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Abdulwahab Alkhamis, MS, MPA/HAPhD student, Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Place, Liverpool L3 5QA, United Kingdom ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Dr Almalki, Dr Fitzgerald and Dr Clark were invited to respond to this letter, but no response was received.

EMHJ, 2012, 18(10): 1078-1079

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Sir,

I read with interest the article entitled “Health care system in Saudi Arabia: an overview” by M. Almalki, G. Fitzgerald and M. Clark, published in the Eastern Mediterranean Health Journal [1].

The article’s title specifies a review of the healthcare system in Saudi Arabia, but the authors have focused primarily on the public healthcare system, and the main points of the article are specific to the Ministry of Health, its achievements and challenges. The authors provided a broad analysis of the Ministry of Health’s healthcare system. They did not, however, provide a clear analysis of Saudi Arabia’s healthcare system as a whole, or comment on Saudi Arabia’s healthcare system in light of the regional or global healthcare setting. The only comparison provided was taken from the World Health Organization’s (WHO) report, wherein Saudi Arabia’s healthcare system ranked 26th amongst international health systems. However, the WHO’s ranking has been the subject of argument in the associated literature [2–4]. This can be partially explained by the fact that WHO has not issued subsequent reports, despite it being more than 10 years since the first report was released.

I disagree with the authors’ claim regarding the move for privatization of some public hospitals being the best way to reform Saudi Arabia’s public healthcare system, as advocated by policy-makers and researchers. The references the authors provided to support this claim were 2 articles from Saudi newspapers and were neither academic papers nor official government documents. There was no mention in the Ministry of Health’s strategic plan to move towards privatization of its hospital and services [5], nor was such a move mentioned in the agency’s National Project for Integrated and Comprehensive Health [6]. Furthermore, there is evidence that privatization has increased barriers to healthcare, mainly for those on a low income, including cases in China and Colombia [7,8].

In addition, there is evidence that privatization neither improves healthcare outcomes nor reduces healthcare expenditure of developing or developed countries. India, a developing country, relies heavily upon private healthcare and spent 4.8% of its gross domestic product (GDP) on healthcare in 2003. In comparison, Sri Lanka spent 3.5% of its GDP on healthcare and relies upon its government to finance healthcare, yet their infant mortality rate is 5 times lower and life expectancy is 9 years longer than in India [9].

Private health insurance dominates the United States of America’s healthcare system. This country spends the highest amount on healthcare per person annually and in 2005 the highest percentage of GDP (US$ 6 697 and 16% respectively), yet 47 million Americans are uninsured and lack access to healthcare [10]. In addition, the United States has the highest infant mortality rate and lowest life expectancy of all high-income countries of the Organization for Economic Cooperation and Development [11].

In summary, the authors have provided insufficient evidence for the plan to privatize some public hospitals in Saudi Arabia, and have failed to address the challenges that privatization of healthcare systems has created in other areas. Therefore, I disagree that the privatization of public hospitals is the best approach in reforming Saudi Arabia’s public healthcare system.

References

1. Almalki M, Fitzgerald G, Clark M. Health care system in Saudi Arabia: an Overview. Eastern Mediterranean Health Journal, 2011, 17(10):784–793.
2. Murray CJL et al. Science or marketing at WHO? A response to Williams. Health Economics, 2001, 10:6.
3. Williams A. Science or marketing at WHO? Rejoinder from Alan Williams. Health Economics, 2001, 10:3.
4. Williams A. Science or marketing at WHO? A Commentary on ‘World Health 2000’. Health Economics, 2001, 10:8.
5. [Strategic planning for the Ministry of Health, 2010]. Riyadh, Ministry of Health, 2010 [In Arabic].
6. The National Project for Integrated and Comprehensive Health 2010. Riyadh, Ministry of Health, 2010:197.
7. Alvarez L, Salmon W, Swartzman D. The Colombian health insurance system and its effect on access to health care. International Journal of Health Services, 2011, 41(2):355–370.
8. Blumenthal D, Hsiao W. Privatization and its discontents – the evolving Chinese health care system. New England Journal of Medicine, 2005, 353(11):1165–1170.
9. Hsiao WC. Why is a systemic view of health financing necessary? Health Affairs, 2007, 26(4):950–961.
10. Relman DA. A second opinion: rescuing America’s health care, 1st ed. New York, Public Affairs, 2007:224.
11. Catlin A et al. National health spending in 2005: the slowdown continues. Health Affairs, 2007, 26(1):142–153.