National health insurance system for universal health coverage: prospects and challenges in Saudi Arabia

Mohammad F. Alharbi


Universal health coverage (UHC) is one of the major health policy objectives to achieve a Nation’s sustainable development. This goal is achieved when all citizens in the country enjoy the highest standards of healthcare at no or low cost. Many countries around the world have achieved UHC through a national health insurance framework and have an extensive range of risks funded by government revenue and contributions from both employers and employees. This study examines the feasibility of developing a National Health Insurance System (NHIS) as a way to achieve UHC in Saudi Arabia. It also highlights the potential role of health insurance in health coverage, improving the quality of care, and use of healthcare. Although establishing a NHIS poses many challenges, addressing them makes it feasible to provide and finance healthcare in the country.


National health insurance, Universal healthcare, Health finance, Saudi Arabia

Full Text:



Khaliq A. The Saudi healthcare system: a view from the Minaret. World Health Popul. 2012;13:52-64.

Walston S, Al-Harbi Y, Al-Omar B. The changing face of healthcare in Saudi Arabia. Ann Saudi Med. 2008;28:243-50.

Ministry of Health. General Directorate of Statistics and Information, Health statistic book. Riyadh (KSA): Ministry of Health; 2014. Available at: Accessed on 3 November 2018.

Al-Sharqi OZ, Abduallah MT. Diagnosing Saudi health reforms: Is NHS the right prescriptions?. Int J Health Plann Mgmt. 2013;28:308-19.

Alborie HM, Damanhouri AMS. Patients’ satisfaction of service quality in Saudi hospitals: a SERVQUAL analysis. Int J Healthcare Quality Assurance. 2013;26:20-30.

World Health Organisation. World Health Report 2010.Health systems financing: the path to universal coverage. Geneva: WHO; 2010. Available at: Accessed on 15 November 2018.

Moreno-Serra R, Smith P. Does progress towards universal health coverage improve population health? Lancet. 2012;380:917-23.

Knaul FM, Gonzalez-Pier E, Gómez-Dantes O, Garcia-Junco D, Arreola-Ornelas H, Barraza-Lorens, et al. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet. 2012;380:1259-79.

OECD. Fiscal sustainability of health systems: bridging health and finance perspectives. Paris: OECD Publishing; 2015.

OECD. Universal health coverage and health outcomes. Paris: OECD; 2016.

James CD, Bayarsaikhan D, Bekedam H. Health financing strategy for WHO’s Asia-Pacific Region. The Lancet. 2010;375:1417-19.

Evans D, Elovainio R, Humphreys G. World Health Report 2010. Health Systems Financing: the path to universal coverage. Geneva: WHO; 2010. Available at: Accessed on 12 November 2018.

OECD. OECD reviews of health care systems: Korea. Paris: OECD Publishing; 2013.

Mathauer Xu, Carrin G, Evans DB. An analysis of health financing system of the Republic of Korea and option to strengthen health financing performance. Geneva: WHO; 2009.

Paris V, Hewlett E, Auraaen A. Health care coverage in OECD countries in 2012. OECD Health working papers. Paris: OECD publishing.

OXFAM. Universal health coverage. Why health insurance schemes are leaving the poor behind. OXFAM briefing paper; 2013: 176. Available at: Accessed on 13 November 2018.

Bagat M, Mihanovic D, Hrzic M. Public expenditure on health through additional health insurance. Croatia: 11th International Scientific Conference on Economic and Social Development-Building Resilient Society Zagreb; 2015.

Hsiao W, Shah R.P. Social health insurance for developing countries. World Development Studies, The World Bank, 2007. Available at: sites/100/2012/09/hsiao_and_shaw_2007_-_shi_for_developing_nations.pdf. Accessed on 17 November 2018.

World Health Organization. Arguing for universal health coverage, World Health Organization. Geneva; 2013. Available at: Accessed on 29 October 2018.

Sommers BD, Gawande AA, Baicker K. Health insurance coverage and health-what the recent evidence tell us. New Eng J Med. 2017;377:586-93.

Torres H, Poorman E, Tadepalli U, Schoettler C, Fung CH, Mushero N, et al. Coverage and access for Americans with chronic disease under the Affordable care act: a quasi-experimental study. Ann Intern Med. 2017;166:472-79.

Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-supported insurance coverage, access to care, and health under the affordable care act. JAMA. 2015;314:366-74.

Sommers BD, Maylone B, Blendon RJ, Orav EJ, Epstein AM. Three-year impacts of the affordable care act: improved medical care and health among low-income adults. Health Aff. 2017;36:1119-28.

Palmer MG. Inequalities in universal health coverage: evidences from Vietnam. World Development. 2014;64:384-94.

Abusaaq HI. Population aging in Saudi Arabia, Saudi Arabian Monetary Agency working paper, WP/15/2/, February, 2015. Available at: Accessed on 17 November 2018.

Almalki M, Fitzgerald G, Clark M. Health care system in Saudi Arabia: An overview. East Mediterr Health J. 2011;17(10):784-93.

Perez D, Ang A, Vega WA. Effects of health insurance on perceived quality of care among Latinos in the United States. J Gen Intern Med. 2009;24:555-60.

Nguyen H, Rajkotia Y, Wang H. The financial protection effect of Ghana national health insurance scheme: evidence from a study in two rural districts. Int J Equity Health. 2011;10:9-10.

Ishfaq M, Qadri FA, Abusaleem KS. Measuring quality of service from customer’s perspectives: a case of healthcare insurance in Saudi Arabia. Health Sci J. 2015;10:1-11.

Alharbi MF. An empirical analysis of customer satisfaction with cooperative health insurance in Saudi Arabia: the role of customer knowledge, service characteristics, and national culture. Int J Health Sci Res. 2017;7:234-46.

Dalinjong PA, Laar AS. The national health insurance scheme: perceptions and experiences of healthcare providers and clients in two districts of Ghana. Health Econ Rev. 2012;2(1):13.

Robyn PJ, Hill A, Liu Y, Souares A, Savadogo G, Sie A, et al. Econometric analysis to evaluate the effect of community based health insurance on reducing informal self-care in Burkina Faso. Health Policy Plan. 2012;27:156-65.

Jehu-Appiah C, Aryeetey G, Agyepong I, Spaan E, Baltussen R. Household perceptions and their implications for enrolment in the national health insurance scheme in Ghana. Health Policy Plan. 2012;27:222-33.

Devadasan N, Criel B, Van Damme W, Lefevre P, Manoharan S, Van der Stuyft P. Community health insurance schemes & patient satisfaction-evidence from India. Indian J Med Res. 2011;133:40-9.

Bauchet J, Dalal A, Mayasudhakar. Can insurer improve healthcare quality? Evidence from a community microinsurace scheme in India. New York; NYC and Financial Access initiative; 2010.

Abuosi AA, Domfeh KA, Abor JY, Amponsah EN. Health insurance and quality of care: comparing perceptions of quality between insured and uninsured patients in Ghana’s hospitals. Int J Equity Health. 2016;15:1-11.

Mohammed S, Sambo N, Dong H. Understanding client satisfaction with a health insurance scheme in Nigeria: factors and enrollees experiences. Health Res Policy Systems. 2011;9:1-9.

Halawany HS, Alhussainan NS, Alghanem AS, Farrash FA. An assessment of the awareness and satisfaction concerning dental insurance among employees in Riyadh, Kingdom of Saudi Arabia. Pakistan Oral Dent J. 2011;31:402-8.

Schansberg DE. The economics of health care and health insurance. The Independent Review. 2014;18:401-19.

Loewenstein G, Friedman J, McGill B, Ahmad S, Linck S, Sinkula S, et al. Consumers misunderstanding of health insurance. J Health Economics. 2013;32:850-62.

Bartholomae S, Russal MB, McCoy T. Building health insurance literacy: evidence from the smart choice health insurance program. J Fam Econ Iss. 2016;37:140-55.

Alkhamis A. Knowledge of health insurance benefits among male expatriates in Saudi Arabia. Saudi Med J. 2017;38:642-53.

Boonen LH, Aldershof TL, Schut FT. Switching health insurers: the role of price, quality and consumer information search. Eur J Health Econ. 2016;17:339-53.

Politi MC, Kaphingst KA, Kreuter M, Shacham E, Lovell MC, McBride TD. Knowledge of health insurance terminology and details among the uninsured. Med Care Res Review. 201;71:85-98.

Aldosari A, Ibrahim Y, Manab MBA. Linking cooperative health insurance service characteristics to expatriates’ satisfaction: mediating role of customer knowledge. Int Review Manag Market. 2016;6:1013-9.

Council for Cooperative Health Insurance, Saudi Arabia, 2017. Available at: /en/pages/default.aspx. Accessed on 10 December 2018.

Alkhamis A, Hassan A, Cosgrove P. Financing healthcare in gulf cooperation council countries: a focus on Saudi Arabia. Int J Health Plann Mgmt. 2014;29(1):64-82.

Ellis PR, Albert C. Health insurance, cost expectations and adverse job turnover. Health Economic. 2011;20:27-44.

Kim J, Braun B, Williams AD. Understanding health insurance literacy: a literature review. Fam Consumer Sci Res J. 2013;42:3-13.