Document Type : Original Article

Authors

Abstract

BACKGROUND: Saudi Arabia aims to achieve Universal Health Coverage (UHC) by a combination
of free public healthcare and mandatory cooperative health insurance. To ensure the effectiveness
of UHC policies, every individual should have a strong knowledge of their health‑care rights and the
system that guarantees it.
OBJECTIVES: The aim of this study is to measure the knowledge of Alfaisal students and record
their perceptions and attitudes about Saudi Arabia’s basic health‑care coverage structure and UHC
policies.
MATERIALS AND METHODS: A cross‑sectional survey was developed with 22 items measuring
knowledge and 7 items evaluating perception and attitudes and distributed through E‑mail with a
consecutive sampling method at Alfaisal University to achieve the required calculated sample size
for March–April of 2020. The accumulated data were organized, tabulated, and statistically analyzed
using SPSS software. Comparison between two groups and more was made using the Chi‑square test.
RESULTS: Students’ self‑reported knowledge on the three main knowledge questions ranged from
30.6% to 57.7%, with medical students admitting to similar or worse knowledge compared to their
colleagues from other colleges. About 57.3% of our respondents believe the Saudi system provides
effective and sufficient healthcare to all, but only 42.7% believe that the system provides financial
protection to all.
CONCLUSION: The study showed a low level of knowledge about Saudi Arabia’s UHC policies
among Alfaisal students, especially among medical students, with a generally positive perception
and attitudes toward them, although with some serious misconceptions that should be addressed.

Keywords

  1. Shatilwe JT, Mashamba-Thompson TP. Mapping evidence on
    access to healthcare information by women of reproductive age
    in low-and-middle-income countries: Scoping review protocol.
    Syst Rev 2019;8:328.
    2. Van der Wielen N, Channon AA, Falkingham J. Universal health
    coverage in the context of population ageing: What determines
    health insurance enrolment in rural Ghana? BMC Public Health
    2018;18:657.
    3. Alharbi MF. National health insurance system for universal
    health coverage: Prospects and challenges in Saudi Arabia. Int J
    Community Med Public Health. 2019;6:5006-12.
    4. de AndradeLO, Pellegrini FilhoA, SolarO, Rigoli F, de SalazarLM,
    Serrate PC, et al. Social determinants of health, universal health
    coverage, and sustainable development: Case studies from Latin
    American countries. Lancet 2015;385:1343-51.
    5. Giovanella L, Mendoza-Ruiz A, Pilar AC, Rosa MC, Martins GB,
    Santos IS, et al. Universal health system and universal health
    coverage: Assumptions and strategies. Cien Saude Colet
    2018;23:1763-76.
    6. Pandey KR. From health for all to universal health coverage: Alma
    Ata is still relevant. Global Health 2018;14:62.
    7. Asmri M, Almalki M, Fitzgerald G, Clark M. The public healthcare
    system and primary care services in Saudi Arabia: A system in
    transition. East Mediterr Health J 2019;25:1-18. [doi: 10.26719/
    emhj. 19.049].
    8. Bureau of Experts at the Council of Ministers, Saudi Arabia’s
    Health Law; 2002. Available from: https://laws.boe.gov.
    sa/BoeLaws/Laws/LawDetails/1169b2b7-4e7d-4775-86b0a9a700f2841e/1. [Last accessed on 2020 May 05].
    9. Al-Hanawi MK, Qattan AM. An analysis of public-private
    partnerships and sustainable health care provision in the
    Kingdom of Saudi Arabia. Health Serv Insights 2019;12:1-10. [doi:
    10.1177/1178632919859008].
    10. Rahman R, Alsharqi OZ. What drove the health system reforms
    in the Kingdom of Saudi Arabia? An analysis. Int J Health Plann
    Manage 2019;34:100-10.
    11. Bureau of Experts at the Council of Ministers, Saudi Arabia’s
    Cooperative Health Insurance Law; 1999. Available from: https://
    laws.boe.gov.sa/BoeLaws/Laws/LawDetails/87c1482d-fa9541ea-98b6-a9a700f2a529/2. [Last accessed on 2020 May 05].
    12. Vissandjée B, Short WE, Bates K. Health and legal literacy for
    migrants: Twinned strands woven in the cloth of social justice
    and the human right to health care. BMC Int Health Hum Rights
    2017;17:10.
    13. World Health Organization. South-East Asia Regional Meeting on
    Health Literacy for health and well-being in the SDGs Era. Nay
    Pyi Taw, Myanmar, 4-6 July 2017. World Health Organization.
    Regional Office for South-East Asia; 2017.
    14. de Leeuw E. The political ecosystem of health literacies. Health
    Promoti Int 2012;27:1-4.
    15. Naccarella L, Osborne RH, Brooks PM. Training a system-literate
    care coordination workforce. Aust Health Rev 2016;40:210-2.
    16. Walston S, Al-HarbiY, Al-Omar B. The changing face of healthcare
    in Saudi Arabia. Ann Saudi Med 2008;28:243-50.
  2. 17. Albejaidi F. Prospects and challenges for free-of-charge health
    care system: A way forward to health insurance in Saudi Arabia.
    Int J Med Sci Public Health 2017;6:449-56.
    18. Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J
    Med Educ 2011;2:53-5.
    19. Amin Pourhoseingholi M, Vehadi M, Rahimzadeh M. Sample size
    calculation in medical studies. Gastroenterol Hepatol Bed Bench
    2013;6:14-7.
    20. Pirisi A. Low health literacy prevents equal access to care. Lancet
    2000;356:1828.
    21. Levy H, Janke A. Health literacy and access to care. J Health
    Commun 2016;21 Suppl 1:43-50.
    22. General Authority for Statistics, Saudi Arabia, Labor Market; 2018.
    Available from: http://www.stats.gov.sa/sites/default/files/
    labour_market_3q_2018_0.pdf. [Last acessed on 2020 May 05].
    23. McCormack LA, Garfinkel SA, Hibbard JH, Keller SD,
    Kilpatrick KE, Kosiak B. Health Insurance Knowledge Among
    Medicare Beneficiaries. Health Services Research. 2002;37 (1):43-63.
    24. Agrawal JR, Huebner J, Hedgecock J, Sehgal AR, Jung P,
    Simon SR. Medical students’ knowledge of the U.S. health care
    system and their preferences for curricular change: A National
    Survey. Acad Med 2005;80:484-8.
    25. Emil S, Nagurney JM, Mok E, Prislin MD. Attitudes and
    knowledge regarding health care policy and systems: A survey
    of medical students in Ontario and California. CMAJ Open
    2014;2:E288-94.
    26. Gordon PR, Gray L, Hollingsworth A, Shapiro EC, Dalen JE.
    Opposition to obamacare: A closer look. Acad Med 2017;92:1241-7.
    27. Sommers BD, Gawande AA, Baicker K. Health insurance coverage
    and health – What the recent evidence tells us. N Engl J Med
    2017;377:586-93.
    28. Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health
    insurance in Germany: A health system shaped by 135 years of
    solidarity, self-governance, and competition. Lancet 2017;390:882-97.
    29. Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health
    insurance on health care utilisation, financial protection and
    health status in low- and middle-income countries: A systematic
    review. PLoS One 2019;14:e0219731.
    30. Bin Saeed Khalid S. Factors affecting patients’ choice of hospitals.
    Ann Saudi Med 1998;18:420‑4.