A Comparative Study of Public and Private Health Insurance Models in Pakistan and Saudi Arabia

Abstract

This study examines and contrasts the health insurance system of Pakistan and Saudi Arabia with respect to (w.r.t) the structure, regulation, coverage, affordability, digital administration and experience reported by the stakeholders of the health insurance system(s). It follows a qualitative, comparative policy analysis design using only secondary sources such as government documents, regulatory documents, international health reports, and academic papers that were located in the source dissertation. The dissertation describes the system as being disjointed with public protection programmes being in parallel with a comparatively limited private insurance market, and with significant out-of-pocket expenditure. Saudi Arabia is characterized as having a more centralized regulatory structure, mandatory insurance for expatriates, employer-sponsored insurance for many in the private sector and digital claims administration via the National Platform for Health Insurance Electronic Services (NPHIES). In Pakistan, the population coverage was estimated to be 18% and out-of-pocket expenditure was 58%, while in Saudi Arabia it was 90% and 20% respectively. It is important to recognize these estimates are for cautions purposes due to fluctuating data and a lack of well-documented data sources for each indicator in the dissertation. The comparison indicates that policy issues of relevance to Pakistan include benefit design transparency, interoperable digital systems, policy coordination and targeted financial support. There are limitations to the analysis due to the use of secondary data and the lack of a documented systematic review protocol and primary stakeholder data.