Benefits, Barriers, Patient’s Satisfaction, and Factors Associated with Implementation of National Health Insurance (NHI) in Saudi Arabia

Abstract

The health care system in the Kingdom of Saudi Arabia (KSA) is financed almost entirely by oil revenues and is "free at the point of delivery” This system is experiencing increase strains because of the escalating expenditures and the growing volatility of the oil market. It is also unlikely to be viable in the medium to long term. The objectives of this research are to quantitatively assess patient satisfaction with healthcare services through questionnaire, and to assess qualitatively the benefits, barriers, and factors associated with implementation of (NHI) system in KSA based on face-to-face interviews. Quantitative data from a survey of 300 insured and 300 uninsured participants was collected using the Patient Satisfaction Questionnaire Short Term (PSQ-18) tool, which addresses seven domains of patient satisfaction. The results demonstrated that the research instrument was valid and reliable for measurement of patient satisfaction on A 5-point Likert scale, the questionnaires were completed by 600 participants. To compare the average satisfaction of insured and uninsured patients according to seven dimensions, two sample independent t-tests were used to. The findings demonstrate that there is a significant difference in mean satisfaction between insured and uninsured participants (t= 3.66, p < 0.000). The average satisfaction for the uninsured participants (Mean 3.21, SD 0.60) was 0.17 higher than the average satisfaction for the insured (Mean 3.04, SD 0.47). There is a significant difference in mean satisfaction between participants from Riyadh region and from Qassim region (t= -3.12, p <0.000). The average satisfaction for the Qassim region’s participants (Mean 3.47, SD 0.914) was 0.28 higher than that of Riyadh’s participants (Mean 3.19, SD 1.07). Overall median satisfaction (Level of patient satisfaction with the provided health care services) was 3.14 S.D 0.54, (56.5%). Insured participants are more aware of the NHI than uninsured participants (p<0.001). Insured participants are more likely to support NHI system than uninsured ones (p<0.00), if this system is implemented in the coming five years. Riyadh's citizens are more likely to support the implementation of the NHI than Qassim citizens (<0.001). In the domains of patient satisfaction, the mean score was highest for financial aspects, the score was found to be 3.58 with S.D 1.44, and the lowest score was for time spent with the doctor 2.38 with S.D 0.91. Qualitative data was collected through 20 interviews conducted to determine the benefits, barriers, and factors associated with implementation of NHI system in the KSA. An Atlas.ti.8 version was selected for the qualitative data analysis. This study attempts to identify the benefits and barriers of implementation of NHI system. The final recommendation of this research is the implementation of the NHI ‘TAKAFUL’ type after the creation of high levels of awareness among citizens, establishment of an administrative control center, and the development of a strong healthcare infrastructure. This is considered feasible option based on the nature of Saudi citizens and their level of satisfaction with existing public healthcare services.