and corporatization projects.Public/private interactions (Individual), Under-development.Finance and regulations of health care system in Saudi Arabia Health care financing Health insurance governance principles Types of insurance in Saudi Arabia Council of Co-operative Health insurance FinancingStrategies for Health Industry Development PolicyHealth care funding and subsidyHealth Regulators

Contents

Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.67.1% of the population are under the age of 30 years and about 37.2% are under 15 years;The population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women).

Finance and regulations of health care system in Saudi Arabia Health care financing In Saudi Arabia, the health service is in general publicly fundedThe percentage of GDP spent on health was 3.4% in 2005. In the same year the percentage of private GDP spent on health was 0.8%The government expenditure on health as a percentage of total expenditure on health was 76.2, and private expenditure was therefore 23.8.This is higher than the percentage of GDP spent on health in the neighbouring country of the United Arab Emirates, where public expenditure was 2% of GDP and private expenditure was 0.9% of GDPFinance and regulations of health care system in Saudi Arabia Health care financing This can be compared with other public expenditure within Saudi Arabia, in order to get an insight into the priorities of the government.There has been an improvement over the years, and it is hoped that the government continues to move in the same directionSaudi Arabia could greatly improve its health system by investing more money in this sector.Despite the disproportionate expenditure on health, the government appears to have a fairly positive health care strategy, and looks to be constantly improving its health system.Finance and regulations of health care system in Saudi Arabia Health care financingThe Health System is monitored and improved by the Ministry of Health, and the progress made in this area, as well as other socio-economic factors has been vast over the past thirty years.Despite the progress already made there are still many further developments required which will become apparent as the system is explored further.Finance and regulations of health care system in Saudi Arabia Availability, accessibility, acceptability and qualityThe AAAQ is an element that is enshrined in General Comment 14 on the highest attainable standard of health.The concepts of availability, accessibility, acceptability and quality are used to tell whether the highest attainable standard of health is being reachedAvailability. Functioning public health and health care facilities, goods and services, as well as programmes in sufficient quantityFinance and regulations of health care system in Saudi Arabia Accessibility covers a wide range of aspects, and as a result has four over lapping dimensions; affordability, information accessibility, physical accessibility, and nondiscrimination of health services.1. AffordabilityHistorically, the health system was publicly funded by the government.

Finance and regulations of health care system in Saudi Arabia AffordabilityHowever, providing free medical care to all was beginning to place a great financial burden on the state, as there is no tax system.In order to improve the situation the Shoura Council passed a law in 2004 to implement mandatory health insurance for all foreign workers in the Kingdom.The law is to be implemented in a three-phase .The first phase covers all foreign workers working in large companies, and the second covers workers in small establishments. Both these phases have now been implemented.Finance and regulations of health care system in Saudi Arabia The third phase will cover all remaining foreign workers2. Information accessibilityAnother aspect of the AAAQ that Saudi Arabia is having problems meeting is a feature of the concept of accessibility: the so-called information accessibility.WHO believes the country needs to establish an efficient National Health Information System (NHIS)

Finance and regulations of health care system in Saudi Arabia 3. Physical accessibilityA further concern is the physical accessibility of health care. It is recommended that primary health care centres should be appropriately situated throughout a country and a citizen should not live more than one hour away from their closest medical centre.Saudi Arabia is a member of the Gulf Council Cooperation 2009 for primary health care promotion, and has implemented a family practice residency programme, to integrate care at primary health centres.

Finance and regulations of health care system in Saudi Arabia Acceptability: All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, as well as sensitive to gender and life-cycle requirements.

Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality.Finance and regulations of health care system in Saudi Arabia Health insurance governance principles

1. Transparency and Predictability2. Accountability3. Participation4. Efficiency and effectiveness

Finance and regulations of health care system in Saudi Arabia Types of insurance in Saudi ArabiaProperty and casualty 34% Aviation

Marine

Medical Malpractice

Car 34%

Health 32%

Finance and regulations of health care system in Saudi Arabia Council of Co-operative Health insurance FinancingThe Council of Cooperative Health Insurance (CCHI) is working to educate the private sector about the benefits of health insurance.The after-effects of the recession, which has negatively affected most of the world, have had less of an impact on Saudi Arabias insurance industry, which has been thriving over the past few yearsHealth insurance is leading as one of the fastest growing segments in the countrys insurance sector, becoming a key growth driver for the overall marketFinance and regulations of health care system in Saudi Arabia Council of Co-operative Health insurance FinancingThere has been much interest in investing in Saudi Arabias private medical care since the Cooperative Health Insurance Act in 1999.This act has provided medical insurance to all private sector workers within Saudi Arabia, successfully insuring over 8.6 million Saudi and expatriate employees and their families to date.There are many benefits of insurance for both workers and the insurance industry. Due to the surge in the number of insured workers, insurance companies have advanced their products and services to serve the target market.Finance and regulations of health care system in Saudi Arabia Council of Co-operative Health insurance FinancingThe role of the Council of Co-operative Health insurance is to work towards educating the private sector about the many benefits health insurance has for their workers. The CCHI certifies 26 insurance firms, five third-party administration companies, and over 2400 healthcare providers.There is a big future of growth for private medical care in Saudi Arabia, with supporting factors such as low penetration, strong governmental support, and rising awareness of insurance.Finance and regulations of health care system in Saudi Arabia Strategies for Health Industry Development PolicyEstablishment of National health Related References Saudi Food and Drug Authority Saudi Commission of Health Specialties Council of Co-operative Health Insurance National Center for Health care Quality and Accreditation The National Health Council Involve Direct and Indirect Health Industry Stake Holders Major Health Providers Private Sector Ministry of civil service, labor, Finance etc.Staging of Health industry Policy Development Finance and regulations of health care system in Saudi Arabia Health care Funding and Subsidy:For nationals Health care is completely funded by the government For private sector workers health care is covered by employers For religious visitors health care is paid for by the governments For business and tourist visitors health care will be insured

Finance and regulations of health care system in Saudi Arabia Health RegulatorsThe National Organizations:

The National Health Council The Saudi Food and Drug Authority Council of Co-operative Health InsuranceThe Saudi Commission for Health SpecialtiesMinistry of healthFinance and regulations of health care system in Saudi Arabia The National Health Council Most important achievements of the Committee during the last period were : 1. Contribute to raise loans to the hospitals (200) million.2. Participate in the amendment of the Regulations of the health system to meet with Undersecretary of the Ministry of Health for Executive Affairs.And hopefully more regulations and effort will be made in the process of Saudi health care development.

Finance and regulations of health care system in Saudi Arabia The Saudi Food and Drug AuthorityThe Saudi Food and Drug Authority (SFDA) was established under the Council of Ministers resolution no (1) dated 07/01/1424 H, as an independent body corporate that directly reports to The President of Council of MinistersThe main purpose of the SFDA establishment is to regulate, oversee, and control food, drug, medical devices, as well as to set mandatory standard specifications thereof, whether they are imported or locally manufactured.The control and/or testing activities can be conducted in the SFDA or other agency's laboratoriesFinance and regulations of health care system in Saudi Arabia The Saudi Food and Drug AuthorityThe main objectives of SFDA can be outlined as follows:1. Observe the safety, security, and effectiveness of food and drug for humans and animal.2. Observe the safety of complementary biological and chemical substances, cosmetics and pesticides.3. Observe the safety of medical devices and its impact on public health.4. Ensure accuracy and safety of medical and diagnostic devices.

Finance and regulations of health care system in Saudi Arabia The Saudi Food and Drug Authority5. Launch clear policies and procedures for food and drug, and plan to achieve and implement these policies.6. Control and supervise licenses procedures for food, drugs and medical devices factories.7. Conduct research and applied studies to identify health problems, their causes, determine its impact on public, with the consideration of methods for research / studies evaluation.8. Disseminate and exchange information with local and international scientific and legal agencies, and setting up a database for food and drug.

Finance and regulations of health care system in Saudi Arabia Council of Co-operative Health InsuranceFunding health care services is a central challenge faced by the government. To meet the growing population demands for health care and to ensure the quality of services provided, the Council for Cooperative Health Insurance was established by the government in 1999.The main role of this Council is to introduce, regulate and supervise a health insurance strategy for the Saudi health care marketFinance and regulations of health care system in Saudi Arabia The Saudi Commission for Health SpecialtiesSaudi Commission for Health Specialties (SCHS) is body corporate scientific commission aims at development of professional performance and encouraging skills and enriching scientific intellect and suitable practical application in the field of various health specialties. It was established under the Royal Decree No. M/2 dated 6/2/1413HIn compliance to (SCHS) objectives, it has undertaken the following:1. To set up professional health specialist programs and approving and supervising the same.

Finance and regulations of health care system in Saudi Arabia The Saudi Commission for Health Specialties2. And to set up programs for ongoing medical education in health specialties within the frame of general policy of education3. To form health scientific boards and sub-committees required for performing work and supervising and approving recommendations thereof.4. To recognize health institutions for the purpose of training and specializing after evaluating the same.5. To supervise specialist examinations and approve results thereof through specialist scientific committees and boards

Finance and regulations of health care system in Saudi Arabia The Saudi Commission for Health Specialties6. To issue professional certificates such as Diploma, Fellowship, and Membership either the examination conducted by it directly or through collaboration with it.7. To coordinate with professional health boards, commissions, societies and colleges inside and outside the Kingdom.8. To evaluate and equalize health certificates.9. To encourage preparing researches and publishing scientific articles in the field of specialty and issuance of journals or periodicals.10. Participation in proposing general plans of preparing and development of manpower in health fields.

Finance and regulations of health care system in Saudi Arabia The Saudi Commission for Health Specialties11. To organize forums and press conferences for discussing internal health problems and proposing suitable solutions and following up implementation of recommendations and resolutions issued in relation thereto.12. To set up principles and standards including ethics for practicing health professions.13. To encourage preparing health scientific researches and proposing subjects and supporting such researches and financing the same either in whole or part.14. To give approval to establishing scientific societies for health specialties.

Finance and regulations of health care system in Saudi Arabia Ministry of healthMinistry of health is the responsible for health care system in Saudi Arabia .Currently the MOH is the major government provider and financer of health care services in Saudi Arabia, with a total of 244 hospitals (33 277 beds) and 2037 primary health care .The MOH is responsible for managing, planning and formulating health policies and supervising health programmes, as well as monitoring health services in the private sector.It is also responsible for advising other government agencies and the private sector on ways to achieve the governments health objectives

Finance and regulations of health care system in Saudi Arabia Ministry of healthThe MOH supervises 20 regional directorates-general of health affairs in various parts of the country.Each regional health directorate has a number of hospitals and health sectors and every health sector supervises a number of PHC centres. The role of these 20 directorates includes implementing the policies, plans and programmes of the MOH; managing and supporting MOH health services; supervising and organizing private sector services; coordinating with other government agenciesFinance and regulations of health care system in Saudi Arabia The role of insurance and private sector in health care system in Saudi Arabia

Contents Country Facts and Current Health SystemHealth insurance in Saudi Arabia Staging of Health InsuranceTypes of Insurance In Saudi market:Key Players of health care in Saudi ArabiaBudget AllocationsSector OverviewKey Stakeholders view points

The role of insurance and private sector in health care system in Saudi Arabia Country Facts and Current Health SystemKSA has the largest and fastest growing population in the GCC.The last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million in 2004.The annual population growth rate for 2004 to 2010 was 3.2% per annum.Fertility rate was 3.04

The role of insurance and private sector in health care system in Saudi Arabia

The role of insurance and private sector in health care system in Saudi Arabia Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females.67.1% of the population are under the age of 30 years and about 37.2% are under 15 years; the population over the age of 60 years is estimated at 5.2%According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050.This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women)

The role of insurance and private sector in health care system in Saudi Arabia Current Health System:The Healthcare sector in the Kingdom of Saudi Arabia is primarily managed by the Government through the Ministry of Health (MOH) and number of semi public organization who specifically operate hospitals and medical services for their employees.In addition, private sector operators are also playing a key role in providing quality healthcare services in the Kingdom.

The role of insurance and private sector in health care system in Saudi Arabia Current Health System:

KSAWHO Data 20132General Government Health Expenditure (GGHE) as% of Gross Domestic Product (GDP)5General Government Health Expenditure (GGHE) as % of General government expenditure (GGE)64General Government Health Expenditure (GGHE) as% of Total Health Expenditure55Out of Pocket Expenditure (OOPS) as % of PrivateHealth Expenditure (PvtHE)20Out of Pocket Expenditure (OOPS) as % of TotalHealth Expenditure (THE)36Private Health Expenditure (PvtHE) as % of TotalHealth Expenditure (THE)22Private Insurance as % of Private Health ExpenditureWHO Data 2013

The role of insurance and private sector in health care system in Saudi Arabia Main Health Providers:

Health FacilitiesThe role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia :Funding health care services is a central challenge faced by the MOH.Since the total expenditure on public health services comes from the government and the services are free-of-charge.This lead to considerable cost pressure on the government, particularly in view of the rapid growth in the population, the high price of new technology and the growing awareness about health and disease among the community.The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia :To meet the growing population demands for health care and to ensure the quality of services provided, the Council for Cooperative Health Insurance was established by the government in 1999.The main role of this Council is to introduce, regulate and supervise a health insurance strategy for the Saudi health care market.The implementation of a cooperative health insurance scheme was planned over 3 stages

The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:In the first stage, the cooperative health insurance was applied for non-Saudis and Saudis in the private sector, in which their employers have to pay for health cover costs.In the second stage, the cooperative health insurance is to be applied for Saudis and non-Saudis working in the government sector.The government will pay the cooperative health insurance costs for this category of employee.

The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:In the final stage, the cooperative health insurance will be applied to other groups, such as pilgrims.Only the first stage has been implemented to date, with the cooperative health insurance being implemented gradually in a 3-phase programme to employees of the private sector and their dependants.The first phase covered companies with 500 or more employees, while the second phase applied to employers with more than 100workers

The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:The third phase included employees of all companies in Saudi Arabia as well as domestic workers.The government is now working systematically to apply the remaining 2 stagesfor employees in the government sector and for pilgrims before they privatize the state-owned health care facilitiesWhile the market for cooperative health insurance in Saudi Arabia started with only one company in 2004.It currently involves about 25 companiesThe role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:The introduction of the scheme is intended to decrease the financial burden on Saudi Arabia due to the costs associated with providing health services free-of-charge.It will also give people more opportunity to choose the health services they require.No information is available yet regarding the cooperative health insurance scheme for the population of Saudi Arabia other than employees and expatriates.

The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:Backed by new regulations, the health insurance market in Saudi Arabia is expected to experience a healthy growth rate. Health insurance Gross Written Premium (GWP) stood at around SAR 8.7 Billion (US$ 2.35 Billion) in 2010. It is expected to reach SAR 21.1 Billion (US$ 5.70 Billion) by the end of 2015, growing at a CAGR of around 19% during 2011-2015.In terms of health insurance premiums, the market is dominated by three companies: Tawuniya (22%), Medgulf (19%) and Bupa (22%) who are estimated to capture 63% of the total Gross Written Premium.

The role of insurance and private sector in health care system in Saudi Arabia Health insurance in Saudi Arabia:This indicates a potential threat to healthcare providers, i.e. it restricts their bargainingpower to set discount levels with the insurance companies.Concurrently this provides an opportunity to healthcare providers to reduce administration costs rather than having to deal with a myriad of differing forms and administration systems from a large number of insurance companies.The role of insurance and private sector in health care system in Saudi Arabia Staging of Health Insurance:

Co-operative Health Insurance for non-Saudis and Saudis in Private SectorNational Health Insurance System for Saudis AndNon-Saudis in the Governmental SectorOther Groups e.g. Religious visitorsThe role of insurance and private sector in health care system in Saudi Arabia Types of Insurance In Saudi market:Property and casualty 34% Aviation Marine Medical MalpracticeCar 34% Health 32%

The role of insurance and private sector in health care system in Saudi Arabia Key Players of health care in Saudi Arabia:Ministry of Health (MOH):Approximately 60% of all hospitals within the Kingdom are owned and operated by the MOH.These hospitals provide basic healthcare services, as well as, in certain cases, specialized facility centres.MOH facilities are increasingly being made available mostly to Saudi Nationals only with accessibility to expatriates in majority of cases restricted to specialized treatments except in rural areas where private sector facilities are not present.

The role of insurance and private sector in health care system in Saudi Arabia Key Players of health care in Saudi Arabia:Other Governmental Organizations: Health treatment in other government and quasi organizations is effectively free for employees, typical organizations would include The National Guard, Ministries of Defence and Aviation and the Royal Commission.Private Sector: Historically most of the outpatient treatments were provided by the private sector. However, increasingly inpatient treatments are also being provided by the private sector due to the high demand and the restrictions placed on entry to MOH facilities.The role of insurance and private sector in health care system in Saudi Arabia Budget Allocations:Between 2005 and 2008 Saudi Arabia allocated approximately SAR 23.5 billion per annum with a cumulative amount of SAR 94 billion investment in the healthcare sector.However, in 2010 and 2011 there was a substantial increase in the healthcare budget which increased from SAR 30 billion (6.3% of total Government Budget) in 2008 to SAR 52 billion in 2009 (11% of total Government Budget) and to SAR 61.2 billion in 2010 (11.3% of total Government Budget).

The role of insurance and private sector in health care system in Saudi Arabia Budget Allocations:The budget allocation was further increased to SAR 68.7 billion (11.8% of total Government Budget) in 2011, a cumulative allocation of SAR 113 billion in last two years compared to SAR 94 billion in the previous four years.In order to maintain the network of healthcare facilities, the Saudi Government has implemented a two tier health service plan; Tier 1 includes a network of primary healthcare centres and clinics established throughout the Kingdom. These clinics and centres are backed by a network of secondary care hospitals and specialized treatment facilities.

The role of insurance and private sector in health care system in Saudi Arabia Budget Allocations:(Tier 2) located mainly in major urban areas across the country.Moreover, comparing the healthcare indicators of Saudi Arabia to other developed countries such as the US, UK and Germany demonstrates there is a shortage of doctors, nurses and beds in Saudi Arabia. The shortage is prevalent across all GCC countries, however, Saudi Arabia has the lowest number of beds, nurses and doctors per population within the GCC.The role of insurance and private sector in health care system in Saudi Arabia Sector Overview:There are currently over 369 hospitals, both within the public and private sectors provide various healthcare facilities and treatment throughout the Kingdom. In 2009, the total number of doctors and nurses was approximately 62,805 with over 20% employed at hospitals in Riyadh.Bed Capacity: Total number of beds at MOH hospitals increased from 28,751 in 2002 to 33,277 in 2008 while the private sector and quasi government hospitals bed capacity increased from 10,133 and 10,300 in 2002 to 11,822 and 10,833 respectively for the same period.

The role of insurance and private sector in health care system in Saudi Arabia Sector Overview:The gradual increase in private hospital beds is also due to influx of expatriate patients seeking medical treatment who previously had access to MOH hospitals.total number of hospital beds in Saudi Arabia increased from 49,148 in 2002 to 55,932 beds in 2008, an increase of 13.7% over the six year period and the total number of hospitals increased from 350 in 2002 to 408 in 2008, an increase of 16.6% during the same period.The bed capacity at MOH hospitals is by far the largest, accounting for 59% of cumulative hospital bed supply in Saudi Arabia.

The role of insurance and private sector in health care system in Saudi Arabia Sector Overview:inpatients and Outpatients: The number of outpatients is considerably higher than in-patients. This is in line with the nature of outpatient treatments which are less than a day long with a high percentage of cases consisting only of consultations.On average residents of KSA visit healthcare facilities five times a year, from which 31% are to Private sector facilities.

The role of insurance and private sector in health care system in Saudi Arabia Sector Overview:Keeping abreast of the increasing healthcare demands and the limited supply of hospitals & specialized treatments, the Ministry of Health in Saudi Arabia has embarked on ambitious plans to establish 195 healthcare projects including thirty-three new hospitals with five hospitals having a bed capacity of over 500 beds.These five hospitals are expected to be constructed in East Riyadh, North Jeddah, Makkah, Balijurashi and Tabuk.The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:Extracted and combined from questionnaires and interviews the following represents the views of key stakeholders (investors and operators) in Saudi Arabia relating to the healthcare sector.Market Structure: The current healthcare sector is dominated by insurance companies (25 companies listed on the Saudi Stock Exchange) and is hence driven by cost versus quality. Unless a set regulation is introduced to monitor pricing, healthcare access and quality of care in private hospitals will continue to face lower profit margins and collection delays which will result in lower quality of care.The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:Shortage of Hospital Beds: The present shortage of beds which is growing with time, can be overcome by funding from the public sector to establish new hospitals both in public and private sectors, as well as, improving and expanding existing facilities.Lifestyle related Disease: There is a tremendous increase in lifestyle related diseases such as diabetes, hypertension, obesity, heart and kidney Presently, the private sector plays an important the role in providing care for these diseases.

The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:However, government needs to take an active role in prevention through educating people and offering preventive services.Shortage of Healthcare resources: One of the major costs for healthcare providers is spending on qualified medical staff. A large number of doctors, nurses, pharmacists and paramedical staff in KSA migrate to Western Countries after a few years due to better opportunities and training facilities.The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:In addition, the current Saudi regulations for recruitment and Saudization continue to further increase the staff cost due to limited available resources. Government role is extremely important in establishing career-focused educational institutions (such as medical, pharmacy and nursing colleges) to increase the supply of local medical professionals and to drive qualified Saudi talent into jobs.

The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:Competition from Public Sector Hospitals: Public Sector Hospitals are not cost driven and therefore provide quality healthcare services to the population either free or at subsidized rates. However, with the current population growth, access has been a major issue in public sector hospitals.This shortage has resulted in an increase in demand for private healthcare facilities. With increased healthcare costs and emergence of lifestyle related diseases, public and private players should form partnerships to create better provision of care.The role of insurance and private sector in health care system in Saudi Arabia Key Stakeholders view points:implementation of best practice: Implementation of Information Technology should have greater prevalence in the sector similar to other developed countries in which medical files for patients are either unified or centrally maintained. Improvement in unified or centralized filing is expected to improve diagnosis and provision of healthcare services.Private hospitals will continue to play an even more important and crucial role within the Kingdom..The role of insurance and private sector in health care system in Saudi Arabia The delivery of healthcare in the Kingdom and around the world continues to evolve as the needs of healthcare provider become increasingly complex.Trends and industry changes requires investors and operators of healthcare facilities to make challenging decisions.Despite improvements in healthcare systems across the Kingdom, the healthcare sector still offers significant opportunities for investors / operators.We believe that due to strong growth fundamentals coupled with the increasing population and regulatory changes the sector is expected to experience robust growth in the foreseeable future .Medication use and distribution systems in Saudi Arabia List of contents Introduction to medicinesdefinition of drugsUse of medications in Saudi ArabiaDrug Distribution ModelsDrug distribution systems (i)Individual Prescription Order System. (ii) Complete Floor Stock System (iii)Combination of (i) and (ii). (iv) The unit dose method.

Introduction to medicines

Amedicationormedicineis a drug taken to cure and/or ameliorate any symptoms of anillness or medical condition, or may be used as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms.Dispensing of medication is often regulated bygovernment into three categories. over-the-counter- (OTC) behind-the-counter-(BTC) prescription only medicine (POM)

Introduction to medicinesOver-the-counter(OTC)drugsaremedicines that may be sold directly to a consumer without a prescription from a healthcare professional .As compared toprescription drugs , which may be sold only to consumers possessing a valid prescription.in many countries, OTC drugs are selected by aregulatory agencies to ensure that they are ingredients that are safe and effective when used without aphysicians 's care.Introduction to medicinesBehind-the-counter (BTC)drugs : which are dispensed by apharmacist without needing a doctor's prescription.prescription medication: Aprescription medicationis alicensed medicine that is regulated by legislation to require amedical prescription before it can be obtained.Medications are typically produced by pharmaceutical companies and are oftenpatented to give the developer exclusive rights to produce them, but they can also be derived from naturally occurring substance in plants calledherbal medicines .

Definition of drugs

A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function.Inpharmacology a drug is "achemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being.According to Federal Food, Drug, and cosmetic Act definition of "drug" includes "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals

Use of medication in Saudi Arabia

Drugs are the fastest rising cost in the health care system. All developed nations are seeking ways to cut down the budgets allocated for buying drugs.In Saudi Arabia and other countries, the cost of maintaining the health care system is escalating out of control.Governments, health care providers and consumers have to find ways to reduce these escalating costs while maintaining the quality of care that these countries have grown to expect.Two contributing factors to the increased costs of medicines are the marketing costs for pharmaceutical firms and the expenses incurred in the development of new drug products

Use of medication in Saudi Arabia

Among the major reason behind the increased expenditure on medication is medication waste which is an unnecessary burden on an already fiscally restrained health care system in these countries.Medication wastage is defined as any drug product, either dispensed by a prescription or purchased over the counter (OTC), that is never fully consumed. Medication wastage may be due to poor compliance of patients, excessive and irrational prescribing, 6or the lack of control of the sales of prescription medications in the community pharmacy. Use of medication in Saudi ArabiaThe problem of wastage is almost universal. In Great Britain, the scale of the problem of wastage is enormous, research suggests that as many as 50% of the patients fail to comply with the terms of their prescription.A survey of 111 households was performed in England to determine the quantity and types of medicines in the homes and to investigate the incidence of double prescribing, wastage and hoarding.

Use of medication in Saudi ArabiaThe investigators found that 51% of the medicines were not in current use by the patients and of those 40% were considered out of date.In Canada, two studies have sorted through piles of discarded medications seeking reasons why the waste of drugs is of "mammoth proportions.The top medicines wasted regarding their dollar value were antihypertensive drugs followed by analgesics and anti-inflammatory drugs.Drug distribution system Traditional methods of distributing drugs in hospitals are now undergoin