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

Abstract

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.

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

“…The newly introduced concepts of privatization and PPPs in Saudi Arabia has limited qualitative data available and once such study explored the perceptions of different stakeholders regarding the privatization of the Saudi health care system by interviewing administrators and clinical staff of the public hospital in the Eastern province of Kingdom. 8 The study findings suggests that the privatization is perceived as an opportunity that introduces the missing role of competition with the private sector, however carefully points-out that a better comprehension of the implementation process and new dynamics determining the Saudi health care system is required. 8 …”

“… 8 The study findings suggests that the privatization is perceived as an opportunity that introduces the missing role of competition with the private sector, however carefully points-out that a better comprehension of the implementation process and new dynamics determining the Saudi health care system is required. 8 …”

“…The privatization of health care in Saudi Arabia is believed to introduce decentralization giving a degree of autonomy to the health clusters and hospitals encouraging a cooperative relationship between the public and private sector. 8 , 18 Although, implementation of health insurance act (2008) warrants private healthcare insurance for all Saudi citizens and expatriates and may have been perceived as an enabler for healthcare transformation for an insurance-based market but in reality all Saudi citizens are covered by national health insurance, and a major change for the Saudis will be their ability to opt for private healthcare institutions for better quality and access to care.…”

Understanding the Impact of Digital Health Strategies During the COVID-19 Outbreak in Saudi Arabia

“…RThe majority of the interviewees (16/27) stated that the relationship between the stakeholders is being improved with the adoption of new strategies and implementation of innovative technologies. However, recent studies 42 , 43 have revealed various factors influencing stakeholder relationships. Significant influence of government regulations, competitors, suppliers, patients, the public, and health service providers, was identified in developing the Saudi health care system, which can be addressed by creating awareness among stakeholders.…”

“… 42 In addition, changes in the governance structure, gradually increased autonomy from the government, lack of accountability in hospitals, and cooperative relationships between cluster hospitals were identified. 43 Though the importance of digital health services is realized for improving relationships between stakeholders, there are few issues as identified from the above studies affecting the process of relationship management. These factors might further affect the delivery of health care services, which in turn affects the usability and the relationship of care providers with citizens.…”