Critical analysis and review of the literature on healthcare privatization and its association with access to medical care in Saudi Arabia

Key aspects of the Saudi healthcare system reform and the potential impact on the main stakeholders: A qualitative study

Objectives

To explore and understand KSA's fundamental healthcare system reform, the potential changes and challenges, and their impacts on major stakeholders.

Methodology

To gain in-depth insights into healthcare leaders' perspectives regarding healthcare system reform in KSA, a qualitative research approach was used. Ten participants from diverse backgrounds were selected, representing various sectors in KSA: private, public, executive, consulting, and regulatory. This study was conducted between august 2022 and June 2023.

Findings

The findings revealed four key themes that shed light on healthcare system transformation in KSA and its effects: healthcare system reform, the impact of corporatization/privatization on healthcare providers, the impact of corporatization/privatization on health insurance, and the impact of corporatization/privatization on the workforce. Furthermore, the findings indicated that the ongoing transformation of the public sector toward privatization in KSA faces various challenges that affect most, if not all, stakeholders in the sector. However, the private sector possesses several strengths that can aid in addressing the challenges associated with the rapid transformation of the system. These strengths include familiarity with the market, robust financial management, extensive experience in coding and billing payers and insurance companies, efficient decision-making processes, flexibility, and maturity.

Conclusion

The study facilitated comprehensive insights into the transformation of KSA's healthcare system and the public sector's shift toward corporatization/privatization. The sector must enhance its capabilities by establishing specialized units and recruiting talent. Further studies are also needed to gain a deeper understanding of the obstacles hindering the transformation.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia

OBJECTIVES

To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems.

METHODS

A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines.

RESULTS

We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities.

CONCLUSIONS

These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

Community pharmacists' perspectives towards automated pharmacy systems and extended community pharmacy services: An online cross-sectional study

Background

Private sector partnerships through community pharmacies are essential for effective healthcare integration to achieve the United Nations 2030 Agenda for Sustainable Development Goals. This partnership can provide significant clinical outcomes and reduce health system expenditures by delivering services focused on patient-centred care, such as public health screening and medication therapy management.

Objectives

To assess the understanding of the proposed strategic and health system reform in Saudi Arabia by exploring community pharmacists' perspectives towards the capacity and readiness of community pharmacies to use automated pharmacy systems, provide extended community pharmacy services, and identify perceived barriers.

Materials and methods

This multicentre, cross-sectional, web-based survey was conducted in Saudi Arabia (October-December 2021). Graphical and numerical statistics were used to describe key dimensions by the background and characteristics of the respondents, and multiple ordinal logistic regression analyses were sought to assess their associations.

Results

Of the 403 consenting and participating community pharmacists, most were male (94%), belonged to chain pharmacies (77%), and worked >48 h per week (72%). Automated pharmacy systems, such as electronic prescriptions, were never utilised (50%), and health screening services, such as blood glucose (76%) and blood pressure measurement (74%), were never provided. Services for medication therapy management were somewhat limited. Age groups ≤40 years, chain pharmacies, >10 years of experience and ≥ 3 pharmacists in place with <100 daily medication prescriptions and Jazan province were significantly more likely to provide all medication therapy management services than others. Operational factors were the barriers most significantly associated with the independent variables.

Conclusion

The results showed that most services and automated pharmacy systems remained limited and well-needed. When attempting to implement these services to drive change, community pharmacies face numerous challenges, and urgent efforts by private and government sectors are essential to improve pharmaceutical care in community pharmacy settings.

Review on Alopecia Areata in the Middle East and Africa: Landscape and Unmet Needs

BACKGROUND

Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss in adults and children. Clinical manifestations range from hair loss in small, well-circumscribed patches to total hair loss on the scalp or any other hair-bearing areas. Although the exact pathogenesis of AA is not fully understood, it is thought that loss of immune privilege caused by immunological dysregulation of the hair follicle is key. Genetic susceptibility also plays a role. Response to currently available treatments is widely variable, causing patient dissatisfaction and creating an unmet need. AA is frequently associated with multiple comorbidities, further affecting patient quality of life.

AIMS AND FINDINGS

AA causes a significant burden on dermatologists and healthcare systems in the Middle East and Africa. There is a lack of data registries, local consensus, and treatment guidelines in the region. Limited public awareness, availability of treatments, and patient support need to be addressed to improve disease management in the region. A literature review was conducted to identify relevant publications and highlight regional data on prevalence rates, diagnosis, quality of life, treatment modalities, and unmet needs for AA in the Middle East and Africa.

Preferences on Policy Options for Ensuring the Financial Sustainability of Healthcare Services in the Kingdom of Saudi Arabia

Background

Escalating global health expenditures pose a threat to healthcare financing sustainability, requiring the exploration of alternative financing policies and resource allocation strategies to curb their adverse effects. The aim of this study was to gather insight into the preferences of healthcare workers, including physicians, nurses, allied healthcare professionals, and healthcare administrators, as well as academics in the field of healthcare management and health sciences in Saudi universities, regarding policy options that can secure the financial sustainability of healthcare services in Saudi Arabia.

Methods

A cross-sectional research design was employed, and data were collected through an online self-administered survey from August 2022 to December 2022 in Saudi Arabia. The survey garnered responses from 513 participants hailing from all 13 administrative regions in Saudi Arabia. Analyses were performed using non-parametric statistical tests, specifically the two-sample Mann-Whitney U-test and Kruskal-Wallis test, to determine the statistical significance of differences in the policy ranking and policy feasibility options.

Results

The study findings reveal a consensus among stakeholders on the most and least preferred policies. All stakeholders expressed opposition to financing healthcare by diverting resources from defence, social protection, and education, while they favoured policies that entail imposing penalties on health-related issues such as waste management and pollution. Nevertheless, variations among stakeholders were evident in regard to the rankings for specific policies, particularly between healthcare workers and academics. Moreover, the results highlight that tax-based policies are the most feasible approach to generating healthcare funds, despite ranking lower in terms of preferred policies.

Conclusion

This study provides a framework for understanding stakeholder preferences on healthcare financing sustainability by ranking 26 policy options according to stakeholder groups. The appropriate mixture of financing mechanisms should be informed by evidence-based and data-driven approaches that consider relevant stakeholder preferences.

The financial performance of private hospitals in Saudi Arabia: An investigation into the role of internal control and financial accountability

The aim of this study was to examine the relationship between internal control, financial accountability, and financial performance in the private healthcare sector in the Kingdom of Saudi Arabia (KSA) through a questionnaire survey of 78 private hospitals. Drawing on agency theory, the study utilized structural equation modelling with partial least-squares technique to test multiple hypotheses. Results indicate a significant positive relationship between internal control and financial performance, with financial accountability acting as a mediator. Additionally, financial accountability was found to have a direct positive effect on financial performance. These findings provide new evidence for improving financial performance in private hospitals in the KSA through the implementation of internal control and financial accountability measures. Further research could examine additional factors that may impact financial performance in the healthcare sector.

Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China

Providing equal geographical access to hospitals, either in the public or private healthcare sector, is vital and will benefit public health in general. Against the background of the partial privatization of the healthcare sector, the impact of private hospitals on equal healthcare access has been a highly neglected issue. We have applied an assessment methodology to study this situation by comparing the status quo scenario with one without private hospitals, based on accessibility analysis and spatial equality measurements. The case study of Beijing, China revealed a double-sided impact. With the presence of private hospitals, the Gini coefficient of spatial accessibility in urban districts was reduced from 0.03391 to 0.03211, while it increased from 0.1734 to 0.1914 in suburban districts. Thus, private hospitals improved spatial equality in urban districts in Beijing but jeopardized it in suburban districts. These research findings should enlighten policymakers to promote healthcare equality but would also need to be repeated in some other big cities.

Epidemiology of Chemical Poisoning among Adults in Qassim Region: An Eight-Year Study

Chemical poisoning is considered a common medico-social problem that, in addition to causing extensive morbidity and mortality, dominates the valuable health care service resources. Therefore, this study was conducted to explore the extent and frequency of chemical poisoning events among adults in Qassim region as well as the most common poisoning agents involved. A retrospective method of data collection was used employing medical record review for chemical poisoning cases that occurred in Qassim region during the 8-year period from January 2008 to December 2015. Data were collected using a standardized, validated data collection sheet. The study revealed that there is no steady trend (either decreasing or increasing) of the number of poisoning cases through time. There is a statistically significant association between the type of poisoning agent and gender (χ2 = 14.3104, p < 0.05). Moreover, there is a statistically significant association between the type of poisoning agent and period in years (χ2 = 19.7565, p < 0.05). It can be concluded that poisoning cases are distributed, to some extent, evenly between males and females, with no pattern through time. Educational programs are needed to raise public awareness about poisoning, especially among women.

Healthcare Transformation in Saudi Arabia: An Overview Since the Launch of Vision 2030

Saudi Arabia’s Vision 2030 has taken a centre stage in the development of its healthcare sector through privatization adopting Public Private Partnerships (PPPs). The objective of this study is to provide an overview of healthcare transformation in Saudi Arabia since the launch of the ambitious Vision 2030, identifying issues those need to be addressed and steps taken towards provision of health systems transformation. Literature review was based on extensive review of published and unpublished articles, where different search engines and databases searched using the key words: ‘Saudi Healthcare’, ‘Healthcare transformation’, ‘Saudi vision: 2030’, ‘Public-Private Partnerships’ and ‘Privatization’, in addition to secondary data as published in government reports, policy, government strategy documents and pertinent press releases. The future of the healthcare like many other developing economies continues to weigh policies for universal coverage while containing costs and the national transformation programme driven by social and economic factors has implemented strategic steps to develop its private healthcare system that includes: establishing health clusters, National Centre for Privatization & PPP – an official enabler for privatization of all government sectors and recently approved Private Sector Participation (PSP) Law involves several legislative enablers designed to enhance investor confidence in the privatization process. Although this study demonstrates systemic legislative progress to facilitate transformation process of healthcare sector, also endorses caution and research in identifying barriers to the implementation of PPPs, Saudi workforce development, implementing effective revenue cycle management function for healthcare reimbursement and ensuring vulnerable population access to good quality and tertiary healthcare. As healthcare of Saudi Arabia embarks on the transformation journey facing daunting challenges, but it appears that the government has laid out a roadmap with the legislative framework; however it is important that there is ongoing monitoring with adjustments as this complex and multifaceted process proceeds.

The direct cost incurred by patients and caregivers in diagnosing and managing prostate cancer in Ghana

BACKGROUND

Over the years, the prevalence of prostate cancer (PCa) has been on the increase. Poor prognosis has been a reflection of increased advance-staged diagnosis and inadequate financial assistance. The prioritization of resources cannot be effective enough to factor in the unexpected economic burden resulting from ill health unless health economic approaches are utilized to estimate the cost of diseases including PCa. With the absence of data on the cost of PCa in Ghana, and the evidence of the benefits of PCa cost-of-illness studies on cancer financing, it has become imperative to investigate the direct health cost of PCa on patients and careers. Hence, we investigate the cost of PCa diagnosis and management, the availability and prices of PCa medications, and the affordability of PCa care in Ghana.

METHODS

The prevalence approach to cost-of-illness studies was adopted in this study through a random selection of two (2) hospitals, four (4) private laboratories, and ten (10) private community pharmacies in the Ashanti Region of Ghana. The diagnostic and management cost of PCa was investigated through the application of validated data collection instruments to representatives of the selected hospitals and laboratories. The availability and prices of PCa medications were studied with the administration of a validated tool to representatives of the selected pharmacies. The data were analyzed with Microsoft Excel Spreadsheet and the affordability of care was assessed considering the 2021 Ghana National Daily Minimum Wage (GNDMW).

RESULTS

The cost of diagnosing non-metastatic and metastatic PCa were respectively estimated at GHC 1686.00 ($ 290.58) and GHC 6876.00 ($ 1185.09). Radical prostatectomy, as a management option, was estimated at GHC 2150.00 ($ 370.56) higher than Extended Beam Radiotherapy (GHC 2150.00: $ 370.56). The mean PCa drug availability for the sampled pharmacies around the public hospital, all the sampled pharmacies, and around the private hospital were respectively 61.54, 51.54, and 41.54%. None of the sampled drugs at the stated strengths had a 100% availability. A 6-month androgen deprivation therapy employing goserelin was GHC 3000.00 ($ 517.05). The median drug price ratio (MDPR) was 0.72 - 15.38, with generic bicalutamide 150 mg tablets as the cheapest and generic flutamide 250 mg tablets as the most expensive.

CONCLUSION

The diagnostic and management cost of PCa currently overwhelms the average Ghanaian because the minimum daily wage in 2021 is GHC 12.53 ($ 0.46). A higher economic burden was associated with metastatic PCa and hence, the need for strategies to improve early detection. Also, the inclusion of PCa management in the National Health Insurance Scheme would lessen the financial burden of the disease on patients and careers, and improve management outcomes.

Selecting the most suitable organizational structure for hospitals: an integrated fuzzy FUCOM-MARCOS method

Background

Previous studies mentioned four organizational structures for hospitals, which are budgetary, autonomous, corporate, and private. Nevertheless, healthcare decision-makers are still required to select the most organizational structure specific to their circumstances. The present study aims to provide a framework to prioritize and select the most suitable organizational structure using multicriteria decision-making (MCDM) methods in Iranian hospitals.

Methods

First, a multicriteria decision-making model consisted of the respective criteria, and alternatives were developed. The pertinent criteria were identified through a systematic literature review. The coefficient weights of the identified criteria were then calculated using FUCOM-F. Finally, organizational structures were prioritized in accordance with the identified criteria using FMARCOS.

Results

The findings reveal that income is the most significant criterion in selecting organizational structures for hospitals whereas the number of outpatient visits is the least important. Also, the private structure is the most appropriate, and budgetary style is the least suitable organizational structure for Iranian hospitals.

Conclusion

Providing a framework in order to select the most appropriate organizational structure could help managers and policymakers of the healthcare sector in Iran and other countries, mainly similar developing countries.

Factors associated with patients bypassing primary healthcare centres in Qassim Region, KSA

Objective

This study investigates the reasons for bypassing local primary healthcare centres (PHCs) by patients with minor illnesses in Qassim Region, KSA.

Methods

A cross-sectional study was performed on 266 patients that visited emergency departments in public hospitals in Qassim Region. The patients were randomly selected and categorised as level five patients (LFPs) using the Canadian Triage and Acuity Scale (CTAS) for patient characterisation.

Results

Of the 266 patients, 85.7% had previous experience of visiting PHC facilities. The majority of these patients were not satisfied with their treatment in PHCs. Approximately 52.9% of the patients reported that the working hours at PHCs were not sufficient, 38.1% mentioned a lack of experienced staff, and 31.7% believed that PHCs were insufficient for diagnostic tests. Another 13.8% of the patients reported the unavailability of prescribed medicines. Interestingly, 17.7% of the patients reported that they never bypassed PHCs. In general, the data demonstrate that patients’ gender, employment, and marital status have no significant role in their decision to skip PHCs in favor of emergency departments of public hospitals (p > 0.05).

Conclusions

Patients bypassing PHCs without a referral form is a serious concern that have a deleterious effect on the healthcare system, particularly emergency departments. If bypassing continues, it will increase the burden on emergency departments, particularly on healthcare services for the general population.

Public-Private Partnership Policy in Primary Health Care: A Scoping Review

BACKGROUND

Given the challenges of governments to deliver primary health care (PHC), engaging private sector in the form of public-private partnership (PPP) can be effective policy. The aim of present study is to review the experiences of implementing PPP policy in PHC.

METHODS

This scoping review study was conducted in 2019 using the framework proposed by Arkesy and O'Malley. Required data were collected through search the related keywords in databases, manual search of some journals, websites, and other sources of information and through references check, from January 2000 to May 2019. All studies, which focused on the results of PPP in PHC, and published in English or Persian were included in the study.

RESULTS

A total of 108 articles were included in the study. The studies were mostly conducted in low- and middle-income countries. The quantitative studies have demonstrated the success of this policy in improving PHC indicators. Based on the qualitative studies PPP in PHC has many benefits, including access improvement, economic benefits, and service quality enhancement.

CONCLUSIONS

The present study provides useful information on the experiences of different countries in the field of PPP in PHC that can be used by experts and decision makers to decide whether to engage the private sector in the form of PPP model.

Policy Discourses: Shifting the Burden of Healthcare from the State to the Market in the Kingdom of Saudi Arabia

Saudi Arabia has modified from a predominantly free, public, and comprehensive system under a welfare model to more of a mixed-economy model of healthcare. The welfare state slowly moved to a liberal model, emphasizing market forces to dominate in the provision of healthcare and the private sector was trusted to provide a better provision of healthcare. The country has to confront enormous problems in the health sector due to population growth, lifestyle changes, the shift of disease patterns, elevated expectations, escalated healthcare costs, limited infrastructure and resources, and poor management practice in the provision of healthcare. Moreover, the government has been emphasizing the need to bring in private sector investment to improve quality and efficiency, development of manpower, and standardization of services. As the current pattern of healthcare is unsustainable, the country is planning to restructure the present healthcare system toward institutionalizing it to meet future challenges. The governments must make an appropriate amount of effort to build their healthcare systems by transforming and modifying the challenges faced by society and its political-economic systems. The government should encourage equity, and fairness in the provision of healthcare.

Autonomy, accountability, and competition: The privatisation of the Saudi health care system

OBJECTIVES

This study aims to explore the perceptions of different stakeholders about the privatisation of the Saudi health care system.

METHODS

Using a qualitative case study design, we interviewed 21 administrators and clinical staff of a public hospital in the Eastern Province of the KSA and analysed all official documents relevant to this study. The analysis followed a thematic approach to provide an in-depth interpretation of the data.

RESULTS

Our analysis generated three main themes. The first was pertinent to the changes in the governance structure, with gradually increased autonomy from the government. The second reflected the necessity to introduce accountability within hospitals. The third described the cooperative relationship among the E1-Cluster hospitals as well as its competitive relationship with the private sector.

CONCLUSION

Our study demonstrates the interplay between newly introduced concepts of autonomy and accountability within the Saudi health care system. The findings of this study and their implications for research, practice, and policy are elaborated. Such an understanding is essential to improve the implementation process of privatisation and to recognise new dynamics that are shaping the health care system. The study contributes to the current scarce literature on health care reforms in KSA by reporting perceptions and experiences of key stakeholders.

Increased Private Healthcare for Canada: Is That the Right Solution?

Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare – universality and accessibility – as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.

Place and health infrastructure in the Gulf Cooperation Council: A systematic scoping review of GIS applications in health

The rising burden of non-communicable diseases is taxing health systems globally. Using data science and information systems is necessary to support public health practices. Geographic Information Systems (GIS) are key to inform and help guide public health policies related to place (i.e. location or where one lives) and how it affects health. Despite the increasing use of GIS for public health globally, its applications to health in the Gulf Cooperation Council (GCC) states remains largely unknown. This systematic scoping review aimed to uncover how GIS has been used in the GCC states to understand "place" and "health". A comprehensive search of the literature was performed in PubMed, Scopus, Science Citation Index Expanded, ScienceDirect, Embase, IEEE Xplore, and ACM Digital Library during June 2020. All journal articles involving the use of GIS for human health applications in the GCC states published in English in peerreviewed scientific journals were considered. After removing duplicates and applying eligibility criteria, qualitative content analysis was performed for 24 of 630 studies. GIS uses in the GCC states were categorized as health access and planning (n=9), health risk analysis (n=8), disease surveillance (n=6) and community health profiling (n=1). The majority of the uncovered evidence in this study focused on the Kingdom of Saudi Arabia. The results of this study indicate a deficiency of published evidence regarding the use of GIS in support of public health in other GCC states. This stands to compromise planning and strategic decision making in health risk analysis, disease surveillance, community health profiling, health services provision and health interventions.

Effects of Financial Inclusion on Access to Emergency Funds for Healthcare in the Kingdom of Saudi Arabia

Background

Having access to convenient and quality healthcare at all times is not only a human right but also a goal that many countries strive to achieve for their population. However, access to healthcare might face blocks in the presence of financial exclusions. Saudi Arabia has, over the years, continued to pursue policy and system reforms to enhance its population’s access to financial inclusion, as well as proper health coverage to improve health outcomes. This study seeks to estimate the effects of financial inclusion on the financial hardships in accessing healthcare in Saudi Arabia.

Methods

This study uses a nationally representative survey conducted with 1009 adults, using the 2017 World Bank Global Findex Study data. The study estimates the conditional probability of coming up with emergency funds and the conditional probability of borrowing for medical purposes to understand access to healthcare. A composite value is created for financial inclusion using several variables for individuals’ interactions with financial institutions, such as access to financial services and loans.

Results

The results revealed that financially included individuals have a higher conditional probability of both borrowing for medical purposes and coming up with emergency funds, compared to those who are financially excluded. Additionally, the study showed that individuals in low-income brackets are more likely to be financially excluded and have a reduced chance of coming up with emergency funds and borrowing for medical purposes.

Conclusion

These findings indicate that there is need for authorities to roll out a financial inclusion drive that will not only incentivise the financially excluded population to become included but that will also aim at promoting various financial products so that those who are already financially included have a wide range from which they can choose.

Awareness of, Beliefs about, Practices of, and Barriers to Teledentistry among Dental Students and the Implications for Saudi Arabia Vision 2030 and Coronavirus Pandemic

Objectives:

Saudi Arabia launched multiple initiatives to overcome the problem of health-care access. The recent coronavirus pandemic created urgent demand to deal with the problem using nonconventional venues such as telehealth and teledentistry. This study aimed to investigate teledentistry knowledge, attitudes, and practices, and barriers to its use among dental students and teaching staff in Makkah province, Saudi Arabia.

Materials and Methods:

A total of 314 dental students participated in this cross-sectional study. Data were collected using a validated self-reported questionnaire to measure teledentistry awareness, attitude, practices, and barriers to teledentistry. The study was approved by Umm Al-Qura University, Saudi Arabia.

Results:

Only 17.2% were aware of the term “teledentistry.” However, after it was explained, participants were able to correctly answer 25.16%–62.42% of items about teledentistry. A total of 67.83% would practice teledentistry, and 70.7% support using teledentistry on a national scale for Vision 2030. Only 25.16% used teledentistry before, but 56.05% did dental consultations via smartphone. The most common barriers were patient satisfaction requiring a dentist’s physical presence, violation of patient privacy, and low levels of population education.

Conclusion:

Dental students seem to know little about teledentistry. However, they are open to learning and using it. It is encouraged to include the topic in continuing dental education, including how to use it during health disasters such as the coronavirus pandemic.

The Privatization of Health Care System in Saudi Arabia

Saudi Arabia's Vision 2030 highlights the development of the health care sector through privatization. This study examines the factors that prompted the privatization of the health care sector in Saudi Arabia. This is a scoping review based on an extensive review of both published and unpublished documents. We have accessed different search engines and databases to collect various research publications, journal articles, government reports, policy and planning documents, and relevant press reports/articles. While privatization of the health care sector in Saudi Arabia has experienced an upward trend, the public health care sector remains vital to bring in overall improvements in the health of all sections of Saudi Arabia's population. Keeping this in view, the government must strengthen its public health care sector to ensure affordable, accessible, and high-quality health care for all. This manuscript focuses on the policy aspect of the privatization of health care and is based on secondary research material. Increased privatization leads to rising expenses in health care, while adversely affecting equity and accountability in the provision of its services. Although this study is an independent analysis of Saudi Arabia's health care system, lessons learned from this context could be used widely for policy-making in other countries with similar socioeconomic settings.

Challenges of privatizing academic medical centers in Saudi Arabia and appropriate strategies for implementation

Purpose

A crisis in the financial sustainability of the public healthcare sector often compels governments to consider privatization. The purpose of this paper is to summarize various strategies to overcome the challenges facing the privatization of academic medical centers (AMCs) in Saudi Arabia.

Design/methodology/approach

In this paper, the authors discuss the challenges faced in privatizing AMCs in delivering their core functions such as patient care, medical education and research. Further, the appropriate strategies are listed to overcome these challenges in privatization of AMCs.

Findings

The authors described the benefits of privatization that include a reduction in the financial burden on government healthcare expenditure, quick decision making and creation of new financial models to improve healthcare services. On the other hand, the profit motive of private management could create pressure on patients and may divert AMCs from their primary objectives. Therefore, it is imperative for the government to develop and implement appropriate strategies that balance the benefits of privatizing AMCs with eliminating the negative impact of privatization on patient care, medical education and research.

Originality/value

Though AMCs privatization is currently feasible in Saudi Arabia, appropriate strategies are essential to overcome the challenges of its implementation. The government should frame a uniform rules and regulations prior to privatizing public hospitals so that it will fulfill the purpose in an efficient manner.

The privatisation of healthcare system in Bangladesh

PURPOSE

The purpose of this paper is to examine the factors that triggered the privatisation of Bangladesh's health sector.

DESIGN/METHODOLOGY/APPROACH

This study follows systematic reviews in its undertaking and is based on an extensive review of both published and unpublished documents. Different search engines and databases were used to collect the materials. The study takes into account of various research publications, journal articles, government reports, policy and planning documents, relevant press reports/articles, and reports and discussion papers from the World Health Organization, the World Bank and the Asian Development Bank.

FINDINGS

While Bangladesh's healthcare sector has undergone an increasing trend towards privatisation, this move has limited benefits on the overall improvement in the health of the people of Bangladesh. The public sector should remain vital, and the government must remobilise it to provide better provision of healthcare.

RESEARCH LIMITATIONS/IMPLICATIONS

The paper focusses only on the public policy aspect of privatisation in healthcare of a country.

PRACTICAL IMPLICATIONS

The paper examines the issue of privatisation of healthcare and concludes that privatisation not only makes services more expensive, but also diminishes equity and accountability in the provision of services. The study, first, makes a spate of observations on improving public healthcare resources, which can be of value to key decision makers and stakeholders in the healthcare sector. It also discourages the move towards private sector interventions.

ORIGINALITY/VALUE

This study is an independent explanation of a country's healthcare system. Lesson learned from this study could also be used for developing public policy in similar socio-economic contexts.

An Analysis of Public-Private Partnerships and Sustainable Health Care Provision in the Kingdom of Saudi Arabia

This study considers the issue of health care provision in Saudi Arabia, looking in particular at the challenges for health care providers and ministry officials. Although the study concentrates on factors specific to Saudi Arabia, it also examines the problem from a broadly international perspective. In particular, the study explores the experience of health care modernisation in the United Kingdom to conceptualise the practicality of fusing public services with market ideals. There is a pressing need to modernise the Saudi health care system with the economic burden on the state-funded Ministry of Health being an unsustainable means of providing health care in future. The solution resides partially in opening the public health care system to alternative sources of management and revenue. In particular, public-private partnerships will be considered as a viable means of funding health care in Saudi Arabia and for improving standards and the quality of care. This study concludes that, whereas the move towards a public-private partnership approach to health care provision has been touted as a precondition for modernisation and development, the precise fusion between government and non-government forces remains a source of conjecture. As a result, the study advocates caution when evaluating the benefits and pitfalls of partnerships between public and private actors.

What drove the health system reforms in the Kingdom of Saudi Arabia? An analysis

PURPOSE

The primary objective of this article is to present the key directions taken by the Saudi health care system, following the announcement of the Saudi Vision 2030. The changing international scenario, together with reduced oil revenues, high population growth, emerging lifestyle diseases, and demands for better quality of care, has impacted the development of the Saudi health system. The government is now ardently pursuing private sector development and has initiated privatization and marketization as a core strategy of reforms in its health system. This article posits that the current economic conditions of the KSA and local and global market dynamics are the primary drivers for these reforms.

METHODS

This study is based on a scoping literature review.

FINDINGS

The intended reforms will have very limited contribution to improving the population's health, and the study remains inconclusive.

CONCLUSION

The Kingdom took a protective approach in reforming its health sector. The social values that undergird the government actions, especially, how much priority it gives to maintain status quo in the social and economic fabric vis-à-vis economic growth and development, have exerted a significant influence on whether the KSA chooses a pro-government or a pro-market approach; however, this could lead to a hybrid model of health care system.