Saudi Arabia: Hospitals step up quality for slice of insurance cake

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Taif - Of late, some private hospitals have taken out newspaper advertisements to announce their success in getting quality certification from the Joint Commission International (JCI), a non-profit affiliate of The Joint Commission, the largest accreditor of health care organizations in the United States, surveying nearly 20,000 health care programs through a voluntary accreditation process.

Dr. Erfan and Bagedo General Hospital, Al-Magraby Hospitals and the International Medical Center are among the well-known hospitals in Jeddah who have got JCI accreditation. Several others have also obtained international certification in recent times.

But why all the hospitals are suddenly running after international accreditation and why they are keen on publicizing their success?

The reason is stiff competition in Saudi Arabia's burgeoning medical insurance market. At present, nearly three million Saudis and foreigners are beneficiaries of the health insurance system.

According to a Saudi Arabian Monetary Agency (SAMA)Saudi Arabian Monetary Agency (SAMA) report, health insurance gross written premiums increased by 38 percent to SR3 billion in 2007 compared to SR2.2 billion in 2006, representing 36 percent of the insurance market.

"It is a big business - the health field," said Dr.Ashra Ismail, CEO and the president of Quality Association Inc. "All hospitals in Saudi Arabia, whether governmental or private, are running towards accreditation."

The Saudi government is making health insurance compulsory for all in the country. The multi-stage process started some years ago with expatriates and now citizens are being brought into the insurance net.

Hence, with such a huge market having opened up - Saudi Arabia's population of 26 million, including expatriates, is growing by 3 percent annually - the third party (insurance companies) will choose only the accredited hospitals, said Dr. Ismail. (See box of licensed insurance companies.)

Dr. Ismail was quick to caution about jumping to conclusions about quality just because a hospital has got an international certification.

"If the hospital is accredited by an international organization, does not mean that is error-free," he said.

"To err is human, as long there is human medical participation there will be mistakes. However, by applying the quality principles and aspects, we will reduce the percentage of mistakes. Technology like health information system, biomedical engineering, new trends in treating patients and quality control can help us make sure our medical devices and equipments are working well."

No end
Hospital accreditation is defined as "A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve"

"Accreditation is a journey that has a beginning but there is no end," Dr. Ismail said. "It continuously needs great efforts in application in order to improve quality."

JCI accreditation is awarded when a hospital satisfactorily meets all of the following: Ambulatory Care Standards, Care Continuum Standards, Clinical Laboratory Standards, Disease or Condition-Specific Care Certification, Hospital Standards and Medical Transport Standards.

The average cost for a Joint Commission International (JCI) accreditation survey of a hospital is approximately SR154,000 (about$41,000), depending on the size and complexity of the medical facility.
The amount exclude, travel, stay and food expenses. Small hospitals will require a two-day survey by two surveyors and large hospitals six days by five surveyors.

This year JCI has improved the value of accreditation by introducing new standards in new survey process called the Tracer Methodology. This new methodology increases interaction and learning during the survey and incorporates an ongoing self-assessment methodology for the hospital.

With more stringent quality evaluation, hospitals have no choice but to step up their performance.
"It is fate, not an option," Dr. Ismail said. "Many Saudi hospitals have got international accreditation, such as Aramco hospital, National Guard hospitals, King Faisal Specialist Hospital and some private hospitals like Al-Saad Private Hospital, Suleiman Faqeeh and Al-Mouasa."

He has visited many military hospitals in the Kingdom. "They have their own standards and are very good compared to international hospitals," he said.

Change management is the main challenge in bringing hospitals up to par with accreditation standards.
"Changing the theory into application takes a long time and great efforts," Dr. Ismail said. "Some people reject change for many reasons, for instance they may not want to try another job, they may be afraid of losing their existing job, or they are just too accustomed to one kind of job."

By Mohammad Murad

© The Saudi Gazette 2008