Healthcare Insurance impact on Access to Care

Hello, I would like to have a literature review for the following topic "Healthcare Insurance impact on Access to Care in Southern Area of Riyadh City, Saudi Arabia" Please make sure to follow the following instructions: 1- make sure there is no plagiarism 2- make comparison and debate between authors of articles, for example, " this author claims, and on the other hand the other author debate, or agree, disagree" 3- make sure to use transition words 4- I just need a literature review and reference page 6- I have included 31 references, focus more on researches that took place in Saudi Arabia. Make sure to get done well from the first time please and on time.

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LITERATURE REVIEW
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1LITERATURE REVIEW
Literature review
Healthcare Insurance impact on Access to Care in Southern Area of Riyadh City, Saudi
Arabia
Several factors are necessary for a reasonable access to healthcare, like the availability of
the health care services in a community, personal health beliefs and behavior (Hoffman &
Paradise, 2008). However these features are often overshadowed by the fact, whether an
individual can meet the expense associated to health care treatment. Health care insurances
assists people to access medical facilities and also protects the families from the huge burden of
the medical costs.
People who are not under the cover of any medical insurances are likely to avoid medical
treatment, even if it is necessary (Alkhamis, 2013). It has been documented by the studies, that a
clear relationship lies between the less use of medical facilities and no health insurance (Kasper,
Giovannini, & Hoffman, 2000).
This study have specifically selected the topic of whether the health care coverage have
influenced the access to health care in the southern part of Riyadh, in the kingdom of Saudi
Arabia. The main change that has occurred in the funding of the health care has begun with the
introduction of the health care insurance. The current system of `health care starts from 1950,
when the `Ministry of health (MOH) was developed with the responsibility to provide healthcare
to the entire population (Al-Hanawi, 2017). This exactly similar to the humanitarian and the
ethical principles of other countries like UK. Under these model, care is provided free to the
public like the services and the supply of medical goods. Some of the other examples of
countries where the health care system has remained purely public is Canada. Although, I has

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been critiqued that Canada had been using an approach of social insurance (Qutub, Al‐Jewair &
Leake, 2009). The NHS in United Kingdom, is one of the most prominent example model by the
government (HM Revenue and Customs, (2017). Although NHS is being funded by the general
taxation, a proportion of the funding is taken from National insurance. Similarly, the KSA
Government utilizes the revenues generated from the taxes for financing the infrastructure. The
Health Insurance council of KSA was developed in the year 2002, to implement the mandatory
health insurance in various phases of health care. Walston, Al-Harbi and Al-Omar (2008) have
stated that Saudi Arabia , had been providing complete and universal access for about a decade
and how the introduction of the health insurance have reformed the health care system of KSA.
The primary insurers for the health insurance in Saudi Arabia includes MedGulf Arabia, Bupa
Saudi Arabia and Tuwania. It has been claimed by Almalki, M., FitzGerald and Clark, (2011),
that the medical insurance in Saudi Arabia comes at a reasonable cost than some of the other
countries.
KSA have started to implement the unified health insurance scheme since 2016, and the
system was fully established in the year 2017 (Almalki, M., FitzGerald & Clark, (011). The
rolling out of the mandatory health insurance to the private sector employees took place in
several stages (Khaliq, 2012). As per the Council of Cooperative Health insurance (CCHI),
which is an independent governing body that has been built for regulating the health insurance in
KSA. All the KSA employers in the private sector employees in Saudi Arabia had took place in a
varieties of stages. According to December 2018, there are about 27 insurance companies that
are operating in Saudi Arabia and the total number of insured person in KSA is about
10,801,693. About 2 million was added to the total number of insured people (Khaliq, 2012).

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Like most of the industrialized countries Saudi Arabia had been witnessing a sharp rise in
the expenditure. Although there were substantial resources that the government has employed,
the health care system is under strain due to a rapid increase of the demand and expenditure,
although the resources are remaining finite. Some of the challenges are the rapid changes in the
demography, ageing, and altered patter of the diseases and lot more (Elachola & Memish, 2016).
In order to deal with the challenges, the government has executed the Obligatory health
insurance that is employment-based. It has covered all the employees in the private sector and is
paid by every employers. It has been suggested by some of the employers. It has been suggested
by the researches to expand the same kinds of facilities to all the citizens. Before the
implementation of the National health insurance scheme, most of the providers had to get access
to fee for service facilities, where the physician used to make huge profits from the pharmacies
as they were permitted to prescribe and provide referrals freely. This often resulted in over-
prescription of the drugs and short but frequent doctor’s office visits (Lu & Hsiao 2003).
It has been pointed out by Rahman & Alsharqi, 2019), that the reform process in the
health sector of Saudi Arabia, is challenging and no indicator has been developed to measure the
outcomes of the reform. No studies have been done so far for the evaluation of the impact in the
health care system of Saudi Arabia. Few of the studies have inferred that the intended
improvements might not have assisted much in improving the health of the public as most of
them are not very comprehensive in their approach.
Jedidia and Medhioub (2015), on the other hand have proposed that the insurance sector
of Saudi `Arabia have a bright future as per the industry services. It plays a crucial role in the
social and the social activity. In contrary to the above mentioned facts few of the authors have
confirmed, that the health care system in Saudi Arabia has upgraded over the past few decades,

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which is due to the provision of universal health insurances free of cost, that have assisted to
ensure that there is affair access to the entire population (Rahman & Alsharqi, 2019). However,
the health care experts and the economic experts have expressed concern over the possibility of
the recent approach for the funding system. The recent level of provision for the KSA population
has consumed about 7 % of the entire GDP and with a rapid growth in the population, the
demand for the provision would just increase and will not decrease (Rahman & Alsharqi, 2019).
In order to deal with this, the government of the Kingdom of Saudi Arabia have implemented a
new plan that is the cooperative health insurance scheme that is closely followed by the
privatization of the skills and the hospitals. Some of the experts have still expressed concern on
the current proposed plan. However, it has been proposed by (Marmor, Oberlander & White,
(2009), that there is a lack of evidences whether the alternative options have experienced any
approach in the healthcare. Hence, there is a need for the policy makers to comprehend, what the
other feasible options are.
While there are many advantages due to the insurance cover, literary sources have also
indicated towards various disadvantages. It can be stated that free services provided without any
co-insurance inflate the volume of the medical services used. Al-Hanawi (2018), have argued
that privatization of the insurances would generate state revenues from the sale of the hospitals
and transference of the liability from government to private groups for providing care to the
providers. Private insurances might create more efficient system. Refuting this, researches has
been made on the accessibility of the health insurance scheme. It was found that only 19 % of
the entire sample is under the coverage of the Private health insurance Scheme and 70 % were
private health care employees that got private health insurance from the employers covering the
employees and their families as per the Saudi labour law (Al-Mazrou et al., 2017). Some

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dissatisfaction has been voiced with regards to the private insurance and the service given by the
health care facilities. It has been found that those under private health insurance coverage had to
stand in long queues in comparison to the ones who paid cash directly. It has been also alleged
that there are some doctors who do not treat patients under the insurance cover and only treat
those who pay direct cash. A study by Yusuf, (2014) has shown, that people often feel
dissatisfied with the employers, as some tines the insurances provided by the company does not
cover the parents. Some of the other negative points that can be provided is that there is an
absence of choice concerning which private hospital could be assessed under the insurance cover
(Yusuf, 2014). In certain cases the private insurances provide very limited coverage outside the
major towns. Hence, it can be anticipated that the patients might want to finance public health
care services via national health care scheme. The private insurance companies tend to increase
their premium for containing the costs, which can have a harmful impact on the healthcare
system. It has been stated by Rahman and Alsharqi, (2019), that the government is perceiving
health care as an instrument for the generation of the instrument rather than serving the public to
provide them with basic health care facilities.
The Labour law of 1999 has included about 3. 5 millions of Saudis in receiving health
facilities from the private insurance providers (Alkhamis, 2017). It can be stated that this
initiative has been successful in reducing the health care burden. But, unfortunately, the private
insurance providers are not able to provide equal services and access and hence a deterioration
can be witnessed in the overall healthcare services (Al-Mazrou et al., (2017). The situation in
worst in the semi urban and the rural areas. As informed by the study by (Alrabeah, et al.,
(2015), that the national health care insurance coverage has been facing challenges to bring an
equilibrium rural and the urban region. There was a huge difference in the allocation of the

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resources, human resources, technology, distribution and quality of care and standard of practice.
It has been revealed that due to lack of evidences, it cannot be stated that privatisation can bring
about any positive changes in the health care access (Alkhamis, 2017).
In conclusion, it can be said that although KSA have introduced certain modifications in
the system of heathcare related to the health care coverage, most of the papers have indicated
towards the fact that KSA has not been utilizing much of its resources in healthcare and there is a
lack of researches based on the insurance system of KSA. The privatisation of insurances has not
been a very helpful option. It can be claimed that involvement of the public is necessary for the
success of the health care reforms and should be considered while designing any health care
financing system. Hence, there had been a need for the national health insurance scheme.

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References
Al-Hanawi, M. K. (2017). The healthcare system in Saudi Arabia: how can we best move
forward with funding to protect equitable and accessible care for all. Int J Healthcare,
3(2), 78-94.
Al-Hanawi, M. K., Alsharqi, O., Almazrou, S., & Vaidya, K. (2018). Healthcare Finance in the
Kingdom of Saudi Arabia: A Qualitative Study of Householders' Attitudes. Applied
health economics and health policy, 16(1), 55–64. https://doi.org/10.1007/s40258-017-
0353-7
Alkhamis, A. (2013). A comparison of access to medical care for insured and uninsured
expatriates in Saudi Arabia (Doctoral dissertation, University of Liverpool).
Alkhamis, A. A. (2017). Critical analysis and review of the literature on healthcare privatization
and its association with access to medical care in Saudi Arabia. Journal of infection and
public health, 10(3), 258-268.
Almalki, M., FitzGerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: an
overview.
Al-Mazrou, Y., Al-Ghaith, T., Yazbeck, A. S., & Rabie, T. S. (2017). How labor laws can
transform health systems: The case of Saudi Arabia. Health Systems & Reform, 3(1), 26-
33.
Alrabeah, A., Ogden, S. M., Edgar, D. A., & Fryer, K. J. (2015). TQM in the Saudi Health care
system: a national cultural perspective. World Review Business Resources, 5(2), 120-136.

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Elachola, H., & Memish, Z. A. (2016). Oil prices, climate change—health challenges in Saudi
Arabia. The Lancet, 387(10021), 827-829.
HM Revenue and Customs, (2017). National Insurance Fund Account 201516 [Internet].
Available from: https://www.gov.uk/governmen t/publications/national-insurance-fund-
accounts [Accessed 22 May 2017
Hoffman, C., & Paradise, J. (2008). Health insurance and access to health care in the United
States. Annals of the New York Academy of Sciences, 1136(1), 149-160.
https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1196/annals.1425.007
Jedidia, L. B., & Medhioub, I. (2015). The efficiency of Saudi Arabia insurance companies.
International Journal of Management Sciences, 5(3), 237-248.
Kasper, J. D., Giovannini, T. A., & Hoffman, C. (2000). Gaining and losing health insurance:
strengthening the evidence for effects on access to care and health outcomes. Medical
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Khaliq, A. A. (2012). The Saudi health care system: a view from the minaret. World health &
population, 13(3), 52-64.
Lu, J. F. R., & Hsiao, W. C. (2003). Does universal health insurance make health care
unaffordable? Lessons from Taiwan. Health affairs, 22(3), 77-88.
Marmor, T., Oberlander, J., & White, J. (2009). The Obama administration's options for health
care cost control: hope versus reality. Annals of internal medicine, 150(7), 485-489.

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Qutub, A. F., Al‐Jewair, T. S., & Leake, J. L. (2009). A comparative study of the health care
systems of Canada and Saudi Arabia: lessons and insights. International dental journal,
59(5), 277-283.
Rahman, R., & Alsharqi, O. Z. (2019). What drove the health system reforms in the Kingdom of
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Walston, S., Al-Harbi, Y., & Al-Omar, B. (2008). The changing face of healthcare in Saudi
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