Pilot Study of Reimbursement Practices in Private Healthcare Centers in the Eastern Province of Saudi Arabia: To What Extent Do They Meet International Best Practices?

This pilot study examines reimbursement practices in private healthcare centers in the Eastern Province of Saudi Arabia. The objective of the study was to assess the extent to which the private healthcare sector in Saudi Arabia follows international best practices in reimbursement, as identified in a literature review. The study examined reimbursement practices in a sample of six private healthcare facilities through the use of similar questionnaire guidelines with each facility. Similarities among the facilities' practices included the use of contracts with insurance companies and the availability of a chargemaster. Differences included the types of reimbursement software used. Bundled payment systems were identified in four facilities but were not examined in all of the facilities studied. International best practices that were not present in any of the facilities in the study included electronic transfer protocols to link healthcare facilities, insurance companies, and banks; the use of reimbursement key performance indicators; the use of diagnosis-related groups; and the integration of disease coding into the reimbursement process. Major findings of this pilot study are that diverse types of reimbursement systems are in use in Saudi healthcare facilities and that these systems are preliminary and are largely unregulated. The authors suggest that regulation and standardization would therefore be easier at this stage than at later stages of the development of private healthcare systems in Saudi Arabia.