Interview: Shabab bin Saad Al Ghamdi, Secretary General, Council of Health Insurance, on system modernisation and strategic reform
How is the rollout of the new national insurance programme expected to reshape demand patterns across the Kingdom?
SHABAB BIN SAAD AL GHAMDI: It creates a clearer separation between public financing and private insurance. A central public purchaser will fund care for citizens not covered by private insurance, similar to systems where a single payer covers government employees and social programme beneficiaries. A dedicated insurance regulator now oversees the commercial insurance market across all lines, including health. Previously, health insurance sat under general health administration; the new independent regulator enables stronger growth.
As universal coverage expands, more citizens will access care through a private insurance-based model, and private insurers will operate in a more competitive environment with clearer rules. This advances the broader health system transformation by promoting standardised purchasing, transparency and accountability for quality and outcomes. The public payer ensures baseline coverage, while the private market develops around employer-based and elective insurance options.
To what extent are private health insurers adapting their models to align with value-based care?
AL GHAMDI: The shift is gradual and multi-stage. The first milestone was standardised medical coding, where compliance is now high, enabling the next phase: measuring patient experience through unified digital tools. The focus is moving to payment reform, progressing from fee-for-service towards bundled payments and models tied to patient-reported outcomes. Value-based care depends on shared definitions, reliable data and aligned incentives. Insurers are using data to shape coverage, while employers and payers show greater willingness to reward quality and efficiency over volume.
What impact does the integration of digital health platforms have on reshaping the sector?
AL GHAMDI: Health care data is complex, with a national dataset spanning over 11,000 codes and millions of transactions across thousands of providers and multiple payers. The national exchange platform standardises data flow, enabling real-time eligibility checks and payment processing. Providers have dashboards tracking utilisation and patient experience, while the platform lays the foundation for artificial intelligence-enabled automation, including early use cases such as prior authorisation and readmission prediction.
Where are the most significant disparities in access between urban and rural regions?
AL GHAMDI: Saudi Arabia’s scale inevitably creates access challenges. Historically, rural areas had limited access to specialist services compared with major cities. Digital health is now closing that gap. The country operates one of the world’s largest virtual hospital models, enabling urban specialists to support diagnosis and treatment planning remotely, without the need for patient transfer. This is reinforced by medical air transport and initiatives to build remote clinical capability.
In what ways is the increase in health insurance beneficiaries affecting the sector?
AL GHAMDI: Coverage has expanded from 3m people in 2010 to over 14.5m by the end of 2025, with annual growth accelerating. This surge has prompted expansion in private health care capacity, with providers opening new facilities and applying standardised operating models. Automation and standardised data are essential to ensuring timely, accurate reimbursement. Adopting VBHC has driven growth in coverage, and providers competition is intensifying, supporting gains in patient experience.
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