Determinants of healthcare utilization and cost among privately insured families in Saudi Arabia

The kingdom of Saudi Arabia is currently restructuring its healthcare system through implementing a number of strategies among which the introduction of insurance coverage for both foreign workers and citizens. The aim of the present study is to assess factors that affect utilization and cost of health services among a group of privately insured families in Saudi Arabia. A six month administrative claims database of employees and their dependents from three different companies covered by a major insurance company was utilized to collect demographic enrollment characteristics, service utilization and services costs. The unit of analysis of the present study was families rather than individuals with a total of 131 families included in the analysis. The study revealed that those covered by the highest class of coverage provided by the insurance company [class VIP and A] had more utilization and higher mean charges per family compared to those covered by class B or C. The study also found that middle aged and older families had more utilization and average charges per family compared to younger families. Families in which women were the primary insured had both lower use and lower average charges. Finally family size seemed not related to any pattern of medical care use. Families with lower insurance class coverage, and families in which women are the primary insured showed lower utilization pattern, but families with older individuals had more utilization. Additional studies are need for a more comprehensive understanding of utilization pattern by the insured population in Saudi Arabia

Physicians' use of and attitudes toward electronic medical record system implemented at a teaching hospital in Saudi Arabia

The present study aimed at investigating the usefulness of an electronic medical record [EMR] system implemented at a large teaching hospital in the Eastern province of Saudi Arabia. Demographic data, data about physician computer background and experience, level of use of core EMR system functions and physician satisfaction with EMR functions were collected from physicians employed at the target hospital for more than one year [n=142]. Results revealed that high percentage of physicians were dissatisfied with EMR system ability to add content, to send messages, to access reference materials and to get timely IT support. Over 75% of physicians indicated positive impact of EMR on work and quality of care. Varying percentages of physicians [0.0 - 54.9%] never used one or more of the 10 investigated core EMR functions. Multinomial logistic regression showed that satisfaction with the EMR system and experience with computers were significantly associated with the use of EMR. It was concluded that the benefits of the EMR are not fully achieved at the study hospital as many core functions are either unknown or never used by physicians. Improvement of the current EMR training and improvement of key identified aspects of the EMR system are likely to improve physicians' use of the system

Dangerous and unapproved abbreviations at a joint commission international accredited hospital in Saudi Arabia

Abbreviations which resulted in harmful patient errors or death are termed dangerous abbreviations. These abbreviations were included in The Joint Commission "Do Not Use" list of abbreviations launched in May 2005. The aim of the present study is to assess physicians' and nurses' use of unapproved and dangerous abbreviations and to explore physicians' and nurses' opinion regarding the use of these abbreviations. The study was conducted in a Joint Commission International [JCI] accredited hospital in Eastern Saudi Arabia. Two study designs were used: retrospective descriptive and cross-sectional descriptive. Data were collected through reviewing 384 paper records and distributing a questionnaire to a random sample of 58 physicians and nurses. The study revealed that the average number of dangerous abbreviations per record was 2.2 while the average number of unapproved abbreviations per record was 1 .96. The most frequent dangerous abbreviation reported in the present study was Discharge/Discontinue D/C accounting for 73% of the total identified dangerous abbreviations for both physicians and nurses. The ability of physicians and nurses to correctly identify the meaning of the most commonly used dangerous abbreviation and unapproved abbreviation ranged between 37.9% and 69.0%. The study revealed high use of dangerous and unapproved abbreviations at the study hospital. Few dangerous abbreviations constitute the majority of identified abbreviations. A quality improvement intervention needs to be instituted to reduce abbreviation use at the study hospital

Use of out-of-plan services by health insurance beneficiaries in Alexandria

This study examined the services obtained by the Health Insurance beneficiaries from non-health insurance physicians. Obtaining health services by Health Insurance beneficiaries from non-health insurance physicians was also examined in the present work. The study was conducted at three Health Insurance Organization [HIO] clinics in Alexandria. A pre-coded interview questionnaire was used to gather the required information from 610 randomly selected beneficiaries. The study revealed a high pattern of out-of-plan use by HIO beneficiaries, 66.6% utilized at least one out-of-plan per year. The beneficiary characteristics that are associated with the out-of-plan use were quality rating of services, perceived health status, seeking second opinion, education and the number of chronic diseases. The mean out of pocket expenditure at the last out-of-plan visit was LE 100. The implications for the Health Insurance Organization and financing of health services were discussed

Testing the reliability and validity of a set of clinical indicators for evaluation of the quality of urosurgical care in Hospitals

The objectives of the present study were to develop a set of clinical indicators for evaluation of quality of urosurgical care in hospitals and to test the reliability and validity of the developed set of indicators. The study was conducted at the two Health Insurance Organisation hospitals in Alexandria. A preliminary set of indicators was selected based on literature review, and consultation with quality assurance physician in the study hospitals. Delphi technique was used to validate this set. Reliability of indicators was assessed in terms of agreement among the investigator, QA physician of study hospital [Ql] and QA physician of the other study hospital [Q2] as well as accuracy of identification of indicator occurrences by different reviewers. The validity of different indicators was assessed in terms of the proportion of identified occurrences by the study reviewers that merits further investigation as determined through independent review of each case of indicator occurrence by the head of urology unit from which the patient was discharged, Ql, and researchers. In case of disagreement among reviewers, the record was submitted to a urosurgery consultant, to obtain his judgement. The results of the present study revealed that response rate in round one Delphi ranged from 61%-71% and 87.5%-100% in round two. Post-operative mortality ranked first as the most useful indicator in both Delphi rounds. The mean of all indicator thresholds was lower in round two than in round one. The overall percentage of unacceptable occurrences for different indicators was 69.6% at one hospital and 74.5% at the other. At both hospitals the observed post-operative mortality and ICU admission rates were below the mean expert threshold, whereas all other indicator rates markedly crossed the mean expert threshold. The overall agreement was in the range 80%-97%, the specific agreement was in the range 71%-95% and Kappa statistic was in the range 0.73-0.96. The accuracy of indicators identification was calculated using sensitivity, and specificity. At both hospitals specificity and sensitivity were highest for the investigator followed by a lower value for both Ql and Q2