Many countries now struggle to provide cost-effective, quality healthcare services to their citizens. Saudi Arabia has experienced high costs along with concerns about quality of care in its public facilities. To address these issues the country is currently restructuring their healthcare system to privatize public hospitals and introduce insurance coverage for both foreign workers and citizens.
Based on the statement given explain the following points:
The history of the Healthcare system in Saudi Arabia.
Define the components of the Saudi health care system.
The challenges that are facing the Saudi healthcare system with emphasize on the quality and the cost of the healthcare service and how is the Kingdom of Saudi Arabia is facing those challenges.
Week 4:
Saudi Health Insurance
Part 2
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What is Health Insurance?
?
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Health insurance assists patients in covering medical costs when
accessing private sector care.
A type of insurance coverage that pays for medical and surgical
expenses that are incurred by the insured. Health insurance can
either reimburse the insured for expenses incurred from illness or
injury or pay the care provider directly
Purchasing a health insurance policy= entering into a contract
between the insurance company and the patient (consumer).
Buy a plan or policy, and they pay the expenses when medical
care is needed.
Different types of plans
People can get health insurance policy through their employers or
purchase it individually.
When employers cover insurance it is called managed care (they
provide care coverage for employees at reduced costs).
Often health insurance companies have certain requirements for
categories of plans, coverage plans as well as payment plans
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How Does it Work in Saudi Arabia?
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Private Health Insurance in KSA resulted
from the 1999 Act.
The Council for Cooperative Health Insurance
(CCHI) established in 2011; oversees the
health insurance industry in KSA
Chaired by MOH, members include
representatives from MOI, MOH, MOL, MOSA,
MOFE, MOCI
Regulates and monitors operations nationally
according to policies and standards
Growth in Saudi Arabia
The market for health insurance in KSA
has grown exponentially in the past 5
years.
? Health insurance Gross Written Premium
(GWP) was SR 8.7 Billion in 2010
? Expected to reach 21.1 Billion by the end
of 2015 (growth rate is 19% between
2011-2015)
?
The Future of Health Insurance
The Patient as a Consumer
CCHI has approved 25 companies and
2150 health care providers.
? Market is dominated by 3 companies:
?
? Tawuniya (22%)
? Medgulf (19%)
? Bupa (22%)
?
(Colliers, 2012)
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Estimated to capture 63% of total GWP
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In 2010, more than 5 million individuals
had health insurance
(up from 3.97 in 2009)
Interaction with Healthcare
Organizations and Patients
Patient accesses care, approval for
treatment sought from company
2. Patient may be obliged to pay minimal
fee
3. Insurance company pays health care
provider (reimbursement)
4. Insurance company may also reimburse
patient for costs incurred (depends on
plan)
1.
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Challenges
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Public uneducated about the necessity of insurance
Not all public have understanding of insurance system and
this leads to apprehension and avoidance
Not having insurance causes issues with access to care
(patients delay seeking medical attention to avoid paying
out of pocket)
Insurance costs to purchase plans privately prohibitive in
comparison to national average salaries.
Healthcare organizations affiliation with insurance
companies
Mistrust on the part of the patient
Abuse of the insurance coverage
Monitoring issues
Procedures for obtaining approvals
Inconsistencies in policies
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Thinking Points
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How can policy makers increase the numbers of
those with health insurance coverage nationally?
What actions can be taken to encourage the
public to uptake health insurance plans?
What measures can the government or the CCHI
put in place to ensure health insurance
companies are clear with their consumers?
What measures can the government or MOH put
in place to ensure health care organizations do
not take advantage of insurance to increase their
income?
References
http://www.colliers.com/~/media/files/emea/uae/res
earch/marketoverview/ksahealthcareoverviewcihq12012.ashx
? http://www.cchi.gov.sa/en/Pages/default.aspx
? Bawazir, S.; AlKudsi, M.; AlHumaidan, A.; Al Jaser,
M.; Sasich, L. (2013) Pharmacuetical Policies Used by
Private Health Insurance Companies in Saudi Arabia.
Saudi Pharmaceutical Journal. V (21: 3) pp: 267-276.
http://www.sciencedirect.com/science/article/pii/S13
19016412000953
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Introduction to Health Systems
and
Introduction to Saudi Health
System
LECTURE OBJECTIVES
To understand what is a health system
To know the components of a health system
To Know the strengths and weaknesses of
the current Saudi health system
LECTURE OBJECTIVES
To Know the Cooperative Health Insurance in
KSA
To know the challenges facing the current
Saudi health system
To know the future changes in the Saudi Health
System Strategy
HEALTH SYSTEM
Definitions
What is Health:
Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity
(WHO) 1948
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??????.
HEALTH SYSTEM
What is a Health System ?
A health system consists of all organizations,
people and actions whose primary intent is to
promote, restore or maintain health.
This includes efforts to influence determinants
of health as well as more direct health-improving
activities. A health system is therefore more than
the pyramid of publicly owned facilities that deliver
personal health services.
(WHO)
WHAT IS A HEALTH SYSTEM?
CONTINUED-
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It includes, for example, a mother caring for a
sick child at home; private providers; behaviour
change
programmes;
health
insurance
organizations; occupational health and safety
legislation. It includes inter-sectoral action by
health staff,
For example, encouraging the Ministry of
Education to promote female education, a well
known determinant of better health.
THE SIX BUILDING BLOCKS OF A
HEALTH SYSTEMS (WHO)
1.
Health services are those which deliver effective,
safe, quality personal. And non-personal health
interventions to those who need them, when, and
where needed. With minimum waste of resources.
1.
A well-performing health workforce is one which
works in a ways that are responsive, fair, and
efficient to achieve the best health outcomes
possible,
given
available
resources
and
circumstances. i.e. There are sufficient numbers
and mix staff, fairly distributed, they are competent,
responsive, and productive.
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THE SIX BUILDING BLOCKS OF A
HEALTH SYSTEMS (WHO)
3. A well functioning health information system is one
that ensures the production, analysis, dissemination,
and use of reliable and timely information on health
determinants, health systems performance, and
health status.
4. A well-functioning system ensures equitable, access
to essential medical products vaccines and
technologies of assured quality safely, efficacy, and
const effectiveness, and their scientifically sound
and cost-effective use.
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THE SIX BUILDING BLOCKS OF A
HEALTH SYSTEMS (WHO)
5. A good health financing system raises adequate
funds for health, in way that ensure people can
use needed services, and protected from financial
catastrophe or impoverishment associated with
having to pay them.
6. Leadership and governance involves ensuring
strategic policy frameworks exist and are combined
with effective oversight, coalition building , the
provision of appropriate regulations and incentives
attention to system-design, and accountability.
HEALTH SYSTEM CONTROL KNOBS
(THE WORLD BANK)
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Financing Where does funding for the Health
System come from? How are the funds pooled?
How are they allocated and spent?
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Payment How are providers (hospitals, clinics,
managers, physicians, nurses, etc.) paid?
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HEALTH SYSTEM CONTROL KNOBS
(THE WORLD BANK)
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Organization and Service Delivery Who delivers
health care and in what settings? How are those
facilities organized? Where do people go for
care and why?
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Regulation How are different actors in the health
system — insurers, producers of inputs,
providers, and facilities regulated?
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HEALTH SYSTEM CONTROL KNOBS
(THE WORLD BANK)
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Persuasion How does personal behavior of providers
and patients influence both individual interaction with
the health system and individual health?
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Politics How can health system reformers mobilize
the political support need to bring about positive
change?
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Ethics and Values How do national health systems
reflect the country’s and community’s values?
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HEALTH SYSTEM: COMPONENTS
? Financing Resources
? Legislative Authorities
? Health Regulators
? Health Care Providers
? Human Resources
? Medical supplies providers
? Pharmaceutical producers
? Judiciary Services
HEALTH SYSTEM: COMPONENTS
FINANCING RESOURCES
? Governmental
% of GNP in 2012
? Out of pocket
? Charity
? Donation
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HEALTH SYSTEM: COMPONENTS
LEGISLATIVE AUTHORITIES
The Royal Cabinet:
? Al Shora Council
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? The Bureau of Experts
HEALTH SYSTEM: COMPONENTS
HEALTH REGULATORS
The National Organizations:
? The National Health Council
? Ministry of Health
? The Saudi Commission for Health Specialties
? Council of Co-operative Health Insurance
? The Saudi Food and Drug Authority
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HEALTH SYSTEM: COMPONENTS
HEALTH CARE PROVIDERS
1.
Public healthcare Services:
? Ministry of Health
? Ministry of Defense and Aviation
? National Guards
? Ministry of Interior
? Specialized Hospitals (KFSH, KKESH)
? Universities (Ministry of Higher Education)
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HEALTH SYSTEM: COMPONENTS
HEALTH CARE PROVIDERS
2. Non-profit and Charity:
? Ministry of Social Welfare
? Charity Health Providers:
? Prince Fahad Bin Salman Charity Association For
Renal Failure Patients Care
? Charity Zamzam Association for Health Services
volunteers
? The Saudi Red Crescent
3. For Profit healthcare providers
HEALTH SYSTEM: COMPONENTS
HEALTH CARE PROVIDERS
Hospital Beds distribution according to
sectors
Private Sector 22 %
Other
Governmental
Sectors 18%
MOH
60%
Source: MOH Annual report 2007
HOME HEALTHCARE 100 TEAMS
1434 H
250
Nurses
450
Ambula
nce ????
100
22
HEALTH SYSTEM: COMPONENTS
HUMAN RESOURCES
? Physicians
?
nurses
?
other healthcare
professions
? Leaders and admins
HEALTH SYSTEM: COMPONENTS
MEDICAL SUPPLIES PROVIDERS
? Medical supplies (consumables)
? Medical Equipment
? Medical Instruments
? Medical Devices
Around 30 Medical Supplies Factories
in KSA
HEALTH SYSTEM: COMPONENTS
PHARMACEUTICAL PRODUCERS
Medications
Medical Solutions
Immunizations
HEALTH SYSTEM: COMPONENTS
JUDICIARY SERVICES
? Committee for Private Sector Violations
? Medico-legal Committee
? Health Insurance Violation Committee
CHALLENGES FACING THE CURRENT
HEALTH SYSTEM
? Financial
Budget allocated to the health sector by the
Ministry of Health :
1956: 39,549,458 SR
1958: 68,480,000 SR
1960: 116,395,000 SR
2009: 40.43 billion SR
2010: 61.20 billion SR
2011: 68.70 billion SR
Health Insurance
The Cooperative Health Insurance in KSA(Takaful)
Act and Laws
1985 : Royal Decree No (M/5)
Based on Islamic Takaful
1999, Cooperative Health Insurance Act
Aimed at covering ultimately the whole Saudi and non
Saudi population.
2003: control law of cooperative insurance companies.
2005: compulsory for all non-Saudis(private sector)
2008: included Saudis (private sector )
May 2009: bylaws were declared
Saudi Health Care System:
Current Issues and Challenges
Week 3 Part 2
Weakness Points of the Saudi
Healthcare System
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Organizational work, measurements, and
performance control
Lack of unified qualified standards
Technical and administrative workforce and
quantitative and qualitative shortage
Low abilities of contracting and employment
Large size of MOH
Limited financial resources
Inefficiency
Weak allowance system and career
development
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Low interests on researching and
education sides
Poor availability of accurate health data
Weakness of health informatics system
Weak infrastructure
Weak referring system and emergency
transporting
Focusing on treatment side without
preventing side
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Strength Points of the Saudi
Healthcare System
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In the last 50 years, Saudi Arabia has made impressive
development in the healthcare infrastructure
The country now boasts a large number of facilities with
advanced technologies and highly trained professionals
Emphasis on PHCs to assure universal access, adopt
essential drugs formulary, develop better referral
system, maintain records, implement accreditation &
licensing requirements has allowed improvement in
efficiency & quality of care
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There has been a steady improvement in public
health indicators e.g. life expectancy at birth,
immunization rates, infant and maternal morality
rate, and incidence of infectious diseases
? Advanced training programs in clinical disciplines
are available; fellowships, certification, and
diploma.
? foreign physicians will be replaced by highly trained
physicians and scientists
? Number of trained nurses and other healthcare
professionals will also increase
(Khaliq, 2012)
?
continued
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Clinical and basic science research has gained a lot of
momentum, and many first-rate articles are
contributed by Saudi biomedical researchers
? A strong biotechnology research infrastructure also
is developed Jeddah BioCity
? Stem cell research center King Faisal Specialist
Hospital and Research Center, and King Abdul Aziz
City for Science and Technology
? Large amount of invested money was assigned to
KAUST King Abdulla University of Science and
Technology
(Khaliq, 2012)
?
continued
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The world health report 2000. Health systems: improving per2. formance. Geneva, Word Health Organization, 2000
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Saudi Health care is ranked 29th amongst 190 of the
world Health system
Gallagher stated: Although many nations have seen
sizable growth in their health care systems, probably no
other nation (other than Saudi Arabia] of large
geographic expanse and population has, in comparable
time, achieved so much on a broad national scale, with a
relatively high level of care made available to virtually all
segments of the population Gallagher EB. Modernization and health reform in Saudi Ara1. bia,
Chapter 4. In: Twaddle AC, ed. Health care reform around the world. London, Auburn House, 2002:181197
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WHO praise on the kingdoms healthcare facilities
remarking that the well-equipped hospitals designated
to serve haj pilgrims indeed surpassed many of the
world-class hospitals.
KSA hospitals surpass some world-class ones Arab News, October 19th 2013.
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Despite these achievements, the Saudi Health care
system faces many challenges that Demands for new
strategies.
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Challenges of the Saudi Healthcare
System
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Increasing demand on healthcare services
Increasing cost of healthcare services
Transitions of disease structure
Size and geographic of Saudi Arabia
Accelerated technological advances in the
healthcare field
Shortage of qualified workforce
?
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?
?
?
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Citizen high expectations
Dependency on governmental allocation
budgets
Hajj and Omrah
Inappropriate environment in rural areas
Close link to other ministries
Resistance to change
Saudi Health Care System:
History, Development and
Structure
Week 3
Saudi Arabia Demographics in
2010
http://www.moh.gov.sa/en/Ministry/About/Pages/Strategy.aspx
The Saudi Population
?
The Saudi population was 27.1 million in
2010. The population is estimated to be
around 36 million in 2020.
Population in Millions
1425
1426
1427
1428
1431
1436
1440
H
H
H
H
H
H
H
(2004
(2005
(2006
(2007
(2009
(2014
(2018
2005
2006
2007
2008
2010
2015
2019
G)
G)
G)
G)
G)
G)
G)
http://www.moh.gov.sa/en/Ministry/About/Pages/Strategy.aspx
Percentages of Age 60+
1425
1426
1427
1428
1431
1436
1440
H
H
H
H
H
H
H
(2004
(2005
(2006
(2007
(2009
(2014
(2018
2005
2006
2007
2008
2010
2015
2019
G)
G)
G)
G)
G)
G)
G)
http://www.moh.gov.sa/en/Ministry/About/Pages/Strategy.aspx
Historical Development
?
In 1925 in Makkah (government seat at that time) the
Department of Public Health and Ambulance was
established with branches in provinces to provide
free care for pilgrims and populace
?
In around 1950 the Ministry of Health was
established
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??????) ????? ?????? ????? ?????? ???????? ?? ???? ???
?????????? ?????? ??????? ???????? ?????? ????????
? ????? ????? ??????1950 ???? ????
Al-Malki 2011
Historical Development
?
In 1970 (after Oil revenue) the first Saudi Five-year
National Development Plan was created, including
healthcare
?
In 1980 (after Almaata the WHO slogan Health For
All (HFA)) Health Care Centers (PHC) were
established
? (??? ?????? ?????) ?? ????? ??? ????1970 ??? ????
? ??? ?? ??? ??????????????? ????? ????? ???????
????????
? (??? ?? ?? ??? ???? ????? ??????1980Al-Malki
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2011
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)?(???
Saudi Health Care System
Structure
MOH is the main provider of health care
services
? Supported by governmental agencies:
?
? Health Services Council
? Health Insurance Council
? Saudi Food and Drug Authority
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Saudi government allocates an annual
budget to support 5-year plan
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The Saudi Health Care System
structure
Ministry of Health MOH
MOH supervises:
Public health care services
Private health care services
Traditional Medicine services
? Recently a traditional medicine
department was established in MOH to
control traditional medicine in the market
How does the MOH supervise?
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Saudi Health Care System
Structure
?
There are 20 Regional Directorates for General Health
Affairs around Saudi Arabia supervised by the MOH,
each one is led by a Regional Director General for
Health Services
?
Each Regional Directorates General Health Affairs
contains a number of hospitals and health services
?
Each Health Sector supervises a number of Primary
Health Care Centers
(Almalki, 2011)
Levels of Health Care Services
Tertiary Health Care
Secondary Health Care
Primary Health Care
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2
Levels of Healthcare Services
Primary Healthcare Centers PHC:
Provide primary care services; both preventive and curative, and
refer advanced medical cases
1.
???
2. Secondary Healthcare Centers SHC:
Provide more advanced care for advanced medical cases
3
3. Tertiary Healthcare Centers:
Provide care to cases that need more complex levels of care
???
(Almalki, 2011)
Levels of Health Care Services
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1. Primary Care
Provides basic care and preventive services
? Through Primary Health Care Centers
provides basic health services such as
prevention, awareness, minor illnesses
treatment
There are more than 2000 primary care
centers in KSA
clinics and mobile units serve rural areas
(minor and preventive care)
(Almalki, 2011)
Levels of Health Care Services
?
2. Secondary Care (268 hospitals, 38,970beds)
? Receives referrals from Primary Care for
more specific cases, increased
specialization, provides surgery and inpatient services
? Usually provided by general hospitals
? considered as a curative service
? 77% of Saudi hospitals are General
Hospitals
(Almalki, 2011)
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Levels of Health Care Services
3. Tertiary Care
? Receives referrals from Secondary Care for
complex cases or specific types of diseases
and illnesses
? Serves more complicated cases that needs
specialized experts treat cases referred
from General Hospitals such as (cancer,
transplants, etc
)
? Provided by more specialized hospitals
? Considered curative service
? 33% of the hospitals among KSA are
considered specialized hospitals
Al-Malki 2011
Hospitals Managed By:
Ministry of Health 63%
Private Sector 13%
Ministry of Defense and
Aviation 8%
Ministry of Education 7%
National Guard 3%
Other 6%
Khalig 2012
Workforce Distribution
Large percentage of expatriate workers
? Europe and Asia
? As of 2009 MOH employed:
?
? Physicians: 22.6% Saudi
? Nurses: 50.3% Saudi
?
Continuous effort to increase number and
quality of Saudi health care professionals
through education, scholarships and
training programs
Khaliq 2010
Ministry of Health (MOH) Values
Patient First
Professionalism
Justice
Quality
Honesty and Transparency
Teamwork
Initiative and Productivity
Societal Involvement
Article 31 of the Basic Law of Saudi Arabia: the State shall
protect public health and provide healthcare to every citizen
MOH Agenda Priorities:
Public Health and Disease Control
? KSA cooperation with World Organizations
and collaborations with experts
? Keeping pace with current developments
in health care
? Building a strong infrastructure across the
Kingdom (E-Health, Staffing and
Facilities)
?
Article 31 of the Basic Law of Saudi Arabia: the State shall
protect public health and provide healthcare to every citizen
5 Year Development Plan by MOH
?
Ministry of Health (MOH) has a 5 year plan
defining its goals and targets (1431-1440H)
http://www.moh.gov.sa/en/Ministry/About/Pa
ges/Strategy.aspx
? Priorities:
? Resolving management issues
? coordination between public, private
military sectors facilities
? e-health strategy
? meeting rising demands
and
???
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Patient Centered Care
Part of current strategic plan
? Ministry of Health implementing modern
methodologies to providing health care
services
? Health system completely devoted to
patients patient-centered
?
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(
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???
Patient Centered Care
?
Aims to meet patients health needs at the right
place at the right time including the following:
?
?
?
?
Primary health care
Specialized therapeutic services
Professional manner and conduct
Preserving patients rights (the right to know about their
condition, the right to know the different treatment
options, the right to choose their physician, and the right
to be always treated with care and respect)
Hajj Health Care Services
?
?
?
?
Saudi Arabia embraces the 2 holiest cities of
Islam: Makkah & Madinah
2,000,000+ pilgrims from all over the world
perform Hajj annually
Health services in the Hajj season provide
preventive and curative care for all pilgrims
Preventive care: educational programs,
vaccinations and giving out medication as
needed
(Al-Malki, 2011)
Hajj Health Care Services
?
Emergency and curative services are
provided through a network and task
forces specifically formed for the Hajj
season
(Al-Malki, 2011)
?????? ????? ??????? ??????? ?? ???? ???? ?????
???? ???? ????? ????? ?????
Challenges to the Health Care
system in KSA
Population expanding
? Chronic diseases prevalence
? Health care expense
? Increase in health awareness and
education in society, contribute to rising
demand for better quality care
?
References
?
?
?
The Ministry of Health www.moh.gov.sa
Khaliq, A. (2012). The Saudi Healthcare
System: A View from the Minaret. World
Health & Population. Vol.13 No.3
https://www.longwoods.com/content/22875
Al-Malki, M., Fitzgerald, G., & Clark, M. (Oct.
2011). Health care system in Saudi Arabia:
an overview. Eastern Mediterranean Health
Journal, 784-793
http://www.emro.who.int/emhj-volume17/volume-17-issue-10/article-11.html
Assignment 1
?
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?
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