The Impact of Health Insurance on the Quality of Healthcare Services in Government Hospitals in Dammam City
Sultan Abdulrahman Al-Qahtani 1, Mohammed Ali Al-Khmasan 2
1 Master
of Healthcare Services Management, Ministry of Health, Saudi Arabia
2 Ministry of Health, Saudi Arabia
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ABSTRACT |
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This study aimed to investigate the impact of health insurance on healthcare services in Ministry of Health hospitals in Dammam City from the perspective of health insurance beneficiaries. The study examined various aspects, including the integration of healthcare services, the reliability of healthcare services, responsiveness to healthcare services, the treatment by healthcare service providers, healthcare service procedures and systems, and healthcare service awareness. The study also aimed to determine the significance of differences in the impact of health insurance on the quality of healthcare services related to variables such as gender, age, income level, and educational qualifications. The study employed a descriptive-analytical approach, with a sample consisting of 250 individuals selected through convenient sampling from health insurance beneficiaries in Ministry of Health hospitals in Dammam City. The study
found statistically significant (p ≤ 0.05) positive impacts of health
insurance on healthcare services in Ministry of Health hospitals in Dammam
City in terms of integration of healthcare services, reliability of
healthcare services, responsiveness to healthcare services, treatment by
healthcare service providers, healthcare service procedures and systems, and
healthcare service awareness. There were also statistically significant
differences (α≤ 0.05) in the impact of health insurance on the
quality of healthcare services related to gender (favoring males), monthly
income (favoring those with monthly income less than 5000 Saudi Riyals), age
(favoring individuals under 30 years old), and educational qualifications
(favoring individuals with a high school diploma or lower). |
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Received 02 December 2023 Accepted 01 January
2024 Published 17 January 2024 Corresponding Author Sultan
Abdulrahman Al-Qahtani, hxbigg@gmail.com DOI 10.29121/granthaalayah.v11.i12.2023.5427 Funding: This research
received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors. Copyright: © 2023 The
Author(s). This work is licensed under a Creative Commons
Attribution 4.0 International License. With the
license CC-BY, authors retain the copyright, allowing anyone to download,
reuse, re-print, modify, distribute, and/or copy their contribution. The work
must be properly attributed to its author. |
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Keywords: Health Insurance, Healthcare Services,
Ministry of Health |
1. INTRODUCTION
Health insurance is
vital in healthcare, providing organizational and administrative support to
meet citizen needs. It operates on the principle of "large numbers,"
aggregating risks from a diverse group who pay premiums, thereby creating a substantial
financial reserve for treating insured individuals. Key principles regulating
health insurance include insurable interest, utmost good faith requiring full
disclosure of material information, and the principle of contribution where
insured parties bear some costs. The policy details covered and excluded
diseases, determined scientifically and in collaboration with medical
institutions. Health insurance benefits the healthcare sector significantly by
maintaining financial stability in healthcare institutions, covering most
treatment costs, improving service quality, ensuring sustainability, and aiding
government agencies like the Ministry of Health in creating a comprehensive
healthcare database. This database assists in decision-making and forecasting
medical needs and the expansion capacity of medical institutions.
Indeed, the focus on
health insurance and related healthcare services is not new, but what is novel
is the use of scientific methods and modern statistical techniques to leverage
health insurance in a way that positively reflects on the quality of healthcare
services. Additionally, establishing appropriate standards for health insurance
to achieve this goal is crucial. Health services provided by health insurance
need continuous monitoring and analysis through field surveys of beneficiaries
to understand their evaluation of the quality of these services and its
reflection on their level of satisfaction. Thus, the primary objective of the
current research is to explore the influence of health insurance on the quality
of healthcare services. This includes an applied study on beneficiaries at the
Ministry of Health hospitals in Dammam to assess how health insurance affects
the comprehensiveness, reliability, and responsiveness of healthcare services.
The study also aims to understand the beneficiaries' perspectives on the
treatment they receive from healthcare service providers. Additionally, it
seeks to identify if variables such as gender, age, income level, and
educational qualification significantly influence the impact of health
insurance on the level of healthcare services provided.
2. Health Insurance Concept and Quality
of Healthcare Services
Health insurance, an integral part of the healthcare system, is essentially the treatment provided to the insured during illness, with costs either partially or wholly covered by insurance companies or the government Aid and Al-Raymi, (2018). The World Health Organization describes health insurance as a mechanism to finance some or all healthcare costs, safeguarding individuals from the high expenses of medical treatments Banerjee et al. (2021). This organization also broadens the concept of health beyond mere absence of disease, encompassing physical, mental, and social well-being, and perceives health insurance as pivotal in enhancing all dimensions of health Sultani & Ilham (2015).
Healthcare services encompass a wide array of offerings including diagnostic, therapeutic, rehabilitative, social, and specialized psychological services, provided by various healthcare departments. These services extend to routine and specialized laboratory tests, emergency and ambulance services, and encompass nursing and pharmaceutical services Hammouri et al. (2021). The World Health Organization sets the benchmark for quality in healthcare services, emphasizing compliance with standards, safety, social acceptability, and cost-effectiveness, ultimately affecting disease rates, mortality, disability, and malnutrition Allen et al. (2021). Quality in healthcare, therefore, involves a set of well-designed policies and procedures that aim to deliver healthcare systematically and objectively, enhancing patient care and addressing health issues effectively Shriah & Ibrahim (2013).
3. The characteristics of healthcare
services
The characteristics of healthcare services, akin to other
public services, include their intangibility, making them hard to conceptualize
or experience before purchase. This necessitates indicators to gauge service
quality, such as location, provider, and equipment. The simultaneity of
production and consumption, the inseparability of the beneficiary from the
service during its delivery, and the heterogeneity in service delivery,
underscore the unique nature of healthcare services. These services are non-storable
and non-ownable, and their provision is continuous, focusing on the holistic
care of individuals Hammad
& Abdullah (2021), Eid
(2016), Al-Taie
and Al-Musawi (2020).
4. The Importance of Health Insurance
and Its Impact on Healthcare Services
Health insurance plays a profound role in contemporary society, offering comfort and psychological stability to beneficiaries while contributing significantly to the national economy. It provides financial liquidity to healthcare service providers, promoting economic stability, and enhancing the quality of healthcare services. It ensures flexibility, accessibility, and affordability of care Al-Rawashdeh & Ziad (2010), Perreira & Oberlander (2021). Achieving the objectives of health development, characterized by clarity, adoption, flexibility, transparency, and participation, is made possible through a well-structured health insurance system that involves all relevant stakeholders Arhab & Muhammad (2017).
In today's world, health insurance is a top priority for nations due to its far-reaching impact on health, economic, and social policies. A well-organized health insurance system reflects a country's level of development, enhances individual productivity and efficiency, and offers a sense of security, particularly for individuals with limited incomes, in the face of rising medical costs Adlan (2019). Healthcare management faces the challenge of providing high-quality, cost-effective services, complicated by financial constraints and limited resources, especially in public hospitals Qurayshi & Al-Hajj (2012). The increasing need for healthcare services, driven by emerging and complex diseases, has intensified the focus on healthcare expenses in developing countries' budgets Hammad & Abdullah (2021).
Health insurance and healthcare services are central to the health systems of many countries. National development plans hinge on having a healthy and efficient workforce, prompting insurance companies to improve service quality and meet customer needs Al-'Utaybi (2019) Healthcare has shifted its focus from merely providing care to understanding patients' growing awareness and demands for high-quality services, emphasizing patient satisfaction and loyalty Qasi (2014). Ensuring the quality of healthcare services remains a paramount concern, with institutions striving to meet patient expectations and needs while understanding the criteria by which patients evaluate service quality Sultani & Ilham (2015).
5. Types and Documents of Health
Insurance
Health
insurance policies encompass a diverse range of forms, each tailored to
specific needs and circumstances. These policies, as identified by Al-Taie and Al-Musawi (2020), are essential in
providing financial coverage for various health-related expenses.
Hospitalization policies cover costs associated with hospital stays, including
room charges, radiography, planning, laboratory analyses, nursing, and
necessary medications. Surgical Expenses policies specifically address the
financial demands of surgical operations. Regular Medical Treatment policies
typically cover doctors' fees, including their visits to hospitals or homes,
and are often bundled with other insurance coverages. For more serious medical
conditions or accidents, Major Medical Treatments policies step in,
compensating for the high costs incurred, with a predetermined amount being the
responsibility of the insured per incident. Lastly, Disability Income policies
provide financial relief for loss of income due to illness or injury, which
results in temporary or permanent cessation of work.
6. Health Insurance in Saudi Arabia
In
Saudi Arabia, the evolution of health insurance has seen significant changes. Mahmud (2013) identifies three main
types of health insurance in the country. First is social insurance, managed by
the General Organization for Social Insurance, which primarily covers
work-related injuries. The second involves direct contracts between companies
and hospitals, offering healthcare to employees or healthcare programs for
premiums. However, this system often operates outside regulatory frameworks.
The third and most prevalent form is private health insurance, managed by
third-party insurance companies and includes both commercial and cooperative
models. Saudi Arabia's involvement in health insurance is relatively recent,
dating back about 15 years with the introduction of the Cooperative Health
Insurance System. Before this, as mentioned by Barai (2016), there were limited forms
of health insurance, including partial coverage for work-related injuries and
occupational diseases through the Social Insurance Institution, as well as
private sector health insurance provided directly through company-owned hospitals
or private contracts.
The
social insurance system in Saudi Arabia has roots dating back over fifty years,
with Royal Decree No. M/22 dated 9/6/1389 AH (15/11/1969 AD) serving as its
initial foundation. It initially focused on occupational hazards and has
evolved significantly over the years. In 2005, the Cooperative Health Insurance
System was expanded to cover non-Saudi employees in the private sector,
benefiting approximately 3.3 million workers and involving 24 Ministry of
Health hospitals. The system is poised to extend its coverage to all citizens
through the Ministry of Health's "Balsam" project, transforming these
hospitals into private-sector-style institutions. These developments align with
Saudi Arabia's Vision 2030 and its Health Sector Transformation Program, which
aims to provide comprehensive, integrated healthcare to all residents.
Oversight is carried out by the Ministry of Health in collaboration with
regional councils, taking into consideration geographic, demographic, and
disease pattern factors in healthcare planning. The Ministry emphasizes patient
involvement in healthcare decisions, as reflected in the Patient and Their
Families Rights Document Digital Government Authority.
(2021). The Health Sector
Transformation Program, a key part of Vision 2030, aims to restructure the
health sector into an efficient and integrated system. It focuses on individual
and community health, embracing value-based care principles for transparency and
financial sustainability. The program highlights public health, disease
prevention, improved access to health services, expanded electronic health
services, and enhanced service quality and patient satisfaction. It underscores
Saudi Arabia's commitment to establishing and strengthening integrated
healthcare systems across the Kingdom Unified National Platform.
(2021), Ministry
of Health (2022).
7. Previous Studies
Numerous
studies have investigated the relationship between health insurance and the
quality of healthcare services. Al-Rawashdeh & Ziad (2010) conducted a study in
Jordan and found low levels of healthcare services for health insurance
beneficiaries, recommending improvements, especially in the public sector, and
addressing issues like personal relationships and nepotism in hospital
management. Qurayshi & Al-Hajj (2012) assessed health insurance
efficiency in Algerian hospitals and emphasized the importance of applying
quality standards. Ali (2013) focused on Sudan and found
that medical insurance improved healthcare quality and patient satisfaction,
suggesting increased attention to healthcare services and budget improvements. Sultani & Ilham (2015) used the Servqual model to assess healthcare services in private
hospitals in Batna, Algeria, recommending
enhancements. Al-Mansour (2016) in Saudi Arabia identified
social factors affecting job satisfaction and satisfaction with health
insurance, emphasizing resource provision and service level improvement. Ghadeer & Fiyadh (2016) revealed low quality of
health insurance services on the Syrian coast, emphasizing material aspects but
stressing the need to meet client expectations. Sadki
(2018) found demographic and functional differences in the perception of
service quality among healthcare providers in Aleppo. Ahmad (2018) in Sudan showed high
adherence to service quality standards. Erlangga et al. (2019) indicated improving health
insurance plans in low- and middle-income countries and their positive impact
on healthcare services. Hammad & Abdullah (2021) found generally good
quality of health insurance services in the White Nile state but identified
areas for improvement. Qin et al. (2021) in China revealed
increased satisfaction and social integration among migrants with health
insurance. Overall, these studies underscore the importance of health insurance
service quality and suggest the need for ongoing improvement and development to
better serve patients and beneficiaries.
8. Research Methodology
The research employed a descriptive analytical approach,
utilizing both descriptive and analytical methods to assess healthcare services
from the perspective of health insurance beneficiaries in the Ministry of
Health hospitals in Dammam. The study's population comprised all health
insurance beneficiaries in these hospitals during the period from January to
May 2022. A sample of 250 individuals was selected through convenient sampling.
The research developed a health services level assessment scale consisting of
32 statements across six dimensions, drawing on previous studies like those by Mahmud (2013), Arhab & Muhammad (2017), Ahmad (2018), and Hammad
& Abdullah (2021). The scale, which used a five-point
Likert scale, underwent content validity evaluation by three Ph.D. holders from
Saudi universities. Internal consistency reliability was assessed through a
pilot study involving 60 health insurance beneficiaries in Dammam's Ministry of
Health hospitals, with all items demonstrating statistical significance (α
≤0.05) and an overall Cronbach's alpha value of 0.95, indicating
acceptable reliability for the study's objectives.
Table
1 shows that the
study sample had a higher proportion of males (71.9%) compared to females
(28.1%). According to monthly income level, the highest proportion of the
sample was in the category of those earning 10000 SAR and above, slightly
exceeding half of the sample at 51.4%. The lowest proportion was in the income
category "Less than 5000 SAR" at 17.6%. Regarding age, the highest
proportion of the sample was in the "30-39 years" age category at
58.1%, while the lowest was in the "Less than 30 years" category at
16.7%. The results also show that the highest educational qualification
proportion was among bachelor's degree holders at 51.9%, and the lowest was
among those with high school education or less at 13.8%.
Table 1
Table 1 Sample
Characteristics According to Study Variables |
|||
Variable |
Categories |
Frequency |
Percentage |
Gender |
Male |
151 |
71.9% |
|
Female |
59 |
28.1% |
Monthly
Income Level |
Less
than 5000 Saudi Riyals |
37 |
17.6% |
|
From
5000 to less than 10000 Saudi Riyals |
65 |
31.0% |
|
10000
Saudi Riyals and more |
108 |
51.4% |
Age |
Less
than 30 years |
35 |
16.7% |
|
30-39
years |
122 |
58.1% |
|
40
years and above |
53 |
25.2% |
Educational
Qualification |
High
school or less |
29 |
13.8% |
|
Bachelor's
degree |
109 |
51.9% |
|
Postgraduate
studies |
72 |
34.3% |
|
Total |
210 |
100.0% |
9. Results
After
analyzing the data using the Statistical Package for
the Social Sciences (SPSS), the following results were obtained:
Results
related to the impact of health insurance on the comprehensiveness of
healthcare services from the perspective of health insurance beneficiaries in
the Ministry of Health hospitals in Dammam. Arithmetic means and standard
deviations of the sample's responses to the dimension were first calculated. Table 2 shows the results related to
the impact of health insurance on the comprehensiveness of healthcare services,
forming a crucial source for understanding the effect of health insurance on
the quality and integration of healthcare services. The results indicate that
health insurance has a significant positive impact on the treatment of
healthcare service providers, with an arithmetic mean of 3.909, suggesting that
providers treat patients with health insurance better, enhancing their overall
experience.
Moreover,
the results show that health insurance significantly positively affects the
procedures and system of healthcare services, with an arithmetic mean of 3.818,
indicating its importance in improving the efficiency and overall organization
of healthcare services. Additionally, the results suggest a high positive
impact of health insurance on responsiveness to healthcare services, with an
arithmetic mean of 3.694, possibly indicating improved service delivery speed
and increased overall patient satisfaction.
On
the other hand, health insurance shows a moderate impact on the reliability of
healthcare services, with an arithmetic mean of 3.650, indicating the presence
of challenges or disparities in service quality or availability. Finally, the
results demonstrate a moderate impact of health insurance on the
comprehensiveness of healthcare services, with an arithmetic mean of 3.643,
suggesting room for improvement in coordination among healthcare providers.
Overall, these results reflect the importance of health insurance in improving
and developing healthcare systems to ensure high-quality healthcare for
patients.
Table 2
Table 2 The Impact of Health Insurance |
|||
Dimension |
Arithmetic
Mean |
Standard
Deviation |
Level |
Treatment
of healthcare service providers |
3.909 |
0.790 |
High |
Procedures
and system of healthcare services |
3.818 |
0.791 |
High |
Responsiveness
to healthcare services |
3.694 |
0.958 |
High |
Reliability
of healthcare services |
3.650 |
0.826 |
Medium |
Comprehensiveness
of healthcare services |
3.643 |
0.885 |
Medium |
Awareness
of healthcare services |
3.623 |
1.004 |
Medium |
Scale
average |
3.72 |
0.985 |
High |
Results
related to statistically significant differences at (α ≤0.05) in the
impact of health insurance on the level of healthcare services attributed to
variables such as gender, age, income level, and educational qualification
9.1. Significance of Differences
According to Gender
The
arithmetic means and standard deviations of the sample's responses to the scale
statements were calculated according to the gender. The "t" test for
independent samples was then used to determine the significance of the
differences between these means, as shown in the Table
3. The table indicates
statistically significant differences (α ≤ 0.05) in the impact of
health insurance on the level of healthcare services attributed to the gender
variable, with the differences favoring males.
Table 3
Table 3 Results of the t-test for the
Significance of Differences Attributed to the Gender |
|||||
Gender |
Arithmetic Means |
S. Deviations |
t-Value |
Degrees of Freedom |
Level of Significance |
Male |
3.899 |
0.763 |
5.491 |
208 |
0.000 |
Female |
3.271 |
0.695 |
9.2. Significance of Differences
According to Monthly Income
Table 4 shows statistically
significant differences (α ≤ 0.05) in the impact of health insurance
on the level of healthcare services attributed to the monthly income. The
results of Scheffe's test for post-hoc comparisons indicated that the differences
were between the income group earning less than 5000 Saudi Riyals and the
groups earning more than 5000 Saudi Riyals, favouring those earning less than
5000 Saudi Riyals.
Table 4
Table 4 Significance of Differences in the Impact of Health Insurance According to the Monthly Income |
|||||
Variable Source of
Variation |
Sum of Squares |
Degrees of Freedom |
Mean Square |
F-Value |
Level of Significance |
Between Groups |
14.534 |
2 |
7.267 |
12.801 |
0.000 |
Within Groups |
117.512 |
207 |
0.568 |
|
|
Total |
132.046 |
209 |
|
|
|
9.3. Significance of Differences
According to Age:
Table 5 indicates statistically
significant differences (α ≤ 0.05) in the impact of health insurance
on the level of healthcare services attributed to the age. Scheffe's test for
post-hoc comparisons showed that the differences were between the age group
under 30 years and the age groups over 30 years, favoring
the under 30 age group.
Table 5
Table 5 Significance of Differences According to the Age |
|||||
Source of Variation |
Sum of Squares |
Degrees of Freedom |
Mean Square |
F-Value |
Level of Significance |
Between Groups |
9.434 |
2 |
4.717 |
7.963 |
0.000 |
Within Groups |
122.612 |
207 |
0.592 |
||
Total |
132.046 |
209 |
9.4. Significance of Differences
According to Educational Qualification
Table 6 indicates statistically
significant differences (α ≤ 0.05) in the impact of health insurance
on the level of healthcare services attributed to the educational
qualification. Scheffe's test for post-hoc comparisons revealed that the
differences were between those with a high school education or less and those
with a bachelor's degree and higher education, favoring
those with a high school education or less.
Table 6
Table 6 Significance of Differences According to the Educational Qualification |
|||||
Source of Variation |
Sum of Squares |
Degrees of Freedom |
Mean Square |
F-Value |
Level of Significance |
Between Groups |
7.639 |
2 |
3.820 |
6.355 |
0.002 |
Within Groups |
124.407 |
207 |
0.601 |
||
Total |
132.046 |
209 |
10. Discussion and conclusion
The results indicate a statistically significant impact of health insurance on the comprehensiveness of healthcare services from the perspective of beneficiaries in the Ministry of Health hospitals in Dammam. There was also a significant effect on the reliability, responsiveness, and treatment by healthcare service providers, as well as on the procedures and system of healthcare services and awareness of healthcare services. The sixth hypothesis of the study was thus accepted. These results can be interpreted from several aspects: the importance of health insurance in providing psychological comfort and stability to beneficiaries, contributing effectively to improving the level of healthcare services, offering suitable and affordable healthcare Al-Rawashdeh & Ziad (2010), Perreira et al. (2021). The growing importance of health insurance reflects a nation's development, with better health insurance services leading to increased productivity and efficiency, especially important for lower-income individuals due to rising medical costs Adlan (2019).
The results can also be understood in the context of Saudi Arabia's healthcare system, which aims to provide comprehensive and accessible healthcare to all residents. The country is working on providing a complete network of healthcare services, with the Ministry of Health clarifying patients' rights and responsibilities, which helps improve service levels and patient trust in health facilities Digital Government Authority. (2021). The Health Sector Transformation Program, part of Saudi Vision 2030, focuses on continuously developing healthcare services and addressing challenges related to health services by enhancing their quality and efficiency Ministry of Health (2022).
Previous studies, such as those by Qin et al. (2021), Hammad & Abdullah (2021), Erlangga et al. (2019), and Ahmad (2018), have found similar results regarding the positive impact of health insurance on healthcare services, though Al-'Utaybi (2019) found lower satisfaction levels among insurance company clients. The results revealed statistically significant differences (α ≤ 0.05) in the impact of health insurance on healthcare services due to gender, favoring males, and monthly income, favoring those earning less than 5000 Saudi Riyals. Younger age groups (under 30) saw health insurance as less necessary than older individuals did.
11. Recommendations
Based on the study's findings, the researcher makes the following recommendations for those responsible for the health insurance system in Saudi Arabia:
1) Increase focus on achieving Saudi Vision 2030's goals related to developing healthcare services, establishing committees and departments within the Ministry of Health for this purpose.
2) Reevaluate the health insurance system to provide comprehensive protection against all diseases.
3) Encourage hospitals to establish pages for receiving patient inquiries and complaints, with prompt attention and responses.
4) Review the patient appointment system to better suit patients' needs and circumstances.
5) Involve patients in implementing healthcare programs in Saudi Arabia.
6) Encourage doctors to play a more active role in explaining medications to patients, especially regarding side effects.
CONFLICT OF INTERESTS
None.
ACKNOWLEDGMENTS
None.
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