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Abstract

The Saudi Vision 2030 emphasizes the need for health insurance in terms of both economic growth and lowering government healthcare costs. Recently, the Saudi Ministry of Health has requested the private sector to contribute more to health spending through alternative financing and delivery systems, specifically health insurance. The main purpose of this review is to systematically review the benefits and issues of the implementation approach for health insurance in Saudi Arabia. Three electronic databases were used to conduct the systematic search for articles published in 2018 or after as this is a recent review of the last 5 years articles. Articles were considered if they matched the following criteria: Saudi articles concentrating on health insurance in Saudi Arabia, with a particular emphasis on issues, problems, barriers, and challenges related to insurance in Saudi Arabia. Of the many references identified in the initial search, 13 studies were identified that met the inclusion criteria. The included studies clearly highlighted, explained the current financial methods of the healthcare system in Saudi Arabia, and evaluated Cooperative Health Insurance’s potential contribution to the healthcare system’s success in achieving the Saudi Vision 2030 goals, as well as the benefits and disadvantages of health insurance. This review exemplifies the need for implementation of health insurance in Saudi Arabia to improve economic growth, and to improve efficiency and quality of care. Many of the issues were identified in this review could be addressed by a strong healthcare infrastructure. The Council of Cooperative Health Insurance and Saudi Arabian Monetary Agency should keep monitoring medical services and collaborating toward enhancing Saudi Arabia’s health insurance.

Keywords

Saudi Arabia health insurance Saudi Vision health transformation health insurance challenges

What do we already know about this topic?

The Saudi Vision 2030 emphasizes the need for health insurance in terms of economic growth and lowering government healthcare costs. As a result, the Saudi Ministry of Health has requested the private sector to contribute more to health spending through alternative financing and delivery systems, specifically health insurance.

How does your research contribute to the field?

This systematic review highlights the advantages, challenges, weaknesses and strengths of implementing health insurance system in Saudi Arabia. Many of the issues related to the Saudi health insurance system were identified in this review after the implementation of health insurance industry in Saudi Arabia.

What are your research’s implications toward theory, practice, or policy?

Introduction

Nations are always attempting to put effective health policies and reforms into place to improve the health and well-being of their citizens. A global understanding of the significance of establishing equitable access to health services and universal health care is developing.¹ At a time when many nations are aiming to meet the third Sustainable Development Goal (SDG); which aims to ensure healthy living and promote well-being for people of all ages, health insurance remains a crucial policy option for improving health outcomes.² “The SDGs aim to transform our world. They are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice, and prosperity.”³

Effective health insurance is defined as a pooling funding function, is a critical tool for obtaining financial security. The term health insurance refers to “a method of dividing the financial risk brought on by the variation in each person’s health care costs by pooling costs over time through pre-payment and across people through risk sharing.”² In order to separate financial contributions from healthcare demands, health insurance should lead to a large-scale and efficient resource pooling that incorporates the entire population in a single risk fund. Different institutional systems, such as the National Health Service (NHS), National Health Insurance (NHI), or Social Health Insurance (SHI) schemes, can be used to achieve this.²

Saudi Arabia provides free access to healthcare services to both Saudis and non-Saudis working in government sectors, which significantly raises the cost of financing healthcare in the kingdom, which is exacerbated by rapid population growth and rising medical technology prices.⁴ Currently, Saudi Arabia is expanding its massive healthcare system. The current countrywide strategy plan, Vision 2030, encourages the formation of complementary autonomous organizations administrations to support basic governmental infrastructures, which will surely grow healthcare and improve access to cutting-edge technological treatments.⁵

Saudi Vision 2030 is a comprehensive strategy for reforming Saudi Arabia’s overall economic system. The key goals are to expand various businesses and industries so that the economy is no longer depending on oil as a source of income, as well as to reduce state spending with a greater emphasis on engagement from the private sector.⁵ The Vision 2030 emphasizes the need for health insurance in terms of both economic growth and lowering government healthcare costs. Furthermore, because Vision 2030 places extreme value on the private sector, the government is expecting developments of private-sector investments. As a result, the Saudi Ministry of Health (MOH) has requested the private sector to contribute more to health spending through alternative financing and delivery systems, specifically health insurance and facilitate collaborations between different parties at different levels.⁶

To reduce the financial burden, the government has implemented Compulsory Employment-Based Health Insurance (CEBHI), which was announced in Saudi Arabia in 1999, but true implementation began on July 15, 2006, for major enterprises employing more than 6000 employees. Organizations that are employing more than 500 employees were added to CEBHI in September of the same year.⁷ This type of insurance is paid for health-related costs by employers and covers all private-sector employees. Some scholars have proposed expanding this to include all citizens, while others have proposed imposing user fees. The government is also exploring transitioning to a national or social insurance-based system, which could help to tackle some of the country’s present healthcare finance issues.⁸

The main objective of this review is to systematically review the advantages and challenges of implementation and strategies for health insurance in Saudi Arabia. In addition, the sub-objectives of this review are to identify the key issues and challenges in health insurance in Saudi Arabia, to highlight the weaknesses and strengths of health insurance, and to provide recommendations describing how health insurance can improve outcomes in the healthcare system in Saudi Arabia in the future.

Literature Review

The National Health Insurance System (NHIS) is a program designed by the government so a country can achieve Universal Health Coverage (UHC).⁹ The NHIS is used as a tool for basic health needs for everyone who has paid premiums, independently or collectively. The World Health Organization (WHO) provides information on implementing NHIS in order to achieve UHC.¹⁰ However, in its implementation, NHIS faces many moral hazard problems, especially the problem of financial budget deficits that increase every year.

According to the WHO, there are 3 critical dimensions influencing the implementation of NHIS, namely the percentage of population coverage, whether or not a guaranteed health service package is complete, and the percentage of health cost coverage being paid by the population.¹¹ These 3 dimensions are mainly based on the level of income and the level of well-being as well as health in a country. In this regard, NHIS needs to consider the risk of each individual before determining the premium. According to the WHO, the objectives of well-functioning, universal healthcare insurance model should involve ensuring equity in access to health services, high-quality medical services produced, and protection of people against financial risks.⁹

Throughout the last century, there were 4 major approaches that distinguished healthcare insurance models had globally emerged. These are Bismarck, Beveridge, National Health Insurance Model (NHI) and Out of Pocket Payment (OPP) models (Table 1).¹² Bismarck’s healthcare insurance system; also referred to as the SHI Model was the first nationally implemented health insurance plan in 1883, named after Otto Von Bismarck, Germany’s first President.¹³ Solidarity is the moral concept that characterizes the Bismarck insurance system, in which mandatory, proportional payments are frequently taken from the gross income of employees and employers.

Table 1.

Major Healthcare Insurance Models.

Healthcare model	Major characteristics
Bismarck model	Usually Financed jointly by employers and employees through payroll deduction.
Beveridge model	Government funds healthcare services, which are paid for through taxation.
National health insurance model	A mixture between the Beveridge and the Bismarck model, the government funds healthcare services, which are paid for through taxation, The delivery of healthcare services is provided, however, mostly through private organizations.
Out-of-pocket	Direct payments to healthcare providers at the time-of-service use.

Theoretically, SHI relies on the pooling of health revenues mandatorily and in principles that should ensure equitable distribution across different population groups.¹⁴ SHI is a form of organizational mechanism for raising and pooling funds to finance and manage health services that will lead to UHC and assist a country to achieve its health system’s objectives.¹⁵ This system has proved effective in countries with a large formal sector such as Germany and the Netherlands. These pooling schemes ensure cross-subsidization from the rich to the poor and from the healthy to the sick. SHI schemes are therefore built on solidarity principles.

Another justification for SHI is that there is more transparency in the way that funds are collected. The funds are usually collected by an independent body and therefore free from political influences.¹⁴ Most low- and middle-income countries face difficulties in funding healthcare in reference to healthcare systems that have accepted the Bismarck model. In addition to Germany, and several other nations have adopted the SHI system, including France, Austria, Belgium, Japan, Switzerland, and Mexico.¹²

The Beveridge healthcare insurance model was named after the British economist William Beveridge, also referred to as the NHIS. In 1942, the renowned Beveridge report stated that every person would have access to comprehensive medical care. As a result, healthcare services have become a human right rather than a worker’s right. Unlike Bismarck, Beveridge felt that healthcare should be available to all.¹²

Furthermore, Beveridge proposed that the public health agency oversees the process of delivering restorative and preventative healthcare services which presents another critical difference from the Bismarck model, which used independent administrative policy to manage both supply and demand networks. In this system, the government provides and pays for healthcare through tax contributions. In the United Kingdom, healthcare is provided via a government-run system which is the NHS. Other countries that have implemented the NHS model include Cuba, New Zealand, Cyprus, Finland, Italy, Spain, and Sweden.¹²

The third major health insurance model that was defined is the NHI. This system combines parts of Bismarck and Beveridge. The NHI is funded by payroll and tax deductions, and it also manages expenses by limiting the range of healthcare services to be covered or by making patients wait.¹⁶ Payments cover health services that are provided by private hospitals and physicians. Single-payer systems frequently possess significant market strength, allowing them to bargain for lower pricing. Although it makes use of private sector suppliers, funding comes from a government-run insurance scheme that each resident contributes to. These universal insurance plans are typically less expensive and administratively much simpler than American-style for-profit insurance because there is no need for marketing, no financial incentive to refuse claims, and no profit.¹⁷ The classic NHI system is found in Canada, but some newly industrialized countries such as Taiwan and South Korea have also adopted the NHI model.¹⁶

Out-of-Pocket Payment (OPP), as defined by the WHO, expenses are the individuals’ direct payments to healthcare providers at the time-of-service use. OPPs, include purely private transactions which are payments made by individuals to private doctors and pharmacies, official patient cost-sharing also called user fees/copayments within defined public or private benefit packages, and informal payments that are payments beyond the prescriptions entitled as benefits, both in cash and in-kind. Therefore, OPPs may be explicitly some part of a policy or can occur through market transactions, or both.¹⁸

OPP are what patients pay to healthcare providers after utilizing their services. Although a simple method of health financing, the use of OPP payments as a means of financing health care raises a number of equities issues. This financing method disadvantages the poor because health treatments are distributed according to the ability to pay rather than necessity. If the impoverished have no choice but to seek care, the risk of poverty is increased.¹⁴

Healthcare insurance in the United States (U.S.) is a combination of all these major distinguished healthcare insurance models. The U.S. spends more on health care per person than ever before, and considerably more than nearly all other countries. The system used to finance health care in the U.S. has evolved over the last century.¹⁹

The result of healthcare industry development through innovations and reforms in the U.S. is a complex and diffuse the U.S. healthcare system. In 2017, Medicare cover the elderly or disabled, and Medicaid covers low-income,²⁰ which make up the majority of government spending on healthcare, accounting for 21.2% and 17.5% of total healthcare spending, respectively. Private health insurance, which includes employer-subsidized plans and policies purchased in state or federal marketplaces, accounted for 35.6% of total health care spending.

The remaining healthcare financial system includes spendings by the Department of Veterans Affairs, the Department of Defense, the Child Health Insurance Program, worker’s compensation, and the Indian Health Service. The OPP payments, which include all household spending on health care including deductibles or co-payments, accounted for 11.0% of total health care spending.¹⁹

Materials and Methods

This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online searching engines were used to identify relevant articles through the included electronic databases: Google Scholar, PubMed, and Saudi Digital Library (SDL). The search terms used were Health insurance, OR Health Insurance advantage, OR Health Insurance benefits, OR Health insurance challenges, AND Saudi Arabia, OR KSA, OR SA, AND Saudi Vision, OR Vision 2030, OR Health transformation (Table 2). All searches were limited to the English language and to the year 2018 and after. The result of this search would be used to offer a thorough overview of the advantages and challenges of implementation and strategies for health insurance in Saudi Arabia. The number of articles extracted for the research is evaluated based on PRISMA through a flowchart diagram shown in Figure 1.

Table 2.

Searching Terms Used in the Literature Electronic Database Search Process.

Health Insurance	Health Insurance advantage, Health Insurance benefits, Health insurance challenges.
Saudi Arabia	Kingdom of Saudi Arabia, KSA, SA.
Saudi Vision	Vision 2030, health transformation.

Figure 1.

PRISMA flow diagram based on PRISMA guidelines of studies evaluation for systematic review.

Exclusion Criteria

Studies were excluded if they investigated health insurance outside Saudi Arabia, review studies, studies were not directly related to health insurance, and studies were excluded if they were published before 2018.

Inclusion Criteria

Studies were included if they met the following: Saudi articles, focusing on health insurance in Saudi Arabia, focusing on issues, problems, barriers, and challenges, particularly in relation to insurance in Saudi Arabia, informative and original research articles, published in the last recent 5 years, published in 2018 or after, and in English language.

Data Extraction

We created a standardized form for extracting data from research that matched the inclusion criteria. The data extraction form was based on the following study characteristics: author, location and year, study design, aim, and objective. Table 3 contains a complete list of the included papers. The researchers evaluated and analyzed all publications after developing a standardized form for collecting data from the included studies.

Table 3.

Descriptive Characteristics of Eligible Articles (n = 13).

Author(s) and year	Title	Study design	Key findings of interest	Strengths and limitations
Albejaidi (2018)	Emerging Role of Cooperative Health Insurance in Achieving Health System Goals under Saudi Vision—2030	Qualitative	Assessments of CHI’s potential contribution to the goals of the health system	Examines the main difficulties the CHI is going to face when collaborating with the private sector and make some policy suggestions.
Alharbi (2022)	Willingness to pay for a National Health Insurance (NHI) in Saudi Arabia: a cross-sectional study	Quantitative	- Determine the willingness of Saudi Arabians to pay for a national health insurance system. - Recognize the elements influencing their capacity or unwillingness to pay NHI.	- One of the limitations of the contingent valuation technique is based on whether it accurately captures consumers’ willingness to pay for goods that aren’t frequently exchanged on the open market. - Strength: explores the public’s willingness to pay for NHI on a national scale, which should inspire more research on the topic.
Al-Hanawi (2021)	Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia	Quantitative	To investigate and separate the variables that contribute to differences in relative OOP health expenditure, which is calculated as the percentage of income used for healthcare in Saudi Arabia.	- The first study in the Arabian Gulf region to use a decomposition approach to analyze disparities in relative OOP health spending. - This study is extremely timely given that the Kingdom of Saudi Arabia is going through a significant economic transformation, which includes the healthcare sector.
Al-Hanawi et al. (2018a)	Healthcare Finance in the Kingdom of Saudi Arabia: A Qualitative Study of Householders’ Attitudes	Qualitative	- Examines Saudis’ satisfaction with public-sector healthcare services and their ability to contribute to system finance through a national health insurance program. - This study looks at the public’s preferences and expectations for a future national health insurance system.	-Strength: A small but comparable purposive sample was employed for exploratory qualitative objectives. -The study is limited by sample size, and any future study aiming to corroborate these results should employ a larger sample.
Al-Hanawi et al. (2020)	The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia	Quantitative	Using data from Saudi Arabia, evaluate what health insurance encourages health-seeking behavior.	Strength: A study found that health insurance can be an effective tool for boosting health-seeking behavior. - There were some missing values in the variables of interest (medical check-ups and insurance). - The Arabian Gulf countries, especially Saudi Arabia, have a unique method of finance in which health costs are reimbursed for using natural resources. - The purpose of this study is to use credible methodologies to provide additional information on the relationship between insurance and health-seeking in Saudi Arabia.
Al-Hanawi and Qattan (2019)	An Analysis of Public-Private Partnerships and Sustainable Health Care Provision in the Kingdom of Saudi Arabia	Qualitative	- Discusses the topic of Saudi healthcare provision. - Examines the issue from a broad international approach. - Investigates the experience of healthcare transformation in the United Kingdom in order to imagine the feasibility of combining public services with market ideals.	Limitations: is largely based on secondary data. Significant efforts were made, however, to gather the essential material for the appropriate analysis, explanation, and understanding of the available literature.
Al-Hanawi et al. (2018b)	Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach	Quantitative	Examines the willingness of families to pay (WTP) for a contributory national health insurance program to determine the feasibility and acceptability of healthcare finance reform.	- Strength: This study indicates a theoretically valid WTP by Saudis for a contributory national health insurance program. - Limitation: The study sample has been biased toward the male gender, raising the possibility of sample bias, and one region in Saudi Arabia.
Alkhamis (2018)	The association between insured male expatriates’ knowledge of health insurance benefits and lack of access to health care in Saudi Arabia	Quantitative	Investigate the connection between foreign nationals’ knowledge of health insurance benefits and their lack of access to medical care.	- Strength: The study demonstrates that the provision of insurance for expats is adequate to provide access to health care. - Limitation: The study’s design was cross-sectional, which limited the ability to investigate causal implications, and the cross-sectional study did not improve the understanding of event chronology.
Alonazi (2020)	Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis	Qualitative	Analyze actions implemented by the Saudi government and related health insurance institutions to decrease moral failures.	- Strength: Establish a connection between insured expats’ knowledge of insurance benefits and their inability to get medical treatment, and according to this study, expatriates with an inadequate reported understanding of health insurance have reduced access to healthcare. - One of the limitations was that only official documents approved by the government could be reviewed.
Benyoussef and Hemrit (2019)	Measuring the relative efficiency of insurance companies in Saudi Arabia: The case study of Takaful vs cooperative industries	Qualitative	The efficiency of insurance businesses in Saudi Arabia is measured using data envelopment analysis (DEA), which is used to examine the effectiveness of underwriting operations by determining primarily inputs and outputs.	Strength: The purpose of this study was to evaluate the technological and scale efficiency of Saudi insurance companies.
Hazazi et al. (2022)	Reform of the Health Insurance Funding Model to Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia	Quantitative and Qualitative	Assesses the characteristics of health funding models that enable improved noncommunicable disease (NCD) control and viewpoints on health insurance as a model from the perspectives of patients, physicians, and managers.	Strength: identified critical features of NCD care that should be considered in moving to any new funding model, including private health insurance.
Orlando and Bace (2021)	Challenging Times for Insurance, Banking and Financial Supervision in Saudi Arabia (KSA)	Quantitative	Assess how well the government thus far has responded to the challenges in the financial sector.	The quantitative study offered has demonstrated how the insurance industry’s diversity has benefited the economy, particularly during the COVID-19 epidemic, when the gap between banks and insurers has been clearer.
Puteh et al. (2022)	Feasibility of National Health Insurance for Saudi Healthcare Services: Qualitative Study	Qualitative	- Investigate the benefits of Saudi Arabia implementing national health insurance. - Determine the barriers to achieving national health insurance. - Investigate the financial implications of introducing universal health insurance.	Strength: identified the benefits and challenges to future implementation and worked on removing barriers during the National Health Insurance- NHI future implementation and promoting its benefits.

As this review relies heavily on a prior systematic review that included online articles, the findings could be affected by selection bias. However, efforts were made to collect the necessary information for the appropriate review, explanation, and interpretation of the available literature.

Results

Results indicate that the usability and outcome of health insurance in Saudi Arabia are based on Vision 2030. Thirteen articles were selected that compliant with the theme of this present systematic review (Table 3).

Among the 13 reviewed articles, 5 articles have explained the current financial methods of the healthcare system in Saudi Arabia.^4,8,21
-23 Two articles assess the prospective role of CHI in achieving Vision 2030 goals in the healthcare system.^6,24 Different health insurances system was explained in different articles.^25
-28 Four articles highlight the strengths and weaknesses of health insurance.^2,6,24,29 Finally, 6 articles have provided recommendations for Saudi health insurance practices.^{2,6,24,26,28,29}

Discussion

The main reason for doing the review is to analyze the benefits and difficulties of the strategies for health insurance implementation in Saudi Arabia. The inclusivity of the healthcare service at all levels—primary, secondary, and tertiary—and the free distribution to all Saudi citizens are the fundamental benefits of the country’s current public healthcare system.⁴ These services are provided by the MOH network of hospitals and primary healthcare centers through which health services are distributed throughout the country, and other governmental institutions such as military or university hospitals, which exorbitantly raises the cost of financing healthcare exacerbated by the rapid population growth and increased prices of medical technology.²¹

Additionally, all non-Saudi employees in the private sector are now required to get health insurance under the Cooperative Health Insurance (CHI), Act of 1999. The CHI was established in accordance with the Act to oversee and control the CHI program’s operation. The council is looked over by the MOH, and its members come from different ministries as well as the private sector. In the accreditation and empaneling of healthcare providers, the Council of Cooperative Health Insurance (CCHI) is a key player. The Saudi Arabian Monetary Agency (SAMA) is in charge of overseeing and regulating insurance providers.²⁴

The target population in the program includes both Saudi and non-Saudi workers engaged in the private sector, including their dependents. In accordance with the policy, it is mandatory for employers to obtain health insurance for their workers and dependents. Except for emergency cases and hospitalization, insured workers are required to pay the agreed-upon deductible amount, as applicable.²⁴

One of the few nations in the world that offers its residents free access to healthcare is Saudi Arabia. Healthcare for non-Saudi nationals is primarily provided by the private sector and is either covered by the employer or the individual. Hospitals and primary care clinics received significant funding over the past 10 years, and as a result, the total amount of money spent by the public on healthcare has increased.²³

The Saudi Vision 2030 is an ambitious growth plan with the main objective of changing its economy by the year 2030. In order to achieve this goal, the country announced an interim development plan called the National Transformation Program (NTP) that sets out strategic objectives for all key sectors of the economy including health. Among other things, vision 2030 envisaged a reduction in public spending through the efficient use of resources and greater participation of private players in different spheres.²⁴

The MOH has identified a number of strategic objectives for the health sector. One of the goals is to enhance the private sector’s participation in health spending by using alternative financing and delivery methods, particularly health insurance and private-sector contracts.⁶

Advantages of the Health Insurance System

- Risk pooling from reform public-private partnerships (PPP). Saudi Arabia’s long and rich tradition of foreign investment, which is rooted in the oil boom of the 1970s, suggests that PPPs might indeed represent the most viable means of establishing a sustainable healthcare system. Moreover, unlike many developing countries, Saudi Arabia is already equipped with modern healthcare facilities funded by considerable government expenditure.^21,29

In Saudi Arabia, people are used to having free public services including healthcare services. Hence, the population’s support and willingness to participate and financially contribute to a particular financing scheme, in this case, health insurance is likely to have a strong influence on the success of the insurance implementation and its sustainability.⁸

- Improve health-seeking behaviors by increasing chances of going to a medical check-up, particularly for chronic diseases such as blood pressure, cholesterol, and diabetes.² Health insurance could lead to an increase in the utilization of healthcare services. Also, lead to improvements in population health if there is existing underutilization of effective healthcare interventions.⁶

- Opening up frontline healthcare providers to market-based corporations increase the choices open to consumers, which in turn has a direct impact on the perpetual rise of service user expectations. Moreover, when the entire population is subject to private health insurance, patients in Saudi Arabia will have a vast array of choices about which types of facilities they want to use and where.^25,29

Challenges That Are Facing the Health Insurance System in Saudi Arabia

- The associated authorities should focus on creating a strong healthcare infrastructure where people followed strict regulations, have strong leadership, and trained staff, and raise job satisfaction among employees. Moreover, they need to create long-term contracts, make authentic registrations for specialists, enhance the profitability of the system, and distribute resources significantly among people and in the medical facilities.²⁸

- The prevalence of fraud worries government agencies and health insurance providers. The policies identified by the Saudi Arabian Monetary Agency (SAMA) and the CCHI, have only contributed to identifying moral hazards in general.²⁶ Therefore, the government and respective authorities need to advance ethical policies to boost the culture of trustworthiness in the community.²⁸

- The financial sector still needs significant reform and improvement in order to stay in line with Saudi Arabia’s vision for economic development. The problem of a more demanding economic and client environment must be overcome by all financial sectors, including banking, insurance, and asset management.²⁷ A more transparent, intelligent, and innovative financial sector is needed to support Saudi Arabia’s ambitious reform ambitions since it has the ability to promote economic growth while effectively managing risks. On this point, a more competitive, open, and global perspective would be advantageous for the current health insurance system.²²

- In the long run aging population will become a major concern to health financing in Saudi Arabia. The proportion of the population in the country aged 60 years and above is expected to reach 25% of the total population of 40 million by the end of 2050. The number of people aged 80 years and above is also expected to reach 1.6 million, or 4% of the total population. As a result, healthcare spending tends to increase manifold times in the future. This will also have an adverse effect on the health insurance market in the country.²⁴

There are worries that the current system won’t be able to satisfy the rising demand; there are dangers associated with this system in terms of care coverage, cost drivers, and care quality. The essential elements that should be considered before moving to any new funding model, include health insurance ensuring continuity of care and equity, funding chronic disease prevention interventions, and prioritizing primary healthcare.⁶

Based on a previous systematic review, this review might be subject to selection bias due to the original inclusion of online articles. Also, there are limited reviews of the topic that would summarize previous findings of health insurance in Saudi Arabia. Despite limitations, comprehensive data collection enabled a thorough review and insightful interpretation.

Conclusion

Health insurance is important for economic growth and for lowering public health spending, according to Saudi Vision 2030. Providing all citizens with affordable, high-quality healthcare while funding healthcare through PPP and privatization is the government’s main challenge. At the same time, it is essential to adhere to the requirements of Saudi Vision 2030, and for this reason, CCHI and SAMA should take the initiative to control and regulate insurance companies. However, it is expected that over time, the CHI will help to advance the delivery of health services and decrease the load on the government to satisfy the needs of a sizable portion of the population. Health insurance is purposive to manage the governmental cost to limit its expenses on the healthcare sector which is beneficial in raising the budget of the medical facilities and enhancing social welfare.

The review recommends implementing health insurance after raising awareness and building a strong healthcare infrastructure in which citizens follow strict regulations, have strong leadership, administrative control, and trained staff, and increase employee job satisfaction. Future research should provide the current health insurance policy in Saudi Arabia and suggest crucial policies. Also, further research could be about the challenges in depth that might be facing health insurance in Saudi Arabia.

Footnotes

Author Contributions

BAA conceived and designed the study, conducted research, collected and organized data, analyzed and interpreted data, and wrote initial draft of the article. BAB critically reviewed and revised content, provided logistic support, and wrote the final draft of article. All authors have approved the final draft and responsible of the content and similarity index the manuscript.

Data Availability Statement

Data is available on reasonable requests from the corresponding author.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

Not applicable.

ORCID iD

Bussma Ahmed Bugis

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Advantages and Challenges of Implementation and Strategies for Health Insurance in Saudi Arabia: A Systemic Review

Abstract

Keywords

Introduction

Literature Review

Materials and Methods

Exclusion Criteria

Inclusion Criteria

Data Extraction

Results

Discussion

Advantages of the Health Insurance System

Challenges That Are Facing the Health Insurance System in Saudi Arabia

Conclusion

Footnotes

Author Contributions

Data Availability Statement

Declaration of Conflicting Interests

Funding

Ethical Approval

ORCID iD

References