Comparison between Health Systems in Saudi Arabia and the United States - Coursework Example

Comparison Between Health Systems in Saudi Arabia and the United s Hanan Algahtani Wayne s Winter NUR 6510, Sec 001 and 200 (COMBINED) Abstract Health promotion and disease defeating are crucial components in conducting nations health. Among the globe, governments and health concerned organizations have devoted all efforts to improve healthcare services and assure its accessibility . Studying diverse health care systems and comparing one to another, would highlight some challenges that countries confront in delivering health care services. This paper displays a comparative review between the health care systems of Saudi Arabia and the United states. In order to understand the underlying factors that influence the design of the healthcare system in both countries, the paper presents an overview on the history and cultural background of Saudi Arabia and the United States; demographic indicators; current healthcare systems; and finally the paper displays challenges and reforms that have been taken in both countries. Comparison Between Health Care Systems of Saudi Arabia and the United States The comparison between, what Oil and Gas Directory reported as the largest oil producer in the world (Saudi Arabia) Almalki, Fitzgerald, and Clark (2011) and a strong industrial country, and the world leader in medical innovation (The United States) might not seem parallel from several perspectives. Though, the diversity in the components that construct each country, creates disparate impediments sometimes, yet main concerns in the operating health care system remain alike. Saudi Arabia was unified in 1932 (BTI, 2014), while the United States declared its independence in 1776 - one century and a half earlier (Constitution Facts.com). By the time that health care system in Saudi Arabia had been formalized (1950s), the United States health care system had been marching in reforms and developmental plan. However, in less than one century Saudi Arabia government have devoted all efforts to transform a vast desert land dwelled by majority of illiteracy population and culturally controlled society to one of the modern country in the area. Demographic Indicators With a total land mass of more than 2 million square kilometers, Saudi Arabia surface area can be described comparatively as 0.22 from the United States surface area (9,831,510 km2) (Countryeconomy, 2012). While the population number of Saudi Arabia was recorded 28.29 million in 2012, the United States population exceeded 313.914 million (World Bank, 2012). Saudi Arabia health expenditure per capita was 758 US$ in 2012 ; it was recorded 8,608 US$ in the United States in the same year. The infant mortality rate for the United States in 2012 was 6 per 1000 live births, which is better than Saudi Arabia infant mortality rate in the same year (7 per 1000 live births) (World Bank). In addition, Life expectancy at birth total was 79 year in 2011 for Americans, four years higher than the Saudis life expectancy at birth (75 year). On the other hand, Saudi Arabia annual population growth percentage is almost 3 folds United States ones with the percentage of 1.8% as a result of a crude birth rate of 20 per 1000 ; the United States annual population growth percentage is 0.7 and crude birth rate is 13 per 1000 (World Bank, 2011). Historical and Cultural Overview Alharthy F et al (1999) traced the history of Saudi health care system to 1925 -even before the unification of The Kingdom of Saudi Arabia - with the establishment of the first public health department in Mecca to provide free health care services for population and pilgrims through different hospitals and dispensaries. In the following year, 1926, WHO-EMRO (2006) revealed that Health Directorate was founded in Jeddah, Ajyad hospital in Mecca and Bab Shareef hospital in Jeddah were established as well in the same year (A. Khaliq, 2012). Finally, WHO-EMRO (2006) mentioned that in 1951 the Ministry of Health was established to be the main provider of health care services in Saudi Arabia (A. Khaliq, 2012). ARAMCO (1927) explained that in early 1950s, in order to control malaria in the eastern region of the kingdom, the first preventive program in the country was held with the collaboration of WHO and ARAMCO oil company ( Sebai, Milaat, & Al-Zulaibani, 2001). In 1978, in the international conference on primary health care, Saudi Arabia embraced primary health care concept as a basis for healthcare delivery system (Sebai et al., 2001). WHO-EMRO (2006) illustrated that with the increase in oil revenues, by 1970 there were 74 hospitals with a total of 9,039 beds, and by 2002 the number of hospitals jumped to 331 hospitals with the capacity of 47,242 beds (A. Khaliq, 2012). Saudi Arabia cultural considerations are mainly subjected to Islam rules and regulations. These cultural sensitive issues have great impact on designing health care system. For instance, "separate wards for opposite gender" should be founded when designing hospitals(Al-Shahri, 2002). Accordingly, assigning independent nursing team for each department is required. Waiting areas in ambulatory care settings follow the same rules as well(Al-Shahri, 2002). On the other hand, healthcare services in the United States could be traced to 1663-around two and a half centuries earlier than Saudi Arabia - when the first hospital in the United States was created to treat injured soldiers in New York. Later, in the mid of 1700 Pennsylvania Hospital was established (Virginia Health Information). Hospitals had improved through 1800s, however, the quality of provided medical services had not been convenient due to lack of proper hygienic practices, untrained nurses, as well as the cost of health services (Denisco & Barker, 2013, p. 155). First board of health was developed by Philadelphia in 1793 due to the outbreak of yellow fever. By 1900 public health departments had been developed among the states (Denisco & Barker, 2013, p. 163). In 1800s, when workers insurance movement against lost wages as a result of work-related injuries had started (Denisco & Barker,2013, p. 190). The development of Blue Cross and Blue Shield plans between 1930s to 1946s had shifted the concern from reimbursement workers for lost wages resulting from injury or illness to reimbursement of providers for the cost of medical service (Denisco & Barker, 2013, p. 190). By 1973, under Nixon administration the Health Maintenance Organization Act (HMO) had been enactment, and its role has been described by Denisco and Barker as providing loans and grants for initiating and developing of healthcare agencies and combined insurance with focus on the preventive and primary healthcare services. Current Healthcare Providers in Saudi Arabia Ministry of Health (MOH) MOH in Saudi Arabia is the main governmental healthcare provider whose services are free of charge for Saudi citizens, and compromise 60% of the total health services in Saudi Arabia (Colliers International, 2012). Al-Yousuf, Akerele, and Al-Mazrou (2002) summarized the role of MOH in planning and managing healthcare policies in Saudi Arabia as well as monitoring healthcare services in the private sector (Almalki et al., 2011). MOH report (2009) revealed that it operates a number of 244 hospitals (33277 beds) and 2037 primary health care centers. Other Governmental Organizations MOH (2009) identified the other governmental healthcare providers in Saudi Arabia as: referral hospitals, security forces medical services, army forces medical services, National Guard health affairs, Ministry of Higher Education hospitals (teaching hospitals), ARAMCO hospitals, Royal Commission for Jubail and Yanbu health services, school health units of the Ministry of Education, and the Red Crescent society (Almalki et al., 2011). Private Sector According to MOH (2009) report, private healthcare providers constitute around 20% of health services in Saudi Arabia with a total of 125 hospitals(11,833 beds) and 2,218 dispensaries and clinics(Almalki et al., 2011). Health services in pilgrimage(Hajj) season. The existence of the two holy cities Mecca and Medina on Saudi Arabia lands has made it Muslims destination which hosts about 2 million Muslims annually in hajj season (Almalki et al., 2011). Jannadi B et al. (2008) explained that a complicated multi-dimensional plan includes housing, transportation, and healthcare has been implemented over decades to ensure the success of this event (Almalki et al., 2011). MOH (2009) reports that seasonal hospitals and primary health care centers are operated annually to provide free preventive and curative healthcare services to all pilgrims regardless of their nationality (Almalki et al., 2011). Healthcare System in the United States Public Health Insurance While governmental (public) health services in Saudi Arabia contributes with the majority of healthcare services in the country, public health services in the United States is offered through governmental public health agencies which work under specific framework to conduct three functions: (1) assessment of overall population data and health problems e.g. centers for Disease Control and prevention(CDC);(2)assurance of safety and accessibility of health care services provided. e.g. FDA food and drug administration; and (3) developing policies and recommendations, such as lead control programs. (Teitelbaum & Wilensky, 2013, pp. 74-79). In addition to that, there are federally funded health programs which targeted specific population groups (Denisco & Barker, 2013, p. 199). This type of health services are delivered in "Community Health Centers, which are private, not-for-profit facilities that provide affordable primary care services for uninsured and medically under-served areas. Department of Health and Human Services reported that 19 million people received healthcare in these centers in 2009 (Bidgood, 2013). Medicare Program It is a federally funded program which enacted in 1965 to provide "health insurance for the aged" (Denisco & Barker, 2013, p. 199). Today, 46 million Americans 65 years of age and older are covered by Medicare health services (Denisco & Barker, 2013, p. 199). Medicaid Program: In 1965, Medicaid program was enacted as a mandatory joint federal-state support program for low income people. Medicaid program is ranked as the third largest source of health insurance in the United States and its health services cover 47.1 million low income Americans (Denisco & Barker, 2013, p. 206). Other Public Systems Bodernheimer T and Grumbach K (n.d.) represented other public systems in two programs: S-CHIP. The State Childrens Health Insurance Program was established in 1997 to cover uninsured children whose families are not qualified for Medicaid and cannot endure purchasing private health insurance. By 2008 more than 7 million children had been enrolled in SCHIP program, yet, 8.1 million children remained uninsured (Denisco & Barker, 2013). VA. The Veterans Administration program provides affordable health care services for veterans of the military in governmental hospitals and clinics. (Chua, 2006). Private sector health programs Bodernheimer T and Grumbach K (n.d.) illustrated that private health services in the United States are provided through insurance programs which could be obtained either through employers as part of benefit packages for employees "Employer-sponsored insurance" and it is the dominant way in the private sector. The other health insurance purchasing manner is through the individual market (private non-group) which covers self employed or people who are unable to obtain insurance through their employer (Chua,2006). United States Census Bureau reported that in 2010, 195.9 million Americans (64% of the population) had private health insurance coverage (Bidgood, 2013). Challenges and Healthcare Reforms Funding Healthcare Services WHO disclosed that providing free-of-charge health services in Saudi Arabia has become a substantial challenge with consideration to the growing number of population (WHO-EMRO 2006; Walston et al. 2008; Almalki et al., 2011). As a result, in 1999 the government established the Council for Cooperative Health Insurance to introduce, regulate and supervise a health insurance strategy for the Saudi health care market(Council of Health Services ; Almalki et al., 2011). In 2008, a paper was presented at "The Board of Healthcare Funders Southern African Annual Conference" described that the cooperative health insurance scheme plan should take place in three stages; the first stage has been implemented for non- Saudis and Saudis who work in the private sector. Further stages for privatization of health services have to be implemented in the future (Almalki et al., 2011). On contrary, inequality of having healthcare insurance coverage in a vast country like United States, created the dilemma of uninsured population. The United States Census Bureau (2000,2001) revealed that 49.9 million Americans had no health insurance coverage in 2010 ( Bidgood, 2013). Though federal law obligates delivering emergency care for stabilizing any patient who presents with a substantial medical problem irrespectively to his health insurance condition, uninsured are deprived from preventive and primary health care ( Bidgood, 2013). The deprivation from primary and preventive healthcare makes uninsured people vulnerable to be having critical health problems by the time they seek medical treatment, and they are more likely encounter bankruptcy as a result of the expensive medical bills (Bidgood, 2013). Patient Protection and Affordable Healthcare Act. Health reform efforts among decades in the United States have not been able to manage the complicated cons in the health care system. Affordable Care Act (ACA) law which passed in 2010 offers remedies to contain the cost of health services, maintain the quality in healthcare, and address the problem of uninsured (Teitelbaum & Wilensky, 2013). Bidgood (2013) cited "healthcare.gov" and mentioned that 94% of the population will be covered by health insurance as a result of ACA in 2019. In contrast, undocumented immigrants will remain with no health coverage in spite of the implementation of ACA, and legal immigrants will be deprived from Medicaid services for their first five years in the country (The Henry J. Kaiser Family Foundation). Shortage of Workforce In "WHO factsheet", the main impediment has faced the Ministry of Health in Saudi Arabia since its establishment is the shortage of national healthcare professionals(Almalki et al., 2011). In order to encourage education, WHO-EMRO (2006) displayed that Saudi government opened universities and sent students to study overseas in different education fields (Almalki et al., 2011). The first Saudi physician graduated from Egypt in 1951(WHO-EMRO 2006). Yet, by 1997 the number of Saudi students who joined medical schools was almost 2500(WHO-EMRO 2006). And by 2009, in public sector of healthcare agencies there were 55,284 physicians 23.1% of them were Saudi and 110,858 nurses 32.3% of them were Saudi(MOH 2009). Nowadays, Saudi healthcare professionals are qualified and skilled in all available specialists. A brilliant example these days is the conjoined twins separation surgeries which perform by Dr. Abdulla Al Rabiah - current minister of health. Saudi Arabia hospitals have received conjoined twins from different countries to have separation surgery for free with approval of king Abdullah (Conjoined Twins). In contrast, United States has a deep rooted history in science and medical revolution. First medical college in the United States was established in the University of Pennsylvania in 1765(universityarchieves). After that, the number of medical schools had kept increasing rapidly to reach 42 in 1850(Denisco & Barker, 2013, p. 156). Saudi Arabia has a small number of healthcare professionals comparing to the United States. For instance, physicians available per 1,000 people in Saudi Arabia in 2010 was 0.9, while it was 2.4 physician per 1000 people in the United States -almost 3 fold the number in Saudi Arabia for the same year. Saudi Arabia nursing workforce was 2.1 per 1000 population in 2010, yet there were 9.8 nurse serving every 1000 people in the United States in the same year (World Bank). E-health Implementation of electronic health systems and electronic information in Saudi Arabia has been taken slow pace, and it limited to a number of hospitals such as, King Faisal specialist hospital and research center, national guard health affairs, and medical services of the army forces and university hospitals (Altuwaijiri, 2008). On the other hand, the utilization of Electronic Health Records has been raised by President George W. Bush in 2004, then with the passage of American Recovery and Reinvestment Act of 2009 under Obama administration, new regulations have taken place through incentives to health organizations that adopt EHR system, and payment penalty to those who have not implemented it by January 2015 (Denisco & Barker, 2013). Conclusion The display of healthcare system of small country with recent history like Saudi Arabia in-front-of healthcare system of inherent country in the medical revolution like the United States, leaves the observer uncertain about best choices available for political leaders to confront healthcare systems disparities. Budget overload resulted from the dominant of governmental funded health care services in Saudi Arabia, and the imbalance in attaining healthcare services in the United States as a result of the dominant of private health insurance programs in funding health services, both have not succeeded in satisfying government-citizen party. 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