Established design principles can transform Saudi healthcare

15 January 2020 Consultancy-me.com

There is mounting evidence that primary care is not merely another medical service or gatekeeper to specialist care, but rather the foundation on which almost all the world’s best health systems are built.

It has long been known that ‘primary care-oriented’ systems such as in Canada, the UK, Spain, Netherlands and Australia deliver better health outcomes at a lower cost. This role is becoming even more powerful over time, as the number of people living with multiple chronic conditions requiring complex, multi-specialty care as the community grows and grows.

Saudi Arabia’s National Transformation Program, which was developed to help fulfil the Vision 2030, has identified several key targets to be met by each government body by 2020.

The transformation programme places the sector on a fast growth trajectory by increasing private healthcare expenditure, doubling the number of primary healthcare visits per capita, decreasing the percentage of smoking and obesity incidence, and focusing on improving the quality of preventive and therapeutic healthcare services among other initiatives.

Although the Kingdom is fairly new in ‘primary care orientation’ in its health system, according to Emmeline Roodenburg, Head of Healthcare for KPMG in Saudi Arabia, the multiple aspects of the ongoing healthcare reform programme contain significant primary care components, including the model of care programme and the planned introduction of healthcare clusters and ACOs (Accountable Care Organisations) by 2020 and 2030 respectively.

Saudi Arabia’s health care reforms

“The impetus behind the need to strengthen Saudi Arabia’s primary care system is clear,” says Roodenburg, referring to a population facing some of the highest health risk factors in the GCC, such as diabetes and other chronic diseases. From a health system perspective, the country is experiencing rising healthcare costs, increased waiting times for specialist care, and the overutilisation of emergency departments.

So how could an integrated approach to primary care transformation work as part of the existing healthcare reforms? The new model of care, e-Health and other change programs provide the ideal opportunity to reorientate the Kingdom’s healthcare system around the foundation of primary care. Here, KPMG proposes four design principles based on its global experience of what works.

Access and Continuity

In the face of rising complex morbidity and shifting patient expectations, new models of primary care are seeking to enhance how access and continuity are provided. One of the ways of achieving this is to bring the primary care clinic itself closer to or even inside the hospital campus, as is the case in King Faisal Specialist Hospital and King Fahad National Guard Hospital.

In addition, it can be achieved by networking clinics together such that they can make shared investments in new services, as well as creating professional HR, IT, leadership and management teams.

Patients and Populations

The government of Saudi Arabia has been making “strenuous efforts” to produce more family physicians to build up the required workforce for a fully comprehensive, primary care-oriented health system.

While the family physician remains the bedrock of most high-income primary care services, many world-class systems have changed their understanding of primary care workforce development in recent years towards a more ‘team-based’ model. The shift towards proactive team-based primary care is one of the key features of a related shift towards population health management and an enhanced role for patients themselves.

Design principles to transform Saudi's primary care system

Information and Outcomes

The development of accountable care arrangements is one of the transformational components of the Kingdom’s ongoing reforms and one of the most promising enablers to drive the scale-up of primary care. Many countries are currently seeking to develop the ‘primary care medical home’, where a family medicine practice assumes full responsibility for the health and care of its enrolled patients. It is a bold concept that relies on a number of other changes taking place at once.

Management and Accountability

As value-based payment mechanisms are introduced, it is critical that a more primary-care oriented cadre of managers and leaders are developed to support service change. This is a challenge shared by many health systems around the world as they seek to scale up and professionalise primary care.

In this respect, professionalised management of integrated care can be developed within the existing workforce and is a key feature in the curriculum of the UK’s NHS Leadership Academy developed by KPMG. Transparency over the performance of providers and payers is another key ingredient in reducing variation and challenging local health systems to improve.

“Applying these design principles involves a constant tension between moving change forward at speed and scale while not stifling local ownership and innovation that is essential to truly changing beliefs and behaviors at the front line,” concludes Roodenburg.

“It is likely that the most impactful change will be achieved by individual clusters taking the lead on this process, and a rationalisation of other primary care-related change programmes currently run through the Ministry of Health.”

For more information, download the KPMG report ‘The paradox of primary care in Saudi Arabia’.


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