A need for managed care in Saudi Arabia

Is the Kingdom of Saudi Arabia getting value for money invested in health? Quality care is being provided throughout health facilities in the Kingdom, however there is minimal control of utilization in all health sectors, consequently leading to abuse and over utilization, particularly in the public sector. Managed care programs have proven effective in reducing unnecessary inpatient and ancillary service utilization by reducing use of expensive procedures and unnecessary, highly specialized services, and shifting to less expensive care options. Health maintenance organizations are the best example of a managed health care model; tracking good performance and cost savings averaging between 20-40% compared to more traditional health plans. Key features of health maintenance organizations include serving a defined population voluntarily enrolled in the health plan; assumption of contractual responsibility and financial risk by plan to provide a range of services, and payment of a fixed periodic payment by the enrollee, independent of the actual use of services. The key characteristic that distinguishes health maintenance organizations from other delivery systems is prepayment for the care that is provided. Preferred Provider Organizations offer discounts for services received from a selected set of physicians and hospitals. Services received by enrollees are not fully reimbursed from this selected list of providers. Preferred Provider Organizations use health maintenance organizations administrative processes for controlling costs but do not include some of the intrinsic cost and quality controls of health maintenance organizations. Review of several studies indicate that patients enrolled in prepaid group practices (managed care organizations) were hospitalized 15-40% less often than those enrolled in fee-for-service health plans.     

Blindness in Saudi Arabia

The prevalence and etiology of visual loss and of eye diseases were determined in the Kingdom of Saudi Arabia. The sample was a stratified geographic cluster sample of 14,577 persons representing the settled population of Saudi Arabia. A nonstatistical sample of 2,233 bedouins was also examined. The survey revealed that 1.5% of the population are blind and another 7.8% are visually impaired according to the World Health Organization definition. The most common causes of blindness include cataract, trachoma, nontrachomatous corneal scars, refractive errors, congenital anomalies, failed medical or surgical treatment, and glaucoma. Refractive errors, amblyopia, and trauma are also important causes of less severe, and often unilateral, lost vision. About 7% of all Saudi Arabians, and 42% of those older than 40 years, have a cataract or its sequelae. Over 3.5% of the population have corneal scars, about half of which are caused by trachoma.     

Diphyllobothriasis in Saudi Arabia

We described a Saudi patient infected with Diphyllobothrium latum D. latum. A 38-year-old male presented, complaining of passing worms. He had a history of recent travel to Europe and South East Asia. Stools examination revealed typical D. latum eggs. He was treated with praziquantel followed by saline purge, after which he discharged an intact tapeworm. Macroscopic and microscopic examinations of the worm confirmed the diagnosis of D. latum. This is the first case of diphyllobothriasis to be reported in Saudi Arabia. The epidemiology and methods of prevention of diphyllobothriasis are discussed.     

Hyperlipidemia in Saudi Arabia

OBJECTIVE: To determine the prevalence of hyperlipidemia among Saudis of both genders in rural and urban communities. METHODS: Selected Saudis in the age group of 30-70 years were studied over a 5-year period between 1995 and 2000 in Saudi Arabia. Data were obtained from history, physical examination, and analysis of fasting plasma lipids. The data were analyzed to classify individuals with hypercholesterolemia (HC) (total cholesterol > or =5.2 mmol/l), and hypertriglyceridemia (HT) (total triglycerides > or =1.69 mmol/l). Logistic regression analysis was performed to provide a risk assessment model and correlation with other coronary artery disease (CAD) risk factors. RESULTS: The number of study samples included in the final analysis was 16,819. The prevalence of HC was 54% with mean cholesterol level of 5.4+/-1.52 mmol/l. Prevalence of HC among males was 54.9% and 53.2% for females, while 53.4% among urban Saudis and 55.3% for rural Saudis. Hypertriglycemia prevalence was 40.3% with mean triglycerides level of 1.8+/-1.29 mmol/l. Males had statistically significant higher HT prevalence of 47.6% compared to 33.7% in females (p<0.0001). CONCLUSION: Hyperlipedimia is reaching higher prevalence rates in KSA. This finding may suggest that CAD will soon be a major health problem. Reduction in obesity by adopting healthier eating habits, and increasing physical activity are of considerable importance to our community.     

Intravenous immunoglobulin utilization in a tertiary care teaching hospital in Saudi Arabia

OBJECTIVE: To evaluate the effect of intravenous immunoglobulin IVIG utilization at King Khalid University Hospital, an 850 bed tertiary care academic center, over a-3-year period. METHODS: Patients who received IVIG in the period from January 2003 to December 2005 at King Khalid University Hospital were identified retrospectively using the hospital computer system. Their charts were subsequently reviewed. We collected data pertaining to patients' demographics, indication of IVIG, dose regimen and physician specialty. Indications were categorized into 4 different categories: US Food and Drug Administration FDA-labeled; off-label recommended as first line; off-label recommended as alternative; and not recommended. RESULTS: A total of 305 patients were identified. Intravenous immunoglobulin was given to 109 (35.7%) patients for FDA-labeled indications, 29 (9.5%) patients for off-label recommended as first line indications, 97 (31.8%) for off-label recommended as alternative indications, and 70 (23%) for not recommended indications. The amount of IVIG consumed during the study period was 43.65 Kgs with an estimated cost of $1.75 million, 24.4% of which was considered inappropriate use. Hematologists and neurologists were the most frequent prescribers. CONCLUSION: A significant amount of IVIG was prescribed for inappropriate indications. This had a large financial burden on an already strained hospital budget.     

Genito-urinary cancer in Saudi Arabia

The incidence of Genito-urinary cancer (GUC) in the Kingdom of Saudi Arabia (KSA) increases with age and is 5-fold higher in men than in women. Genito-urinary cancer accounts for only 9.2% of all cancers in KSA, while the rate in the United States of America (USA) is as high as 24.1%. An epidemiological search on GUC in KSA revealed a relatively low incidence compared to developed countries. This is more evident in prostatic cancer, which is 50 times lower than in the USA. The most common GUC in KSA is bladder, followed by the prostate, kidney, and testicular cancer. Penile cancer is extremely rare. Genito-urinary cancer is not among the 10 most common cancer in KSA, however, bladder cancer ranking tenth. Reviewing the National Cancer Registry data in addition to the available literature on GUC in KSA for the past 50-years showed the changing pattern of this disease over time.