Interview: Shabab Al Ghamdi, Secretary-General, Council of Health Insurance
In what ways are new initiatives under Vision 2030 changing the relationship between beneficiaries, insurers and health care providers?
SHABAB AL GHAMDI: The Health Sector Transformation Programme (HSTP) was established as part of Vision 2030 and sets clear aspirations in terms of governance, funding and the delivery of health care. In particular, it will drive clarity in the relationship between beneficiaries, insurers and health care providers. This is fundamental as the Kingdom prepares for the introduction of comprehensive government-funded health coverage, which will enhance the effectiveness of universal health coverage in the Kingdom. Indeed, the private health care market is set for growth. As of early 2024 around 36% of the population had private health coverage and by 2030 this figure should reach 50%. Indeed, by 2030 the country’s Cooperative Health Insurance Policy is expected to cover 22m beneficiaries.
What opportunities does the Insurance Authority present for the sector as a whole?
AL GHAMDI: The responsibility of overseeing the insurance sector has been delegated to the Insurance Authority, a shift from its previous management by the Saudi Central Bank. The establishment of the Insurance Authority was a strategic move intended to enhance the sector’s overall contribution to GDP. This is expected to drive growth in non-health segments of the insurance market.
For its part, CHI will continue to engage in collaborative initiatives with the Insurance Authority to foster growth in the health segment. This includes promoting a unified approach that includes both insurance providers and health care providers. Through such efforts, we are able to bolster the expansion of the health segment while also supporting the insurance sector as a whole in expanding its contribution to the Kingdom’s wider economic goals.
How is the introduction of value-based health care expected to benefit the Kingdom?
AL GHAMDI: The expected growth of CHI should be reflected in terms of real value for beneficiaries. Here, we draw upon the clearly established strategic objective of the Kingdom’s health care transformation agenda to shift to value-based health care. As a part of this transformation, a long-term and multi-disciplinary approach with all relevant organisations will be required. In particular, coordination with external stakeholders will be necessary to achieve synergies and avoid duplication.
CHI has progressed significantly thus far in standardising data and introducing minimum data sets, launching a health information exchange platform and deploying patient classification systems. It has also raised the requirements and standards around health information management, such as clinical coding, training, accreditation and billing. In the coming years efforts will focus on improving information infrastructure and processes, conducting benchmarking initiatives, addressing payment models and reviewing care delivery organisation.
The shift towards value-based health care requires the adoption of value-based payment models. Within the extensive spectrum of payment models for health care services, the health insurance market currently uses the fee-for-service model. This model is deeply entrenched in the system but is not aligned with a value-based health care paradigm.
However, value-based payment models are not possible unless health outcomes and patient-reported outcomes, combined with patient experience, are established and measured as standard tools. For these purposes we have now a clear strategy to incorporate all of these and launch a cataract value-based payment pilot in 2024, the first to be implemented in the country. This will further improve patient care and empower beneficiaries.
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