Determinants of Healthcare Utilization and Cost among Privately Insured Families in Saudi Arabia

Document Type : Original Article

Authors

1 Department of Health Administration and Behavioural Sciences (Health Administration, Planning and Policy Division), High Institute of Public Health, Alexandria University, Alexandria, Egypt

2 Department of Health Information Management and Technology, College of Applied Medical Sciences, King Faisal University, Saudi Arabia

3 Department of Health Administration and Behavioural Sciences (Hospital Administration Division), High Institute of Public Health, Alexandria University, Alexandria, Egypt

Abstract

Background: The kingdom of Saudi Arabia is currently restructuring its healthcare system through implementing a number of strategies among which the introduction of insurance coverage for both foreign workers and citizens. Objectives: The aim of the present study is to assess factors that affect utilization and cost of health services among a group of privately insured families in Saudi Arabia. Methods: A six month administrative claims database of employees and their dependents from three different companies covered by a major insurance company was utilized to collect demographic enrollment characteristics, service utilization and services costs. The unit of analysis of the present study was families rather than individuals with a total of 131 families included in the analysis. Results: The study revealed that those covered by the highest class of coverage provided by the insurance company (class VIP and A) had more utilization and higher mean charges per family compared to those covered by class B or C. The study also found that middle aged and older families had more utilization and average charges per family compared to younger families. Families in which women were the primary insured had both lower use and lower average charges. Finally, family size seemed not related to any pattern of medical care use. Conclusions: Families with lower insurance class coverage, and families in which women are the primary insured showed lower utilization pattern, but families with older individuals had more utilization. Additional studies are need for a more comprehensive understanding of utilization pattern by the insured population in Saudi Arabia.

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