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Module 6
HCM 500
1Reimbursement practices in both Saudi Arabia (SA) and United States (US) healthcare
are complex and vary depending on the type of provider and payer. In SA the government
provides free healthcare to all citizens and expatriates. This is done through a network of public
hospitals and clinics.(Alasiri & Mohammed, 2022) The Saudi government is the main payer for
healthcare in SA. In 2023, Saudi Arabia allocated a budget of 50.4 billion USD (SAR 189 bn) for
health sectors.(Budget Statemennt 2023) while in the US the government pays for certain groups
of the population through Medicare and Medicaid. Medicare is a health insurance program for
people aged 65 and older, as well as people with certain disabilities. Medicaid is a joint federalstate program that provides health insurance to low-income individuals and families.(United
States, 2020)
Private healthcare providers in Saudi Arabia are reimbursed by a variety of payers,
including commercial health insurance companies, the government, and patients themselves.
Commercial health insurance companies are becoming increasingly important payers in the
Saudi healthcare system, as the government is gradually shifting to a mandatory health insurance
system for all citizens and residents.(AlRuthia et al., 2020)
The most common reimbursement model in both SA and US is fee-for-service (FFS).
Under FFS, healthcare providers are reimbursed for each service they provide to patients. This
model has been criticized for incentivizing providers to over-treat patients and for contributing to
the rising cost of healthcare.(AlRuthia et al., 2020; Trends and Challenges in the U.S.
Healthcare Payment System, n.d.)
FFS is a relatively simple reimbursement model to understand and implement. It also
gives providers the flexibility to choose how they treat their patients and to set their own prices.
allows them to maintain their autonomy and make decisions about their practices without
interference from payers. It is a transparent reimbursement model, meaning that patients can
easily see how much they are being charged for each service.(Wang et al., 2021)
On the other hand, FFS can incentivize providers to overtreat patients in order to generate
more revenue. This can lead to unnecessary tests and procedures, which can increase the cost of
healthcare and potentially harm patients. It is a relatively expensive reimbursement model. This
is because providers are often paid more for more expensive services, even if those services are
not necessary. FFS does not incentivize providers to focus on prevention. This is because
providers are not paid for preventive services such as screenings and immunizations. This type of
reimbursement can be inequitable for patients with low incomes or chronic health conditions.
This is because these patients may need more services, which can be expensive under
FFS.(Wang et al., 2021)
References:
Alasiri, A. A., & Mohammed, V. (2022). Healthcare Transformation in Saudi Arabia: An
Overview Since the Launch of Vision 2030. Health Services Insights, 15,
11786329221121214. https://doi.org/10.1177/11786329221121214
AlRuthia, Y., Abdulaziz Bin Aydan, N., Sulaiman Alorf, N., & Asiri, Y. (2020). How can Saudi
Arabia reform its public hospital payment models? A narrative review. Saudi Pharmaceutical
Journal, 28(12), 1520–1525. https://doi.org/10.1016/j.jsps.2020.09.020
Budget Statemennt 2023. (n.d.). Retrieved October 8, 2023, from
https://www.mof.gov.sa/en/budget/2023/Documents/Bud-En%202023MoF.pdf
Trends and challenges in the U.S. healthcare payment system. (n.d.). Retrieved October 9, 2023,
from https://dhge.org/about-us/blog/healthcare-payment-system-trends-and-challenges
United States. (2020, June 5). https://www.commonwealthfund.org/international-health-policycenter/countries/united-states
Wang, Y., Hou, W., Wang, X., Zhang, H., & Wang, J. (2021). Bad to All? A Novel Way to
Analyze the Effects of Fee-for-Service on Multiple Grades Hospitals Operation
Outcomes. International Journal of Environmental Research and Public Health, 18(23),
12723. https://doi.org/10.3390/ijerph182312723
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Description of current reimbursement formats in Saudi Arabia and the United States
In Saudi Arabia, the healthcare reimbursement system is primarily funded by the government
through the Ministry of Health (MOH). The MOH provides and funds a significant portion of
healthcare services, covering 57% of services through hospitals and primary healthcare centers
(Al-Hanawi et al., 2018). The government also oversees and supervises private sector services
and other government healthcare sectors. The funding model in Saudi Arabia is mainly based on
a tax-funded system, where healthcare services are provided free of charge to all Saudi citizens
(Hazazi et al., 2022). Private health insurance is also available, but its implementation is still in
progress.
In the United States, the healthcare reimbursement system is a mix of public and private
funding. The government provides healthcare coverage through programs like Medicare for the
elderly and Medicaid for low-income individuals and families. These programs reimburse
healthcare providers based on predetermined rates and fee schedules. Private health insurance,
either through employers or individual plans, is another significant source of healthcare
reimbursement in the United States. Private insurance companies negotiate reimbursement rates
with healthcare providers, and individuals pay premiums to access these services.
Pros and cons of the current reimbursement model in Saudi Arabia and the United States
Saudi Arabia
Pros:
1. Universal access: The tax-funded system in Saudi Arabia ensures that all citizens have access
to healthcare services without financial barriers.
2. Government control: The government’s oversight and funding of healthcare services allow for
centralized planning and coordination.
3. Cost control: The government’s control over healthcare funding enables cost control measures
and allocation of resources based on population needs.
Cons:
1. Financial sustainability: The reliance on government funding raises concerns about the longterm financial sustainability of the healthcare system, especially with rising healthcare costs and
population growth.
2. Limited private sector involvement: The limited implementation of private health insurance
restricts competition and innovation in the healthcare sector.
3. Potential strain on resources: The free healthcare services provided by the government may
lead to increased demand and strain on healthcare resources.
United States
Pros:
1. Choice and competition: The presence of private health insurance allows individuals to choose
their healthcare providers and plans based on their needs and preferences.
2. Innovation: The involvement of private insurance companies encourages innovation in
healthcare delivery and payment models.
3. Financial sustainability: The mix of public and private funding helps distribute the financial
burden of healthcare across different stakeholders.
Cons:
1. Access disparities: The reliance on private insurance can lead to disparities in access to
healthcare, as not all individuals can afford or qualify for private insurance.
2. Administrative complexity: The multiple reimbursement systems and insurance plans in the
United States can result in administrative complexities for healthcare providers and patients.
3. Affordability: The high cost of private health insurance premiums and out-of-pocket expenses
can make healthcare unaffordable for some individuals and families.
References:
Al-Hanawi, M. K., Alsharqi, O., Almazrou, S., & Vaidya, K. (2018). Healthcare Finance in the
Kingdom of Saudi Arabia: A Qualitative Study of Householders’ Attitudes. Applied health
economics and health policy, 16(1), 55–64. https://doi.org/10.1007/s40258-017-0353-7
Hazazi, A., Wilson, A., & Larkin, S. (2022). Reform of the Health Insurance Funding Model to
Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia. Healthcare, 10(11),
2294. MDPI AG. Retrieved from http://dx.doi.org/10.3390/healthcare10112294
Module 6
HCM 520
First one:
King Abdualaziz Medical City Mission and Vision statements
COLLAPSE
A vision statement sets an organization’s ultimate goals and focuses on the future while a mission
statement focuses on the present and the actions taken by an organization to fulfill it. A mission
statement outlines an organization’s core functions, serving and accomplishing its goals. It serves
as a roadmap for the future, while a vision statement outlines the organization’s long-term
aspirations. Together, these statements coordinate stakeholders’ actions, establishing a clear
sense of direction and purpose, and helping to coordinate the actions of the organization. (Barr,
2020)
The mission and vision statements for King Abdualaziz Medical City will be discussed below.
King Abdualaziz Medical City’s (KAMC) goal is to offer high-quality, individualized care to
those in Saudi Arabia’s Western Region who have cancer and blood problems. They promote
education and research while also enhancing cancer care through evidence-based methods,
research, and quality improvement. They also work to advance the prevention and treatment of
cancer and blood disorders by developing novel therapies and doing laboratory research. With an
emphasis on excellence, safety, and satisfaction, their mission is to provide complete, highstandard, and holistic cancer patient treatment on a national and worldwide level. To stay at the
leading edge of cancer management, they place a strong emphasis on teaching, research, and
technology. By carefully examining the mission statement, it becomes evident that the current
goal of KAMC is to provide excellent, patient-centered care for cancer and blood disorders in the
Western Region of Saudi Arabia. They also place a strong emphasis on education, research, and
innovation as essential elements of their purpose. With regard to the vision statement, it shows
their goals for the future. The goal of KAMC is to provide comprehensive, top-notch cancer care
and establish itself as a leader both domestically and globally. They place a strong emphasis on
the value of innovation, safety, and excellence. Both phrases emphasize patient-centered care,
excellence, and innovation in similar ways. They demonstrate a dedication to improving
healthcare and cancer management, with a strong emphasis on teaching and research, not just for
the benefit of their patients but also for greater national and global contributions to the field of
cancer care. (Mission and Vision, n.d.)
King Abdualaziz Medical City (KAMC)’s mission and vision align with Saudi Vision 2030’s
goals. KAMC focuses on providing high-quality, patient-centered care and advancing healthcare
through research and innovation, aligning with the kingdom’s goal of enhancing healthcare
services. Its dedication to education, collaboration, and international leadership aligns with Saudi
Arabia’s vision of becoming a global leader. KAMC’s emphasis on cutting-edge technology in
cancer management reflects the nation’s drive for technological advancement and innovation.
(Health Sector Transformation Program, n.d.)
References:
Barr, E. (2020, February 4). The Difference Between Mission and Vision Statements •
SpriggHR. SpriggHR. https://sprigghr.com/blog/alignment-direction/the-difference-betweenmission-and-vision-statements/
Health Sector Transformation Program. (n.d.). Retrieved October 9, 2023, from
http://www.vision2030.gov.sa/en/vision-2030/vrp/health-sector-transformation-program/
Mission and Vision. (n.d.). Retrieved October 9, 2023, from
https://ngha.med.sa/English/MedicalCities/Jeddah/MedDepartments/PNOC/Pages/MV.aspx
Second one:
Vision and mission
COLLAPSE
All organizations must have a vision and mission that will help to achieve their goals. In
addition, focus and a clear definition of mission and vision will lead the hospital to a unique
development. (JOSSO 2 by Atricore, n.d.) Vision and mission statements differ on some points.
The vision statement is a statement that an organization’s leadership wants to achieve in the
future, and it includes critical characteristics. Also, the vision represents the hospital’s overall
direction. On the other hand, the mission statement is a short statement that describes the
hospital’s overall objectives and purposes. Also, the mission statement addresses the purpose and
directs the employee to achieve the vision. (Qin et al., 2023)
National Guard Health Affairs Hospital is one of the main hospitals in Saudi
Arabia. NGHA’s vision is to be an internationally recognized hospital in excellence and to
promote public and individual health status. The mission of NGHA is to give the Saudi Arabia
National Guard individuals, their dependents, and other eligible patient the optimum healthcare
services. Also, NGHA’s mission is to give a good academic opportunity, conduct research, and
participate in community and industry service programs in the health field. (Mission, Vision &
Core Values, n.d.)
As a part of Saudi Vision 2023, the health sector transformational program aims to improve
healthcare accessibility, increase the quality of healthcare services, and prevent any health
threats. (Health Sector Transformation Program, n.d.). This aligned with NGHA’s vision by both
of them prioritizing the well-being of the individuals and aiming to develop healthcare outcomes.
According to NGHA, the development of healthcare outcomes aligned with the Saudi Vision of
being an internationally excellent hospital.
Reference:
HealthSectorTransformationProgram.(n.d.c).https://www.vision2030.gov.sa/en/vision2030/vrp/h
ealth-sector-transformation-program/
JOSSO 2 by Atricore. (n.d.). https://www.shrm.org/resourcesandtools/tools-and-samples/hrqa/pages/mission-vision-values-statements.aspx
Mission, Vision & core values. (n.d).
https://ngha.med.sa/English/aboutnghanew/Pages/missionvisionvalues.aspx
Qin, X., Wang, B., Zhao, J., Wu, P., & Liu, T. (2023). Learn from the best hospitals:
a
comparison of the mission, vision and values. BMC Health Services Research,
23(1). https://doi.org/10.1186/s12913-023-09699-8
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