Saudi Healthcare System Research Articles

Cost-Effectiveness of First-Line Cetuximab in Metastatic Colorectal Cancer in Saudi Arabia

ObjectivesOur objective was to evaluate the cost-effectiveness of first-line cetuximab in relation to primary tumor location and after resection from the perspective of the Saudi healthcare system over a lifetime horizon. MethodsTwo standard partitioned survival models were developed in this study comprising 3 health states in each model. The first model was to simulate outcomes and costs of folinic acid, fluorouracil, and irinotecan (FOLFIRI) plus cetuximab compared with FOLFIRI alone in 2 target groups—first, in RAS wild-type left-sided metastatic colorectal cancer (mCRC) and second, in patients administered with 4 cycles of FOLFIRI plus cetuximab, who underwent a resection of liver metastases. The second model compared FOLFIRI plus cetuximab with FOLFIRI plus bevacizumab in wild-type left-sided mCRC and after resection. All cost data and utilities were extracted from published data. ResultsFOLFIRI plus cetuximab in RAS wild-type left-sided mCRC compared with FOLFIRI alone resulted in an incremental cost-effectiveness ratio of Saudi Riyal (SAR) 180 880 per quality-adjusted life-year (QALY) gained ($102 019; cost-effective). After resection of liver metastases, it resulted in SAR140 442 ($79 211) per QALY gained (cost-effective). When comparing FOLFIRI plus cetuximab with FOLFIRI plus bevacizumab, it resulted in SAR35 818 ($20 201) per QALY gained (highly cost-effective). After resection, it resulted in SAR109 612 ($61 822) per QALY gained (highly cost-effective). Thus, FOLFIRI plus cetuximab improved QALYs compared with FOLFIRI plus bevacizumab at the minimized difference in costs in left-sided mCRC and patients with unresectable metastases. ConclusionFOLFIRI plus cetuximab is cost-effective compared with FOLFIRI plus bevacizumab or FOLFIRI alone in RAS wild-type left-sided mCRC and patients who undergo resection.

Knowledge, Attitudes and Perception toward COVID-19 Vaccines among Adults in Jazan Province, Saudi Arabia.

Background: Saudi Arabia is one of the countries that initiated early vaccination programs despite the global challenges concerning the availability of COVID-19 vaccines. Massive vaccination campaigns have been undertaken in the country; however, negative perception and hesitancy toward vaccines may exist which could reduce public response to vaccination. Further, studies evaluating the current perception and attitude toward COVID-19 vaccines are scarce. Thus, this study aims to assess the community attitudes and perceptions toward COVID-19 vaccines in Jazan Province, Saudi Arabia. Methods: A cross-sectional, retrospective study using an online questionnaire was conducted among the public in Jazan, the southern region of Saudi Arabia. General and demographic data were collected, and perception and attitude toward COVID-19 vaccines were evaluated. Results: Most participants in this study were female (67%) with a median age of 23 years. The majority held a bachelor’s degree, and they trusted the Saudi healthcare system. Our survey showed that 67% of the study participants had positive perceptions toward COVID-19 vaccines, a finding that is significantly associated with receiving the influenza vaccine in the past, the existence of trust on the current healthcare system and holding positive beliefs toward the effectiveness of the current COVID-19 vaccines in reducing the risk of infection, complication, and mortality. Conclusions: The proportion of the public in Jazan who believed in the COVID-19 vaccine effectiveness is not inferior from similar international reports. Thus, national awareness programs toward the effectiveness of the vaccine could be enhanced to accelerate vaccination coverage. Further, nationwide surveys are warranted to include larger populations from different communities to assess the overall perception toward COVID-19 vaccines in the whole country.

Public Perception and Attitude toward Community Pharmacists in Saudi Arabia

Background: The Saudi healthcare system is undergoing a major transformation, and pharmacists will assume more responsibilities in providing healthcare services. The current study aims to determine the current perception and attitude of the public toward pharmacists, as well as the public satisfaction with pharmacists’ practices and services in the community pharmacy setting. Methods: A cross-sectional, online questionnaire-based study was conducted between February and April 2019 and included adult participants (≥18 years) who could read and complete an Arabic online survey. χ² and correlation tests were used to investigate differences in perception and attitude toward community pharmacists based on study population demographics and characteristics and assess the association between public perception and attitude. Statistical analysis was conducted using SAS software, version 9.4. Results: A total of 387 participants completed the survey. The overall Saudi public’s perception and attitude toward community pharmacists were positive in the study population, scoring 81.4% for perception and 69.8% for attitude, with female participants having a more favorable perception of community pharmacists than male participants (89.3 vs. 77.7%, p < 0.01). A strong and positive correlation between public perception and attitude was recognized in the study (r = 0.71, p < 0.01). The participants were found to be mostly satisfied with pharmacists’ commitment and communication skills, but not, however, with the level of pharmaceutical care services provided. Conclusion: The current positive perception and attitude toward community pharmacists among the Saudi public create an opportunity for pharmacists to assume expanded roles as healthcare providers. However, their pharmaceutical care skills should be improved in order to gain their patients’ trust and provide them with valuable services.

Understanding Patient Needs Regarding Adverse Drug Reaction Reporting Smartphone Applications: A Qualitative Insight from Saudi Arabia.

Background: A pragmatic shift in the healthcare sector characterized by moving from curative to preventive approaches highlights the role of pharmacovigilance in patient safety. There have been few published studies on patient reporting of adverse drug reactions (ADRs) in Saudi Arabia. This qualitative study aims to explore the community opinions and the need for patient-friendly smartphone applications (SPAs) to enhance their participation in ADR reporting. Methods: Purposeful sampling was followed to recruit study participants, a semi-structured interview guide was used to conduct interviews, and the saturation was reached after the 13th interviewer; no new information was obtained after two subsequent interviews. All the interviews were audio-recorded, transcribed verbatim, and analyzed by means of a standard content analysis framework. Results: As per the WHO guidelines, eleven participants were aware of the term “ADR”. All the participants denied receiving any prior education and attending events about ADRs and were unaware of the Saudi FDA-ADR reporting systems. The use of technologies such as SPAs has been widely accepted with a high level of concern for data confidentiality and privacy. Conclusions: These findings point out the need to build patient-oriented educational programs to increase their awareness of ADR reporting and to prioritize the use of artificial intelligence (AI) to be integrated in the Saudi healthcare system to develop future SPAs for improving both patient safety and signal detection of ADRs.

Awareness, Attitudes, Practices, and Perceived Barriers to Medical Error Incident Reporting Among Faculty and Health Care Practitioners (HCPs) in a Dental Clinic

BackgroundGood Catch programs are being increasingly embraced by the Saudi healthcare system to improve incidence reporting rates and patient safety. However, dental health care is at a critical stage of promoting a safety culture; there is insufficient use of incident reporting systems (IRS) in several dental schools. Therefore, in this study, we evaluated the level of awareness, attitudes, practices, and perceived barriers to incident reporting among faculty and health care practitioners (HCPs) working in a university dental clinic.MethodsIt is a cross-sectional study design where participants have been recruited from faculty working in a dental clinic at Imam Abdulrahman bin Faisal University during the year 2019. A self-administered questionnaire was distributed including domains of awareness, attitude, practice, and barriers to use.ResultsA total of 199 completed questionnaires were received. HCPs differed with respect to their levels of awareness, attitudes, and practices of incident reporting when compared with non-Saudi HCPs. Nurses showed high awareness scores (X= 4.4, p <0.001), practice scores (X= 3.61, p <0.001), and attitudes (X= 3.9, p <0.001) in comparison with dentists and interns. The respondents agreed that the most common factor that influenced the rate of their incident reporting was “possible negative effect on the relationship with employees.”.ConclusionNurses showed higher levels of awareness, attitude, and practice regarding IRS than did dentists and interns. We uncovered key factors influencing incident reporting among the faculty and HCPs in a university dental clinic. These findings could aid policymakers to focus on these factors so as to frame appropriate strategies to encourage incident reporting and to improve the effective use of the IRS.

Factors Influencing Patient Safety Culture in Saudi Arabia: A Systematic Review

ABSTRACT&#x0D; Context: Patient safety, which is concerned with preventing harm to patients, has already become a vital element of the global healthcare system. The evidence relating to the status of the patient safety culture in Arab countries suggests that it is at a sub-optimal level because of a punitive approach to errors and deficits in communications openness.&#x0D; Aim: The given review aimed to identify the relevant evidence related to factors influencing patient safety culture in Saudi Arabia hospitals from patients and health care provider perspectives.&#x0D; Methods: A systematic search was conducted in five electronic databases—MEDLINE, CINAHL, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews. Related papers and reference lists of included studies were also hand-searched. One reviewer verified that the research met the inclusion criteria, assessed the research quality, and extracted their relevant features. The Yorkshire Contributory Factors Model (YCFF) was used to categorize factors influencing safety culture in the included documents.&#x0D; Results: 14 documents were included, and most research was appraised as being satisfactory to high quality. Strength and weakness factors that are influencing patient safety culture have been identified. In Saudi Arabia, ineffective leadership, a blame culture, workload/inadequate staffing, and poor communication are key factors hindering a positive patient safety culture. Conversely, 'strength' factors influencing a positive patient safety culture included good teamwork within units, realistic manager expectations and supportive actions promoting patient safety, and organizational attitudes to learning/continuous improvement. There is an absence of patient perspectives about patient safety culture in Saudi Arabian studies.&#x0D; Conclusion: In the Saudi healthcare system, policymakers should pay attention to factors that may influence a positive patient safety culture, particularly the development of a blame-free culture, improving communications and leadership ability, learning from mistakes, and involving patient perspectives in safety initiatives. Further study must understand the barriers and facilitators in Saudi Arabia Hospitals to implement a positive patient safety culture.

Transformation of health care and the new model of care in Saudi Arabia: Kingdom’s Vision 2030

The Kingdom of Saudi Arabia espoused “Vision 2030” as a strategy for economic development and national growth. The vision demonstrated the Kingdom’s objectives to become a pioneer nation globally by achieving three main goals: a vibrant society, a thriving economy, and an ambitious nation. To fulfill this, the Kingdom launched a national transformation program (NTP) as outlined in “vision 2030” in June 2016. The health care transformation is one of the eight themes of the NTP’s. The history of health care facilities in the Kingdom is almost a century. Although the Kingdom has made notable progress in improving its population’s health over recent decades, it needs to modernize the health care system to reach the “vision 2030” goal. This article aims to describe the new Model of Care (MOC) according to the recent Saudi health care transformation under the Kingdom’s vision 2030. The MOC concept started with understanding the current state and collecting learnings. It is based on the six systems of care (SOC)- keeping well, planned procedure, women & children, urgent problems, chronic conditions, and the last phase of life. The SOC is cut across different “service layers” to support people’s stay well and efficiently get them healthy again when they need care. The new MOC describes a total of forty-two interventions, of which twenty-seven split across the six SOC and the rest fifteen cut-across the multiple SOC. Implementation of all MOC interventions will streamline the Saudi health care system to embrace the Kingdom’s “vision 2030”.

Vision 2030 and Sustainable Development: State Capacity to Revitalize the Healthcare System in Saudi Arabia

Vision 2030 is a social and economic strategic program by the Kingdom of Saudi Arabia (KSA) aimed at diversifying the nation’s economy and stimulating numerous changes in its social and economic sectors, including in healthcare. Sustainable Development (SD) 2030 is a global consensual agreement among nation-states to build a sustainable, desirable and progressively interrelated world. The Saudi government highlighted Vision 2030 to improve population health and the world body reiterated that SD 2030 will contribute to “healthy lives and promote well-being for all at all ages.” This article analyzes the state capacity in revitalizing the healthcare system in Saudi Arabia with the context of Vision 2030 and SD 2030. Scoping reviews and thematic data analysis techniques were used as a method of this study. The realization of Vision 2030 is essential for the fulfilment of the SD Goals 2030. The government has realigned its national programs, plans and strategies with global development targets, indicators, and goals to achieve the SD Goals. Achieving SD 2030 is seen as the main component of development for health. Prudent reforms should be taken to accommodate the goals and objectives of Vision 2030 and SD 2030. These measures will help strengthen governance and state capacity so as to ultimately revitalize the Saudi healthcare system and improve population health. Saudi Arabia’s Vision 2030 encourages the state to play a renewed role in development in light of the UN’s declaration of the “right to development.” While pursuing SD Goals, the state must create the necessary environment for sustaining capacity, need to improve service delivery by building cooperation and coordination among providers and interactions among groups to realize constructive roles and functions in maintaining state affairs, which ultimately enhances state capacity to revitalize healthcare system of Saudi Arabia.

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

ObjectivesThis study aims to explore the perceptions of different stakeholders about the privatisation of the Saudi health care system. MethodsUsing 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. ResultsOur 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. ConclusionOur 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.

PCN75 Direct Medical Cost of Breast Cancer in Saudi Arabia

Breast cancer is the most common type of cancer among females in Saudi Arabia. As a result, the Saudi healthcare system is expected to face a heavy economic burden to provide sufficient healthcare services to breast cancer patients. The purpose of this study is to estimate the direct medical cost associated with breast cancer in Saudi Arabia form a healthcare perspective. This was a retrospective prevalence-based multicenter cost of illness study conducted at KSUMC and KFMC. Breast cancer patients medical recorded were examined for the year 2018. A micro-costing approach was conducted to estimate the direct cost that included (medications, lab and diagnostics, hospitalization, procedures, visits, emergency). Prices and costing data were collected from NUPCO, MOH and institutional business centers costing data. Descriptive and inferential statistics were performed. A total of 300 breast cancer patients were included in the study. The total estimated direct cost was SAR 54,854,100. The average direct medical cost per patient was estimated as SAR 182,847 ± SAR 13,065. The cost significantly varied between breast cancer stages I-IV (SAR 53,432, SAR 74,102 ,SAR 109,280 ,SAR 305,585) respectively (p<0.001). In addition, the average cost significantly varied between pre and postmenopausal status (SAR 154,817, SAR 107,610) respectively (p<0.001). The cost of medications was major driver of the total direct cost (85%) followed by hospitalization and diagnostic tests costs (6%, 4%) respectively. The majority of drug cost were related to regimens include the combination of trastuzumab and pertuzumab with an average direct cost of SAR 117,137 ± 33,506 per cycle. The direct medical cost of breast cancer are extremely high in Saudi Arabia and mainly driven by the cost of medication. Decision makers may focus on better cost effective approaches including screening programs and the use of biosimilars to help controlling the cost of breast cancer in Saudi Arabia.

Factors contributing to the patient safety culture in Saudi Arabia: a systematic review

BackgroundPatient safety, concerned with the prevention of harm to patients, has become a fundamental component of the global healthcare system. The evidence regarding the status of the patient safety culture...

Adopting the Triple Aim Framework in the Saudi Healthcare System: A Delphi Study.

PurposeHelping healthcare systems to optimize performance using particular metrics through objective monitoring will positively impact an organization’s progress toward strategic goals and objectives. The Institute of Healthcare Improvement introduced the Triple Aim framework for guiding new or transforming health systems, concurrently improving population health and patients’ care experience, and reducing per capita cost. Consensus to determine applicable and appropriate measures to monitor this transformation within the scope of the three objectives is required. Thus, the study aimed to adopt the Triple Aim measures and reach a consensus among experts in healthcare systems on the applicability of the measures in the health system of Saudi Arabia.MethodsA two-round Delphi study was conducted with 17 invited experts who were knowledgeable and experienced in healthcare systems and administration, quality improvement, and strategic planning. These rounds were based on the measures of the three objectives, where they were introduced as statements and grouped under each respective aim. The experts were instructed to score each measure using a 5-point Likert scale and were invited to formulate new measures related to the same aim. Statements reaching a consensus level of 80% were considered applicable measures for the Saudi health system.ResultsA total of 17 measures were circulated among experts; out of which, 16 measures reached a consensus. The 16 measures represent the three main domains of the Triple Aim model, ie, population health, experience of care, and cost per capita. The measure that failed to reach a consensus was the predictive model scores because it requires medical knowledge, where the majority of the experts were non-physicians.ConclusionA Delphi study was used to reach consensus among experts on the Triple Aim measures as a first step to building a solid foundation for the population management required to implement these initiatives in the future.

Knowledge, Perception, and Application of Pharmacogenomics Among Hospital Pharmacists in Saudi Arabia.

IntroductionThe accelerated transformation in the healthcare system supported by the Saudi Vision 2030 makes the present the best time to start the real application of pharmacogenomics in Saudi Arabia. The current study aimed to assess the knowledge, perception and the application status of pharmacogenomics among pharmacists in the hospital settings in Saudi Arabia.MethodsThis cross-sectional observational survey was conducted among 206 qualified pharmacists working in Saudi hospitals. A self-administered questionnaire was sent to all participants.ResultsOnly 30% of the pharmacists had received any type of formal training on PGx. Of these, only nine participants had actually put the knowledge into practice. Participants showed a moderate to low level of knowledge when responded to the pharmacogenomic knowledge indicators used in the study. The low knowledge and the availability of the pharmacogenetic test are the main barriers for the low adoption of the pharmacogenomics in the clinical practice. Approximately 83% felt the need to know more about pharmacogenomics. Participants show positive perception with high motivation levels to incorporate this technology in practice. For example, 76% stated that pharmacogenetic testing should be applied to pharmacy practice. Around 38% of participants reported that the Saudi government and the Saudi FDA had been promoting the pharmacogenomics. However, 50% of the total participants reported that their hospital management is unaware of the pharmacogenomics importance in clinical practice.DiscussionThis study emphasizes on two needs which can help promote the use and implementation of pharmacogenomics. One is the need to update the pharmacy education and training programs with pharmacogenomic-related areas to raise the pharmacist’s knowledge and practical skill to apply pharmacogenomics in the clinical practice effectively. Another need is to increase the awareness of the decision and policy-makers with the importance of pharmacogenomics for the patient benefit and safety. This preliminary evaluation will provide future insight into the best approach to applying pharmacogenomics in the Saudi healthcare system.

The experiences of foreign doctors in Saudi Arabia: A qualitative study of the challenges and retention motives

BackgroundThe Saudi healthcare system is mainly staffed by foreign doctors who constitute about 73% of the total medical workforce. But, the high rate of turnover among these foreigners had deposited an additional unbearable cost and threatens the stability of the provided healthcare services in the country. ObjectivesThis study was conducted to explore the professional and personal challenges that were experienced by foreign medical doctors while working in one of the major governmental tertiary-care hospitals in Riyadh city. The study also seeks to explore the factors that could influence or motivate their retention. MethodsA qualitative study based on semi-structured interviews was conducted on January 2018. A total of 16 foreign doctors were recruited purposefully using a maximum variation sampling strategy. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis technique. ResultsThree primary themes have been emerged based on the data analysis: (1) Work-related challenges such as; communication and discrimination challenges. (2) Living-related challenges such as; supportive services and restricted movement challenges. (3) Factor motivating retention such as providing good children education, offering flexible traveling regulations, and providing professional development opportunities. ConclusionsThe findings of this study have indicated that there are more important motivators than money for improving the retention of foreign doctors in the country. Several policy actions have been recommended to maintain their essential role. For example; implementing an ethical code to protect them from receiving deceptive hiring information, developing a specialized pocket dictionary to overcome language barriers, embracing "workforce diversity management" techniques to minimize discrimination at institutional level, and finally it is also recommended to include the foreign doctors' family needs and other living related challenges in any future retention strategies.

Integration of Palliative Care Into Primary Health Care: Model of Care Experience

BackgroundThe World Health Organization (WHO) has recognized access to palliative care as a basic human right. Palliative care service has been established in Saudi Arabia for more than two decades; however, it is still limited to secondary and tertiary healthcare institutions. While primary care is the first level of care in the Saudi healthcare system and covers the largest amount of the population, palliative care is still far from implemented at this level.ObjectivesThis study sought to evaluate the outcome of integrating palliative care service at the primary healthcare level and assess patient satisfaction with services provided by primary healthcare centers (PHCCs).ResultsTwo hundred patients participated in the study, including 50 new patients and 150 existing patients for follow-up. One hundred ten patients, in addition to 200 caregivers, attended the clinic. Twenty percent were on active oncology treatment. The no-show rate was 45%, and the overall satisfaction score was 90%.ConclusionPalliative care service integration into primary care is beneficial for improving access to early palliative care, and subsequently, improving symptom control, compliance with cancer treatment, quality of life, and overall satisfaction. This model will be implemented in all PHCCs in Saudi Arabia.

Identifying the factors influencing Saudi Arabian nurses' turnover.

This study identifies and analyses the risk factors contributing to nursing turnover in Saudi Arabia and identifies practical solutions to decrease turnover and encourage nurses to stay in their jobs. Saudi Arabia has a unique nursing profile, as the majority of the nursing workforce are expatriates. The Saudi health care system relies on contracted expatriate nurses to provide most of the direct patient health care. For nurses from other countries, Saudi Arabia can be a challenging place to work due to a range of factors including personal, policy and organisational variables. There is a high turnover of expatriate nurses, and this has been long-standing problem for the Saudi Arabian health care system. A cross-sectional survey design among nurses in Saudi Arabia including 502 nurses, of whom 83.7% are female. Structural equation modelling is used to examine the relationships between the study variables. Confirmatory factor analysis is used to create and validate the measurement models for variables. The analysis of the survey data identifies that Filipino nurses are more likely to intend to leave their current position than other expatriates, including Malaysian, Pakistani, Indian or local Saudi nurses. Many expatriates identify discrimination as an important contributing factor for their intention to leave, citing that the national salary remuneration for nurses should be based on competency and delivery of care. Furthermore, several independent variables are found to be significant predictors of anticipated turnover, including discrimination; social support from immediate supervisor; organisational commitment; and autonomy. This study provides the most comprehensive information available to date about the factors that influence nurses' desire to leave their current job and provides evidence for better health workforce planning in Saudi Arabia. This study strongly indicates that the main factor related to turnover is the unfair and unequal salaries paid to nurses of different nationalities in Saudi Arabia. The findings relating to both Saudi and foreign nurse employment could be helpful to policymakers and the Ministry of Health in Saudi Arabia.

Nurses’ intention to report child abuse in Saudi Arabia: A cross-sectional study

BackgroundChild abuse is a prevalent problem with short and long-term consequences. While most countries have enacted child abuse reporting laws, the Saudi healthcare system has not paid sufficient attention to nurses’ role in the reporting of child abuse. ObjectiveThis study aimed to 1) identify the factors associated with nurses’ intention to report child abuse by testing a hypothetical model; 2) examine the patterns underlying their intention to report child abuse; and 3) investigate the differences in reporting based on clinical practice areas. Participants and SettingA convenience sample of 248 nurses recruited from emergency and pediatric inpatient units and primary healthcare centers in Riyadh, Saudi Arabia was used. MethodsIn this cross-sectional study, data were collected using the Child Abuse Report Intention Scale and another self-report measure in February 2019. ResultsMost nurses had not reported even one case of child abuse during their clinical practice. Knowledge about child abuse (β = .210, P = 0.000), subjective norms (β = .218, P = 0.001), and organizational support in guideline implementation (β = .138 P = 0.038) were significantly associated with the intention to report child abuse. Nurses reported a stronger intention to report child sexual abuse than other types of abuse. Clinical practice areas were significantly associated with nurses’ intention to report child abuse. ConclusionsNurses’ professional preparation for child abuse reporting is inadequate. The findings underscore the importance of enhancing their knowledge about child abuse and reporting laws, promoting social support, and creating an empowering clinical environment.

Pharmaceutical companies’ views on a health technology assessment (HTA) entity in Saudi Arabia

Saudi Arabia is undergoing a massive healthcare transformation to fulfill its new, national “Vision 2030.” To align with this objective, Saudi Arabia is establishing a new, independent and evidence-based health technology assessment (HTA) entity to help it maximize health gains through efficient use of resources. This study was designed to ascertain how pharmaceutical companies perceive the creation of such a national HTA entity in Saudi Arabia; what they think about it and expect from it. To achieve the study’s aim, we held a workshop in Riyadh, Saudi Arabia, lasting four and a half hours and hosted by the Saudi Ministry of Health (MOH). We invited 16 market access directors and managers from different multinational pharmaceutical companies to discuss the establishment of a national HTA entity. The findings from the workshop were structured around three axes: vision and remit; HTA method; and implementation and practical considerations. Overall, the pharmaceutical company participants were positive about HTA’s value for the Saudi healthcare system and expressed willingness to adapt to meet its future requirements.

Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis.

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: −83.398 to −24.202; P < .003 and −28 > 638 to −7.362; P < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome Coronavirus Infection: A Single-Center Retrospective Chart Review Study.

BackgroundAmong the countries affected by Middle East respiratory syndrome (MERS), Saudi Arabia was impacted the most, with 2,058 cases reported as of June 2019. However, the impact of the MERS epidemic on the Saudi economy is unknown.PurposeThe present study aimed to evaluate the direct medical costs associated with the management of MERS cases at a tertiary referral hospital in Riyadh, Saudi Arabia.MethodsThe study involved a retrospective chart review of confirmed cases of MERS coronavirus (MERS-CoV) infections in a tertiary care referral center in Riyadh, Saudi Arabia, from January 2015 to October 2018. The collected data included sociodemographic characteristics, medical information, and the cost of hospitalization of each patient as estimated by micro-costing.ResultsA complete set of relevant information was available only for 24 of 44 identified MERS-CoV cases. Patients were mostly females, and the mean age was 52 years. Diabetes, hypertension, and chronic kidney disease were the most frequent comorbidities. The length of hospital stay varied from 1 to 31 days, averaging 4.96 ± 7.29 days. Two of the 24 patients died. The total cost of managing a MERS case at the hospital ranged from $1278.41 to $75,987.95 with a mean cost of $12,947.03 ± $19,923.14.ConclusionThe findings of this study highlight the enormous expenses incurred by the Saudi health care system due to the MERS-CoV outbreak and the importance of developing an enforceable nationwide policy to control MERS-CoV transmission and infection.