Saudi Arabia is undergoing a significant transformation of its healthcare system as part of its Vision 2030 initiative, focusing on a comprehensive overhaul of healthcare financing. The new approach shifts from a traditional model, where providers are compensated solely for treating illnesses, to a value-based system that incentivizes keeping the population healthy. This transformation aims to enhance financial sustainability by aligning financial incentives with patient outcomes, thereby controlling costs, reducing ineffective care, and encouraging responsible fiscal practices.
Central to this reform is establishing the Center for National Health Insurance (CNHI), which will act as the sole purchaser of healthcare services. Utilizing extensive population health data, CNHI is tasked with developing funding mechanisms and financial incentives crucial for the new system. The focus will be on analytics to drive decision-making related to health needs assessments, budget calculations, and performance monitoring.
A key element of the new financing structure is the implementation of risk-adjusted capitation payments. Healthcare providers will be transformed into corporatised local accountable care organizations (ACOs) that are government-owned but managed like private enterprises. These ACOs will receive a fixed budget, adjusted based on the health risks of their populations, promoting a fair allocation of resources while balancing financial risks for both payers and providers. This approach not only encourages preventive care but also improves healthcare delivery efficiency.
The reforms will address various financial flows within the system in addition to capitation payments, ensuring that specialized high-cost services and interactions with private insurance are effectively managed. To mitigate financial risks, a multi-layer safety net involving the Health Holding Company (HHC), CNHI, and the Ministry of Health will be established to monitor and support funding processes.
The implementation of this new system will occur in three phases. The first phase focuses on intensive data collection and analysis, essential for accurate budgeting. The second phase involves transitioning ACOs to ‘shadow’ capitation calculations, allowing for refinements while minimizing financial exposure. Finally, in the third phase, ACOs will take on full financial responsibility for their designated populations. This gradual approach is critical for building capacity and adapting to the complex changes. Overall, this initiative exemplifies how financial mechanisms can drive transformative change in healthcare systems, addressing the challenges posed by growing and aging populations worldwide.
