Saudi Arabia’s ambitious Vision 2030 economic transformation plan aims at transitioning the Middle East’s largest economy away from an over-reliance on fossil fuels and into a more diversified modern nation. This transition is being felt especially keenly in healthcare, where the Ministry of Health’s functions are shifting with the aim of providing Saudi citizens with a healthcare system committed to better access, quality, and value.
PharmaBoardroom recently sat down with Prof. Ahmed Aljedai, assistant deputy minister of therapeutic affairs for support services at Saudi Arabia’s Ministry of Health (MoH) to talk through the changes underway within the Saudi healthcare system and the overarching goals of Vision 2030 as it pertains to healthcare
Healthcare System Overview
“The healthcare system in Saudi Arabia is governed by multiple bodies. Pharmaceuticals, medical devices, food, supplements, and herbal products are governed by the Saudi FDA. The FDA oversees the review, registration, and classification of these products, but also their pricing and assuring their quality.
“In terms of healthcare practices, the MoH is the regulator for both the government and private sectors. In the national governmental healthcare system citizens are treated free of charge and we have about eight governmental healthcare sectors. There is also a private sector, which today accounts for about 20 to 25 percent of the whole market, a number that is expected to reach 35 percent by 2030. The MoH accounts for 80 percent of the governmental sector and 60 percent of the overall healthcare sector. Then we have other healthcare sectors such as National Guard Health Affairs, Ministry of Defence Health Affairs, Ministry of Interior, King Faisal Specialist Hospital General organization, ARAMCO, and many others.
“The MoH, as the largest healthcare sector, provides three main functions. The first is provision of care through a network of healthcare systems, including about 300 hospitals, about 2200 to 2400 primary healthcare centres and other specialized centres like oncology, cardiology, eye specialist hospitals, nephrology, and dialysis centres. MoH is also the regulator of the healthcare sector as a whole, however the other governmental healthcare sectors have some governance within their sectors. The MoH is the payer for these healthcare costs. In total, therefore, currently, the Saudi MoH is the provider of care, the regulator, and the payer.”
Healthcare Transformation
“Within the healthcare transformation in Vision 2030, which has been ongoing since 2018, we are going to separate these functions. MoH is going to be the only regulator of health, including all governmental healthcare sectors, and all other healthcare systems will be under its governance, not operationally but in terms of regulatory and auditing standards and accreditation credentials etc.
This will be one of the largest healthcare transformations in the world in terms of number of centres, size of population served, and complexity
“In terms of provision of care, we are giving this up to 20 ‘accountable care organisations’, which will include primary, secondary, and tertiary care healthcare centres. These organisations will provide care to Saudi citizens free of charge and will then bill the government through an independent payment centre, currently called PHAP but eventually to be known as the National Centre for Health Insurance. These organisations are not really private in that they are initially owned by a holding company that is owned by the government. The overall super-regulator of health will remain the MoH by 2030. This will be one of the largest healthcare transformations in the world in terms of number of centres, size of population served, and complexity.
“Saudi citizens will continue to get free healthcare through the government, but via a more corporatized provision of care. This will help remove both complexity and conflicts of interest.”
Budget Management
“The three goals of our healthcare transformation are improving access, improving quality, and improving value. We are looking at healthcare services that provide value to society and this includes making sure that we are utilizing the most cost-effective approaches, treatment modalities, and diagnostic modalities to our patients.
“Healthcare expenditure is continuously increasing and no healthcare system in the world can completely accommodate the ever-increasing costs of medications, diagnostics, and devices. That is one of the reasons we want to link the payment for healthcare services to the outcomes. The National Centre for Health Insurance will reimburse the 20 accountable care organizations based on outcomes such as length of stay, surgery outcomes, and treatment outcomes, with certain clinical metrics and KPIs that are set in advance for all of these healthcare systems, where we reward those who excel and provide care with extra support payments and penalise those who underperform by not giving them the full reimbursement.
“This will encourage improvements in the quality of, access to, and efficiency of care. Treating cancer patients a few months after they are diagnosed is different to treating them immediately, for example. That is why it is very important to bundle quality, access, and efficiency into a payment model that rewards good performers and underpays underperformers.”
Vision 2030: Bold Ambitions
“I am very optimistic about Vision 2030 and am keen to work with all stakeholders towards achieving its goals. We believe that by 2030, we will have better control of certain non-communicable diseases such as obesity, diabetes, hypertension, hypercholesterolemia; the four most prevalent non-communicable diseases here. We will put communicable diseases through vaccination programs and have already been doing a great job in this aspect. Also, we will invest in Saudi citizens’ health in terms of preventing health risks in several areas, from road traffic accidents to obesity, smoking, and other chronic diseases, and extending the average life expectancy to a minimum of 80 years. This ageing population is a challenge; we will have more seniors about 65 and need to take care of them, which will put pressure on the budget. Nevertheless, it is good to take care of healthy seniors.
“We are also very optimistic about introducing value to our healthcare, only paying for what really works. Saudi Arabia is nicely equipped for this push, with well trained, highly qualified, and ambitious Saudi nationals, many of whom have experience in North America and Europe, who are eager to help achieve Vision 2030. Moreover, we are fortunate to have government support in achieving the Vision. While it will be challenging, it is achievable. We have the right infrastructure, the right governance, and we know the direction in which we are going.”
