Introduction
Health care is one of the critical areas for development in any country because the quality of this care determines physical, emotional, and social well-being and the overall quality of life. During the last several years, multiple transformations within healthcare systems have been noticed to improve health outcomes, support vulnerable populations, and stabilize care access. In developed and developing countries, certain achievements and challenges affect care delivery. This paper aims to compare the systems of the United States of America (USA) and the Kingdom of Saudi Arabia (KSA), their private insurance markets, and challenges in the rural market and give several recommendations. Despite the offered public initiatives and evaluations of vulnerable population segments, the USA can learn a lot from the KSA’s example to reduce healthcare spending, increase health outcomes, and enhance equal care access. Comparing the systems of the chosen countries and future changes, it is clear that the US and Saudi service providers have achieved some progress, but much work should be done to eradicate damaged market conditions.
The US Health Care System
The United States is a developed country, the population of which is constantly growing due to high fertility rates and immigration. In 2020, more than 326 million people lived in the USA, and about 8.6% were uninsured, while the country spent $3.9 trillion on various health expenditures and insurance programs (Congressional Research Service, 2022). Compared to other developed countries, the USA does not find it effective to implement universal health care standards. Instead, mixed approaches offer new private health insurance plans and support publicly financed coverage like Medicare and Medicaid (Young et al., 2021). Only several years ago, the decision to mandate care coverage for all citizens was made (the Affordable Care Act), but most healthcare spending continues coming from private funds, households, and private businesses (Khairalddin et al., 2020). However, this step was not enough to stabilize care services, and many subsystems need improvements to be integrated as a common delivery system.
The problems emerge in the relationships between private and public markets, social justice, and power balance. Out-of-pocket payments are commonly practiced in many American hospitals and clinics, which explains the difference between rich people and low-income families. State and local taxes, as well as a portion of federal taxes, are not enough to cover all care costs, and the flow of funds in the US hybrid healthcare system needs to be thoroughly examined (Khairalddin et al., 2020). To support the population, hospitals, and private clinics enlarge their range of services from general therapy and preventive care to mental health care, diagnostic services, and nutritional support. However, the lack of national health insurance affects the USA and explains the necessity of addressing other countries as better examples.
The KSA Health Care System
The main distinction between the USA and the KSA is that the latter is still a developing country despite its evident success on the monetary level. The population of Saudi Arabia has already exceeded 32 million through the prism of urbanization and globalization (Khairalddin et al., 2020). The KSA is known for its rich oil and gas reserves, and the government defines the development of healthcare services as one of the highest priorities in the country (Young et al., 2021). Compared to the USA, Saudi Arabia promotes a national health care system and free universal coverage controlled by several government agencies, including security or army forces and the Ministry of Higher Education. The World Health Organization (WHO, 2000, as cited in Al-Hanawi et al., 2019) ranked the KSA 26th compared to its neighbors Qatar (44th) and the United Arab Emirates (27th). In this list, the USA takes only the 37th place, while Canada is the 30th (WHO, 2000, as cited in Al-Hanawi et al., 2019). Much attention is paid to the improvements in the public health sector, which is mainly governed by the Ministry of Health (MOH).
Although the KSA healthcare system is of mixed type, most hospitals provide high-quality services at all levels. There are many primary care centers and hospitals where specialist and outpatient services are offered to Saudi citizens and employees from the public sector. The government approves about 9% of the GDP to be spent on healthcare services annually (Young et al., 2021). This decision covers hospital treatment, dental care, and medication prescriptions. The Council for Cooperative Health Insurance is required to provide general coverage for workers in all private organizations. Insurance premiums are available for all household members according to the principles of national health insurance (Al-Hanawi et al., 2020). All services are equally accessible to citizens, and the MOH is responsible for indicating controversies and solving problems in a short period not damaging the level of cooperation between other agencies.
Private Insurance Market in the USA
In the United States, private health insurance has already become a credible source of insurance for many citizens. This market consists of the group market (employer-sponsored insurance) and the non-group or individual market (insurance obtained directly from insurers) (Congressional Research Service, 2022). Insuring organizations deal with non-medical costs like taxes, profits, and reserve losses and offer them to cover hospital care and general physician services. During the last several years, the Congressional Research Service (2022) has noticed a decline in private spending due to the pandemic, which was about $1,151 billion for about 200 million individuals. Although the Obamacare reform improved access to health coverage among people with different income levels, it is hard to ignore that the private insurance market is more prevalent and bigger than public opportunities. Public health insurance is supposed to be sponsored by the federal government, and Medicare and Medicaid are the two well-known programs. However, these programs have age and care restrictions, which proves the necessity of private insurance when care plans are individually developed and funded.
Private Insurance Market in the KSA
Comparing the USA and KSA health care, one should notice that both countries support the idea of hybrid systems. Thus, Saudi Arabia may also rely on financial help from private stakeholders and develop its private insurance market. Many hospitals have faced rapidly changing healthcare costs and considered the idea of privatization as the only solution not to decrease the quality of their services (Al-Hanawi et al., 2019). Because of the connection between oil prices and healthcare, MOH was able to control price fluctuations and used money directly for curative care, which slowed down the private healthcare industry (Young et al., 2021). However, such steps negatively affected other aspects of care, including prevention and education. The KSA could not ignore the progress of the private insurance market by inviting new local and even international investors. Vision 2030 is one of the most recognizable reforms in the country, and its goals are to privatize some government services, increase care access, improve healthcare quality, and promote disease prevention (Alasiri & Mohammed, 2022). However, if the USA heavily relies on private insurance, the KSA is more interested in a public-private partnership.
Challenges in Rural Health Care: The US and KSA Perspectives
Despite certain successes in establishing an appropriate health care system, the USA and the KSA face challenges with providing services in rural markets. In Saudi Arabia, 83% of the total population (about 5 million) is urban, and people living in the Kingdom’s cities do not understand the problems rural populations might have (Khairalddin et al., 2020). In the United States, more than 55 million people live in rural areas, which is about 14-19% of the total population (Coughlin et al., 2019). In both countries, similar problems are observed: poor access and utilization of primary care, unequal treatment, and poor health outcomes (Coughlin et al., 2019; Khairalddin et al., 2020). Such factors affect the population’s well-being because rural older adults are exposed to higher risks of chronic conditions like diabetes and coronary heart disease (Coughlin et al., 2019). They are poorly aware of preventive care and are diagnosed at later stages, which requires severe treatment and more expensive medications. Thus, cancer- and diabetes-related mortality rates are higher in rural areas.
The level of healthcare providers’ professionalism is lower in rural areas compared to urban areas. Not many individuals with a high education want to work at hospitals with poor equipment and small patient databases (Young et al., 2021). Thus, employment challenges and nurse and pharmacist turnover must be solved in American and Saudi rural hospitals. Besides, the progress of the US private insurance market does not allow American patients to pay for their services, while Saudi rural citizens face fewer financial problems based on their geographical location.
Recommendations for the USA and the KSA
The main recommendation to address the challenges of rural citizens in the United States addresses the intention to increase the public insurance market. When rural citizens obtain additional information and support from the federal government, they can invest in their health, visit hospitals, and improve their awareness of chronic conditions. Several federal reforms have already been implemented in the KSA, which expanded the health workforce and facilities in rural areas (Young et al., 2021). However, compared to the US system, Saudi hospitals lack mental health services and prevention programs (Coughlin et al., 2019). Therefore, it is recommended to exchange national experiences and observe which changes apply to the KSA based on the US system and vice versa. According to Al-Hanawi et al. (2019), the KSA should solve the increased need for skilled professionals in healthcare management by making the workforce more local and focused on well-talented young people. Teaching capacity, equipment, and cooperation are the main areas for improvement within the KSA and US healthcare systems. Continued policy-making and research help examine the existing disparities in diseases and involve federal, state, and local governments to understand the problems.
Conclusion
Globalization and urbanization are the processes that continue changing the healthcare systems in different countries. The examples of the USA and the KSA prove the worth of federal funding and the necessity to establish specific approaches for delivering care services among populations. Although the KSA health care system is currently applied in a developing country with limited human resources and equipment, its success over the already developed US health care system is evident. Both countries have certain organizational and educational challenges, and the exchange of experience, the growth of the public insurance market, and cooperation are the solutions to be considered.
References
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