Healthcare in Saudi Arabia
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Transcript Healthcare in Saudi Arabia
Pharmacy In Health Care System
PHCL 411
Course Contents
Overview of the Health care systems
Professional, Economic and Public Aspects of Health Care System
Pharmacy and Health Care System
Medication Use and Distribution System
The Structure of Health Care System in Saudi Arabia
The Organization of Health Care System in Saudi Arabia
Finance and Regulation of Health Care System in Saudi Arabia
Accreditation of Health Care System in Saudi Arabia
The Role of Insurance and Private Sector in Health Care System in
Saudi Arabia
Group Project Presentation
health care system
Introduction to health care system
According to the World Health Organization
(WHO) , the Saudi health care system is ranked
26th among 190 of the world’s health systems
It comes before many other international health
care systems Canada (ranked 30), Australia (32),
New Zealand (41), and other systems in the region
such as the United Arab Emirates (27), Qatar (44)
and Kuwait (45)
Despite these achievements, the Saudi health care
system faces many challenges which require new
strategies and policies by the Saudi Ministry of
Health (MOH) as well as effective cooperation
with other sectors.
Components of Healthcare Systems
Consist of a number of interrelated
subsystems .
Each of these subsystems has a purpose
which, if attained, aids the larger system in
reaching its overall goals.
For examples the healthcare systems of
U.S.A, Canada , Saudi Arabia,
Health care system in the United States
Health care in the United States is provided by many
separate legal entities. Health care facilities are largely
owned and operated by the private sector .
health insurance is now primarily provided by the
government in the public sector, with 60-65% of
healthcare provision and spending coming from
programs such as Medicare ,Medicaid , Tricare , the
children's Health insurance program , and the veterans
Health Administration
Health care system in the United States
The U.S census Bureau reported that 49.9 million residents,
16.3% of the population, were uninsured in 2010 (up from
49.0 million residents, 16.1% of the population, in 2009).
According to the world health organization (WHO), the
United States spent more on health care per capita ($7,146),
and more on health care as percentage of its GDP (15.2%),
than any other nation in 2008.
The United States had the fourth highest level of government
health care spending per capita ($3,426), behind three
countries with higher levels of GDP per capita: Monaco,
Luxembourg, and Norway.
Health care system in the United States
The World Health Organization (WHO), in 2000,
ranked the U.S. health care system as the highest in cost,
first in responsiveness, 37th in overall performance, and
72nd by overall level of health (among 191 member
nations included in the study).
The common wealth fund ranked the United States last
in the quality of health care among similar
countries, and notes U.S. care costs the most
Canadian health care
system
United States health care
system
◦
◦ Coverage: Universal and
comprehensive
◦
◦ Access: No financial
◦
Barriers
◦
◦ Private insurance: Small
◦
◦ Payers model: single
◦ Cost control: High and
◦
Centralized
◦ Comparison
System capacity: High
between
degree of control
Coverage: Mixed:
Medicare and private
Access: Financial Barriers
Private insurance: Large
Payers model: multiple
Cost control: Low and
fragmented
System capacity: Low
degree of control
Canadian and
American Health Care system
Overview of Healthcare system in Saudi
Arabia
Table of contents
Introduction to health care system
Aspects of health
Determinants of health
Components of Healthcare System
Health and System Goals
Overview of the Healthcare System in the
Kingdom of Saudi Arabia
Demographic and economic patterns of Saudi
Arabia
Table of contents
Pharmaceutical Care
Levels of health care
Health insurance in Saudi Arabia
Brief overview of health services development
How do you become a Pharmacist in Saudi Arabia
Role of pharmacist in health care
Comparative Health Care Systems
Challenges facing the current health system
Elements of Saudi health system reform
What Makes a Good Healthcare System
Introduction to health care system
What is health care system?
A health system is the sum total of all the organizations,
institutions and resources whose primary purpose is to
improve health.
•
•
A health system needs staff, funds, information, supplies,
transport, communications and overall guidance and
direction.
A health system needs to provide services that are
responsive and financially fair, while treating people
decently. (WHO)
Introduction to health care system
Health is a complex and multidimensional issue. Many of
the factors influencing over all health either not in the
traditional domain of health care or are difficult to
influence , e.g.: Water quality , diet , genetics , and
consumption of tobacco & other.
The most famous modern definition of health was
created during a Preamble to the Constitution of the
World Health organization adopted by the international
health conference in new York
Introduction to health care system
According to World Health Organization's (WHO's)
"health "is defined as a state of complete physical, mental,
and social well-being and not merely the absence of
disease or infirmity.
Historically, all the great advances in health have been
caused by prevention of diseases.
Aspects to health
Most people accept that health can be divided into
two broad aspects - physical and mental health.
Physical health : For humans, physical health means
a good body health, which is healthy because of
regular physical activity (exercise), good nutrition,
and adequate rest.
Physical health is defined as health relates to
anything concerning our bodies as physical entities
Aspects to health
Mental health: Mental health refers to people's
cognitive and emotional well-being. A person
who enjoys good mental health does not have a
mental disorder.
According to WHO, mental health is "a state of
well-being in which the individual realizes his or
her own abilities, can cope with the normal
stresses of life, can work productively and
fruitfully, and is able to make a contribution to
his or her community".
Determinants of health
The health of individual people and their
communities are affected by a wide range of
contributory factors. People's good or bad health
is determined by their environment and situations
WHO says that the following factors probably
have a bigger impact on our health than access
and use of health care services:1.Where we live
2.The state of our environment 3.Genetics
4.Our income
Determinants of health
5. Our education level
6 .Our relationship with friends and
family
WHO says the main determinants to health
are:
Our economy and society ("The social and
economic environment"),Where we live, what is
physically around us ("The physical
environment"), What we are and what we
do ("The person's individual characteristics and
behaviors")
Components of Healthcare System
Health care system Consist of a number of
interrelated subsystems .
Each of these subsystems has a purpose which,
if attained, aids the larger system in reaching its
overall goals.
For examples the healthcare systems of U.S.A,
Canada , Saudi Arabia, and other countries
Elements of Healthcare System
Inputs ( human resources , material , technology
, information , capital , …….
Outputs ( patient care , acceptable costs ,
training , other objectives ) .
Process
Feedback
Outcome (improvement in infant mortality rate
and life expectancy at birth
Overview of the Healthcare System
in Saudi Arabia
The Ministry of Health is responsible for the
supervision of healthcare and hospitals in both
the public and private sectors. The system offers
universal healthcare coverage.
The healthcare system has two tiers. One is a
network of primary healthcare centers and
clinics. The second tier is represented by the
hospitals and specialized treatment facilities
located in urban areas.
Overview of the Healthcare System
in Saudi Arabia
In 1970, there were 74 hospitals with 9,039
beds; by 2005, there were 350 hospitals with
nearly 48,000 beds. The Ministry of Health
operates 62% of the hospitals and 53% of the
clinics and centers; the remaining facilities are
operated by government agencies, including the
Ministry of Defense, the National Guard, the
Ministry of the Interior, and several other
ministries, as well as by private entities
Overview of the Healthcare System
in Saudi Arabia
The breakdown of facilities is as follows:
1) Ministry of Health Facilities
These serve the general public and are located
in both the large cities and the small towns
throughout Saudi Arabia.
2) Military Hospitals
These serve members of the Saudi Arabia
armed forces and members of their families,
according to the branch of the military in which
the individual serves.
Overview of the Healthcare System
in Saudi Arabia
Saudi Arabian National Guard (SANG)
SANG has four hospitals which provide
care to the soldiers of the Saudi Arabian
National Guard and their dependents:
King Abdul-Aziz Medical City, Riyadh (650
beds, formerly the King Fahad National
Guard Hospital);
King Abdul-Aziz Medical City, Jeddah (350
beds, formerly the King Khalid National
Guard Hospital);
Overview of the Healthcare System
in Saudi Arabia
King Abdul-Aziz Medical City – Dammam (100
beds);
The Saudi Arabian National Guard also
operates clinics in Riyadh and Taif.
Saudi Arabian Ministry of Defense and Aviation
(MODA)
It includes the Saudi Arabian Army, the Royal
Saudi Naval Forces, the Royal Saudi Air Force
and Royal Saudi Air Defense
Riyadh Military Hospital Al Kharj, Riyadh
(1,000+ beds);
Overview of the Healthcare System
in Saudi Arabia
Prince Sultan Cardiac Center, Riyadh (150+
beds);
North West Armed Forces Hospital, Tabuk (350
beds);
Ministry of the Interior
This serves members the ministry of the
interior, including the police and customs
collectors.
Security Forces Hospital, Riyadh (500 beds),
serves the Ministry of Interior personnel.
Overview of the Healthcare System
in Saudi Arabia
Referral Hospitals
Every citizen is eligible to go to the referral
hospitals for specialized care. These facilities
include:
King Faisal Specialist Hospital & Research
Centre-Riyadh Site (700 beds);
King Faisal Specialist Hospital & Research
Centre-Jeddah Site (250 beds);
King Khalid Eye Specialist Hospital, Riyadh (360
beds);
Overview of the Healthcare System
in Saudi Arabia
Private Facilities
For-Profit: Saudi German Hospital, Jeddah; Dr. Erfan
& Bagedo Hospital, Jeddah; Al-Habib centers and
Kingdom Hospital, Riyadh
Saudi ARAMCO Hospital, Dhahran (480 beds);
serves employees of the oil company Saudi
ARAMCO, and their family members
Social Insurance Hospital, Riyadh (GOSI) (300 beds)
Royal Commission Hospitals, which
Demographic and economic patterns
of Saudi Arabia
According to last official census in 2010 placed
the population of Saudi Arabia at 27.1 million,
compared with 22.6 million in 2004
The annual population growth rate for 2004 to
2010 was 3.2% per annum
According to United Nation projections, it is
estimated that the population of Saudi Arabia
will reach 39.8 million by 2025 and 54.7 million
by 2050
Demography of Saudi Arabia
The last official census in 2010 placed the population of
Saudi Arabia at 27.1 million, compared with 22.6 million
in 2004.
The annual population growth rate for 2004 to 2010
was 3.2% per annum ,and the total fertility rate was
3.04
Saudi citizens comprise around 68.9% of the total
population; 50.2% are males and 49.8% females.
67.1% of the population are under the age of 30 years
and about 37.2% are under 15 years;
Demography of Saudi Arabia
The population over the age of 60 years is estimated at
5.2%
According to United Nation projections, it is estimated
that the population of Saudi Arabia will reach 39.8
million by 2025 and 54.7 million by 2050.
This is a natural outcome of the high birth rate (23.7
per 1000 population), increased life expectancy (72.5
years for men, 74.7 years for women).
Overview of health services development
Health services in Saudi Arabia have increased and
improved significantly during recent decades .
The first public health department was established in
Mecca in 1925 based on a royal decree from King
Abdulaziz.
This department was responsible for sponsoring and
monitoring free health care for the population and
pilgrims through establishing a number of hospitals and
dispensaries.
While it was an important first step in providing
curative health services, the national income was not
sufficient to achieve major advances in health care
Overview of health services development
The majority of people continued to depend on
traditional medicine and the incidence of epidemic
diseases remained high among the population.
The next crucial advance was the establishment of the
MOH in 1950 under another royal decree.
Twenty years later, the 5-year development plans were
introduced by the government to improve all sectors of
the nation, including the Saudi health care system.
Since then, substantial improvements in health care have
been achieved in Saudi Arabia.
Current Structure of health system in Saudi Arabia
Currently the MOH is the major government provider
and financer of health care services in Saudi Arabia, with
a total of 244 hospitals (33 277 beds) and 2037 primary
health care (PHC) centers .
The Ministry of Health is responsible for the
supervision of healthcare and hospitals in both the
public and private sectors.
The healthcare system has two tiers. One is a network
of primary healthcare centers and clinics that provide
preventive, prenatal, emergency, and basic services, as
well as mobile clinics for remote rural areas.
Current Structure of health system in Saudi Arabia
The second tier is represented by the hospitals and
specialized treatment facilities located in urban areas.
In 1970, the first of the government’s five-year plans to
promote development in a variety of areas, including
healthcare, was instituted.
In healthcare, the plan only meant establishing the
necessary infrastructure of hospitals, clinics, pharmacies,
laboratories and research facilities, but hiring expatriate
staff to work in the facilities and encouraging Saudis to
pursue careers in the healthcare field.
Pharmaceutical Care
1.
2.
3.
4.
5.
6.
The principal goal of pharmaceutical care is to
achieve positive outcomes from the use of
medication that improves patients' quality of
life. These outcomes include:
cure of a disease;
elimination or reduction of symptoms;
arresting or slowing a disease process;
prevention of disease;
diagnosis of disease;
desired alterations in physiological processes,
all with minimum risk to patients.
Levels of health care
>2000
Around 400
PRIMARY HEALTH CARE
SECONDARY HEALTH CARE
TERIEARY HEALTH CARE
Brief overview of health services
development
Health services in Saudi Arabia have increased
and improved significantly during recent
decades
The first public health department was
established in Mecca in 1925 based on a royal
decree from King Abdul-Aziz
This
department was responsible for
sponsoring and monitoring free health care
The next crucial advance was the establishment
of the MOH in 1950 under another royal
decree
Brief overview of health services
development
Twenty
years
later, the
5-year
development plans were introduced by
the government to improve all sectors of
the nation, including the Saudi health care
system
Since then, substantial improvements in
health care have been achieved in Saudi
Arabia
Role of pharmacist in health care
Pharmacist are health professionals who practice the
science of pharmacy
The fundamental role of pharmacists is to distribute
drugs that have been prescribed by a healthcare
practitioner to patients
One of the most important roles that pharmacists
are currently taking on is one of pharmaceutical care.
Pharmaceutical
care
involves
taking
direct
responsibility for patients and their disease states,
medications, and the management of each in order to
improve the outcome for each individual patient.
ROLE OF PHARMACIST IN GLOBAL HEALTH
Role of pharmacist in health care
Pharmacists should adequately inform patients
and the general public about unwanted effects
of medicines, and should monitor such
unwanted effects and their consequences in
collaboration
with other health
care
professionals and the appropriate authorities
Role in Health measurement
Role of pharmacist in health care
Role in Transmitted Diseases Pharmacist can
educate people by giving information that
explain disease, its transmission, risk reduction
and prevention against disease. Patient
counseling is one of the important role that a
community Pharmacist can provide.
Role in Epidemiology : Epidemiology is the study
of the distribution and prevention of health
related events in specific population
Role of pharmacist in health care
Role of pharmacist to Provide up-to-date
information about New Guidelines, New
Medications , News reports about medications
Provide answers to patient questions before
They are asked to medical staff , Drug-drug
interactions, Drug-food interactions , Drugdisease interactions
Challenges facing the current health system
Financial
Manpower
Geographical
Population:
Growth
Aging
Demanding
Changes in Disease patterns (NCD)
New medical technologies and new medications
Elements of Saudi health system reform
To Change the Role of MOH to be Responsible for:
Primary Health Care Services
Preventive medicine
Standardization of medical practice
Supervision of health system
Health system Support
To Establish The National Organization of Hospitals
To Establish The National Health Fund
What Makes a Good Healthcare System
WHAT MAKES A GOOD HEALTHCARE SYSTEM
What Makes a Good Healthcare System
The University of Chicago established the first master's
degree program in 1934. now it is the American College
of Healthcare Executive (ACHE).
About 60 graduate programs were accredited by the
Accrediting Commission on Education for a professional
Health Services Administration.
Health Education : The objective of health education is
to provide the individualized information necessary for
patients to modify their behavior, all in an effort to live a
healthier life. Pharmacists actively promote good health
practices through their own personal example
What Makes a Good Healthcare System
United States master's degree programs have more than
25,000 graduates.
Educational programs provide a generic education in
health services, rather than hospital, management . Some
offer specialty preparation in hospital, nursing facility, or
ambulatory services management.
The most common educational preparation for HSO
managers is the master degree.
What Makes a Good Healthcare System
The didactic portion for accredited programs is two
academic years; 4 Semesters. Most programs include
field experiences of varying lengths. Many require a 1year residency that allows application of the academic
preparation under the guidance of an On-Site preceptor.
The basic curriculum in accredited health services
management graduate programs covers eight areas: 1. Assessment and understanding of health status of
populations; determinants of health and illness; and
factors influencing the use of health services.
What Makes a Good Healthcare System
2 . Understanding of the organization, financing and
delivery of health services, drawing on the social
science disciplines ( economics, law, political science,
physiology, sociology, and related disciplines).
3 Understanding of, and development of skills in,
economic, financial, policy, and quantitative analysis.
4 Understanding of the values and ethical issue
associated with the practice of health services
administration, and the development of skills in ethical
analysis
What Makes a Good Healthcare System
5 Understanding of, and development of skills in, positioning
organizations favourably in the environment and managing
these organizations for continued effectiveness.
6.Provision of opportunities for development of leadership
potential including stimulating creativity, and interpersonal
and communication skill development.
7 Understanding of, and development of skills in, the
management of human capital information resources.
8 Understanding of, and development of skills in, evaluation
methods to assess organisational performance and, in
particular; methods to assure the quality of services
provided.
What Makes a Good Healthcare System
AS with the graduate programs, rapid growth in
the number of undergraduate programs
preparing health services management
personnel occurred its the late 1960s and early
1970s.
Master programs prepare graduates to become
senior-level line or staff managers for pharmacy
; baccalaureate programs train middle-level
supervisors or department managers.
Licensure, Certification, and Registration of
Caregivers
Licensure, Certification, and Registration of
Caregivers
Licensure: a process performed by government
that allows someone to engage in an occupation
after finding that the applicant has achieved a
certain minimum competency . Physicians and
dentists are always licensed, for example .
Registration: qualified individuals are listed on an
official roster maintain by government or
nongovernmental body (registered nurse)
Certification
A process by which a nongovernmental agency
or association grants recognition to someone
who meets its qualification (Nurses-midwives
are certified for example).
Physicians
Nonphysical Caregivers : Dentists, Physician
Assistant, Pharmacists, Technologists, & other .
Professional ,Economic and Public Aspects
of health Care System
LIST OF CONTENTS
Introduction to health system
Goals of health care system
Professional aspects of health care system
Economic aspect of health system
Public aspect of health care system
Challenges for health care reform
Professional ,Economic and Public Aspects of
health Care System
Introduction to health system
A health system is the sum total of all the organizations,
institutions and resources whose primary purpose is to
improve health.
A health system needs staff, funds, information, supplies,
transport, communications and overall guidance and
direction. And it needs to provide services that are
responsive and financially fair, while treating people
decently.
A health system is broader than the (relatively) simple
function of delivering clinical care, and should maximize
its potential for prevention and the promotion of equity
.
Professional ,Economic and Public Aspects of
health Care System
The goals of health system according to the WHO
◦ Good health,
◦ responsiveness to the expectations of the population,
◦ fair financial contribution
Progress towards them depends on how systems carry out
four vital functions:
provision of health care services,
resource generation,
financing,
stewardship.
Professional ,Economic and Public Aspects of
health Care System
Other dimensions for the evaluation of health systems
include
quality,
efficiency,
acceptability,
equity .
They have also been described in the United States as "the
five C's": Cost, Coverage, Consistency, Complexity, and
chronic illness
Also, continuity of health care is a major goal.
Professional ,Economic and Public Aspects of
health Care System
Professional aspects of health care system
In Saudi Arabia, many health professionals are
expatriates of various nationalities.
A gradual change has been observable, with increased
numbers of Saudi nationals becoming qualified and
taking up employment in the health sector.
In 2002 figure of 15.6 physicians/10 000 populations
compares favorably with the WHO minimum
recommendation of 1 physician/10 000 populations for
developing countries, and the WHO Eastern
Mediterranean Region average of 9.4 physicians/10000
populations
Professional ,Economic and Public Aspects of
health Care System
Professional aspects of health care system
The annual large influx of pilgrims during the Haj season
dramatically alters the health worker/population ratio as
doctors, nurses, pharmacists and allied health personnel
are drawn from the different parts of the country.
The pilgrimage poses special problems, not only in terms
of the number of people, but also the special health
problems associated with this diverse group.
Saudi Arabia provides the essential man power and other
resources needed to manage Haj season safely
Professional ,Economic and Public Aspects
of health Care System
Professional aspects of health care system
The Saudi health system is unique in that medical
consultations are overwhelmingly doctor– patient
encounters, unlike in other settings where there are
different mixes of personnel.
Examples of the latter include physicians, clinicians and
nurse practitioners in the United States, physicians and
barefoot doctors in China, and physicians and medical
auxiliaries in most Asian and African countries.
The burden of the Saudi approach can better be
appreciated by the enormous workload of health centre
physicians in some areas.
Professional ,Economic and Public Aspects
of health Care System
Professional aspects of health care system
There are a number of health care centers of excellence,
such as the King Faisal Specialist Hospital and Research
Centre and the King Khalid Specialist Hospital for Eye
Diseases in Riyadh.
The military hospitals, university hospitals and some
private hospitals also have state-of-the-art equipment and
well-qualified personnel.
There is an air ambulance service that provides prompt
transfer of patients from one part of the country to the
other to optimize care.
This arrangement helps to minimize the need for
overseas treatment.
Professional ,Economic and Public Aspects
of health Care System
key current human resource issues and concerns.
The health worker/population ratio in Saudi Arabia has
improved in the last 10 years to facilitate accessibility to
health services.
Increased number of health colleges and institutes, and
increased training and scholarship budget allocation is
aiming to provide the health services with different and
qualified health specialties to cover the issue of shortage
in health human recourses with expansion of Saudization
of health jobs.
Professional ,Economic and Public Aspects
of health Care System
Professional aspects of health care system
Human Resource Training Institutions for Health
Type of institution
current
planned
No of institutions capacity
No of institutions
capacity
target year
Medical school
10
1861
2
120
2013
School of dentistry
4
373
2
74
2013
School of pharmacy
4
625
3
150
2012
Nursing schools
43
9813
8
1600
2010-15
4
1200
2
120
Paramedical colleges
School of public health
not applied
2012
Professional ,Economic and Public Aspects
of health Care System
Professional aspects of health care system
Saudi Board for Health specialties with MOH
cooperation is responsible for accreditation, and
registration mechanisms for HR Institutions
Human resources policy and reforms over last 10 years
Increase number of qualified health workers.
Saudization, in the previous 7th five year plan reached
50.9%
Increased number of health colleges and institutes.
Issue of guidelines for policy and procedures aiming to
raise the quality of health work
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
Economics is concerned with the allocation of scarce
resources among their competing uses, on the face of
unlimited human wants.
Among these wants are health care services for which we
cannot use exactly the same Economic Principles we use
for other goods and services; because they have special
characteristics that make them different than the others.
That is why a special branch of economics is developed
to deal with them called “Health Care Economics”.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
Health Care Economics is a new branch of Economics
concerned with how to apply the Economics Tools for
heath care issues and explain its different aspects to make
them more analyzable.
It also offers measures to determine if a certain policy will
increase or decrease the economic efficiency and the
equitable distribution of health care services.
Of course, economic analysis cannot help in all the
concerns of health professionals and the general public in
the area of health care services.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
The particular problems suitable for economic analysis
are those related to scarcity of resources. In this respect,
economics can explain the most preferable choices of the
society when its available resources are not enough to
satisfy all its needs.
That is usually the case in all societies because of the
strong competition between the different needs of each
society such as education, health care, security, defense,
roads, ….etc.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
Economics Tools:
The most used two economics tools for the analysis of
health care services are:
◦ The marginal analysis which deals with optimization
problems.
◦ Supply and demand analysis which is used for
predicting the new equilibrium situations.
Professional ,Economic and Public Aspects
of health Care System
Marginal analysis is used to assist people in allocating their
scarce resources to maximize the benefit of the output
produced.
Simply getting the most value for the resources used.
Marginal analysis: The analysis of the benefits and costs
of the marginal unit of a good or input.
Professional ,Economic and Public Aspects
of health Care System
DEMAND AND SUPPLY ANALYSIS
1. The law of demand states that consumers will purchase
more of a good at lower prices and less of a good at
higher prices.
2. The law of supply states that producers will sell less of a
good at lower prices and more of a good at higher prices.
3. Equilibrium exits when there is no reason for a situation
to change.
When equilibrium exits, the quantity people plan to buy
is equal to the quantity that producers plan to sell.
The laws of demand and supply cause the market to
move to equilibrium.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
The Assumptions of Health Care:
There are many assumptions concerning health care that
makes it different from other industries. The following
are some examples:
1. Consumers of health care services lack information
concerning their health problems and how they should
be treated.
2. Uncertainty about the medical expenditures the patients
or the government may have to pay.
3. Uncertainty about the results of treatment.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
4. The double role played by the doctor as an agent for the
patient and as a supplier of the medical service, at the
same time
5. The large number of non-profit medical firms which
determine the prices of their services based upon their
costs only.
6. Barriers to entry in the medical profession and in certain
tasks delivered by the different health professionals.
7. The desire of the society to provide each of its
individuals with the minimum level of health care.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
To sum up the forgoing discussion, health care economics
benefits the health care sector in many ways, which are:
1. It provides a background by which medical care issues
could be analyzed
2. Economics can be used in the traditional aspects such as
predictions and planning which are required in any other
sector or industry
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
3. It enables the evaluation of the effects of medical
legislations and regulations on the supply and demand in
the four interrelated health care markets, which are:
◦ The final market for health care.
◦ The market for health care institutions.
◦ The market for health care manpower.
◦ The market for health care education with all its levels
and types.
Professional ,Economic and Public Aspects
of health Care System
Economic aspect of health system
4. Economics provide measures to evaluate health policies
in order to achieve efficiency and equity in health care.
5. Economics determine the costs and benefits of the
different health care choices.
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
The public health system once was thought of as
comprising only official government public health
agencies
now is understood to include both other public-sector
agencies (such as schools, Medicaid and environmental
protection agencies, and land-use agencies) and privatesector organizations whose actions have significant
consequences for the health of the public.
The public health system includes the following four
main components:
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
1-Mission – The mission of the public health system
includes its goals at any point in time and how, at the
conceptual level, these goals are operationalized. At the
beginning of the 21st century, the mission of public health is
to ensure conditions in which people can be healthy.
2-Structure – The structural capacity of the public health
system is the cumulative resources and relationships
necessary to carry out the important processes of public
health
Professional ,Economic and Public Aspects
of health Care System
Structural capacity includes the following elements:
◦
◦
◦
◦
◦
information resources,
organizational resources,
physical resources,
human resources,
fiscal resources.
3-Process – The practice of public health can be thought of
in terms of the key processes through which practitioners
seek to identify, address, and prioritize community or
population-wide health problems and resources and the
outputs of these more fundamental processes, public
health’s interventions, policies, regulations, programs, and
services.
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
The processes of public health are those that identify and
address health problems as well as the programs and
services consistent with mandates and community
priorities.
4-Outcome – The immediate and long-term changes
experienced by individuals, families, communities,
providers, and populations are the system’s outcomes, the
cumulative result of the interaction of the public health
system’s structural capacity and processes, given the macro
context and the system’s mission and purpose.
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
Outcomes can be used to provide information about the
system’s overall performance, including its efficiency,
effectiveness, and ability to achieve equity between
populations.
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
What Is Public Health Quality
Quality in public health is the degree to which policies,
programs, services and research for the population
increase desired health outcomes and conditions in
which the population can be healthy.
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
Public Health Aims:
The nine aims help guide public health practices across
the entire system to ensure quality for increasing positive
population health outcomes.
1. Population-centered: Protecting and promoting healthy
conditions and the health for the entire population
2. Proactive: Formulating policies and sustainable practices
in a timely manner, while mobilizing rapidly to address
new and emerging threats and vulnerabilities
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
Public Health Aims:
3. Equitable: Working to achieve health equity
4. Health promoting: Ensuring policies and strategies that
advance safe practices by providers and the population
and increase the probability of positive health behaviors
and outcomes
5. Risk reducing: Diminishing adverse environmental and
social events by implementing policies and strategies to
reduce the probability of preventable injuries and illness
or negative outcomes
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
Public Health Aims:
6. Vigilant: Intensifying practices and enacting policies to
support enhancements to surveillance activities
7. Transparency: Ensuring openness in the delivery of
services and practices with particular emphasis on valid,
reliable, accessible, timely and meaningful data that is
readily available to stakeholders, including the public
8. Effective: Justifying investments by using evidence,
science and best practices to achieve optimal results is
areas of greatest need
Professional ,Economic and Public Aspects
of health Care System
Public aspects of health care system
Public Health Aims:
9. Efficient: Understanding costs and benefits of public
health interventions and to facilitate the optimal use of
resources to achieve desired outcomes
Challenges for Health Care Reform
Challenges for health care reform
1. Provide universal coverage. Enact systematic health care
reform guaranteeing access to affordable health care for
all individuals from the health care providers of their
choice.
2. Eliminate health disparities. Dedicate more resources to
assuring health equity and eliminating the disparities that
persist in vulnerable populations. Payment for preventive
interventions should include psychosocial initiatives and
innovative care models.
Challenges for Health Care Reform
Challenges for health care reform
3. Focus health care resources on wellness, disease
prevention and primary care. Promote a greater supply
and usage of primary care professionals as defined by the
Institute of Medicine, including certified nurse‐midwives
(CNMs) and certified midwives (CMs).
4. Improve care integration and coordination. Promote
seamless consultation, collaboration and referral among
providers and institutions to improve consumer access to
health care services and to their personal health
information.
Challenges for Health Care Reform
Challenges for health care reform
5. Align payment systems with evidence‐based practice and
optimal outcomes rather than on maximizing billable
interventions. Promote collection and transparent
reporting of standardized performance measures by all
providers and institutions.
6. Improve women’s access to high quality care.
7. Recognize that women play a key role in the health of
the family and they often access the health care system
through their reproductive health care provider.
Challenges for Health Care Reform
Challenges for health care reform
8. Preserve direct access to the full range of reproductive
and primary care services for women of all ages from the
providers of their choice.
9. Improve quality and value by strategically expanding the
use of CNMs and CMs as integral members of the health
care team by ensuring licensed independent provider
status, universal access to hospital privileges and equal
payment for professional services in all 50states and US
territories
10. Educate more midwives by expanding funding for
scholarships, clinical sites and loan repayment.
Challenges for Health Care Reform
Challenges for health care reform
11. Expand funding for midwifery research, demonstration
projects and collaborative training of midwives and
physician residents. Provide incentives for innovative
delivery models such as community‐based birth centers
and group prenatal car
12. Significantly improve maternal and infant
health. Promote high quality, evidence‐based maternity
care emphasizing normal birth and the appropriate use of
technology and medical interventions.
Organization of health care system in Saudi Arabia
Table of content
Brief history of the health care system organization
organization
Central organization
Regional Health Organization
Public Health Care System
Private Health Care System
Levels of health care
International health and health related organizations
Brief history of the health care system
As said before a public health department was
established in 1925, by a Royal decree from King AbdelAziz Al-Saud, based in Makka AlMukrma, with branches
in provinces, followed by establishment of dispensaries,
hospitals, and laboratories.
This was the beginning of emphasis on prevention and
environmental health.
The first school of nursing was opened in 1926,
followed by the school of heath and emergences in
1927.
In 1951, the Ministry of Health was established. From
that date the health services expanded.
Brief history of the health care system
From 1970 to 1980, health services were predominantly
curative as most health personnel had received their
formative training in patient-oriented, hospital-based
medical institutes.
There was a general population expectation of curative
care.
This care was delivered through a network of hospitals
and dispensaries,
preventive care was delivered by health offices and to
some extent through maternal and child health care
centers
Brief history of the health care system
Disease control activities, such as for malaria, tuberculosis,
leprosy, schistosomiasis and leishmaniasis, were handled by
vertical programs.
Episodic outbreak control activities were managed through
the health offices.
In the early 1980s, the concept of primary health care (PHC)
became popular, with the WHO slogan ‘Health For All’ (HFA)
gaining recognition.
A ministerial decree in 1980, led to the establishment of the
health centers, administratively integrating the existing
dispensaries, health offices and maternal and child health
(MCH) centers into one unit.
Brief history of the health care system
At the same time, health posts were upgraded to health
centers, thus paving the way for the delivery of integrated
health services, i.e. initiation of the PHC approach.
there are 1848 PHC centers, and 200 hospitals run by
Ministry of Health. The MOH budget increased from 2,8% of
the total National budget in 1970 to 6,4% in 2004.
http://www.moh.gov.sa/Ministry/OpenData/Pages/OpenDat
aLibrary.aspx
The Saudi health system was established by a Royal decree in
2002, aimed to insure the provision of comprehensive and
integrate health care to all inhabitants in Saudi Arabia in an
equitable, affordable and organized manner
Organization
Saudi Arabia is a welfare state with health services right
to every citizen .
Ministry of Health (MOH) and about 20 other
government agencies and the Private Health Sector .
MOH is the most important providing 60% of hospital
services, 50% of Health centers services.
Private Sector employs 28% of physicians, 19% of nurses
and provides 19% of all hospital services
Central organization : Minister appointed by King for 4
years renewable. Two Deputy Ministers and four
Assistant Deputy Ministers appointed by Council of
Ministers at the recommendation of the Minister
Ministry of Health Organizational Chart
Organization
Deputy Minister for Executive Affairs has two Assistants (
Preventive and Curative health services).
Deputy Minister for Planning and Development has two
Assistant ( Planning & Research and Manpower
Development)
There are several Directors General and Directors ( such as
Nutrition, Primary Care, Laboratories, etc…).
Regional Health Organization: ( 20 offices) : 13 regions
headed by Director General ( Riyadh, Makkah, Gassim, Assir,
Gizan, Medina, North Border,Eastern Region, Hail, Tabuk,
Baha, AlJouf, Najran ) 6 Director of Health Affairs ( Holy
Capital ( Makkah City), or Director of Health Services in
Provinces ( Jeddah,Taif, Hafr Al Batin, Al Ehssa, Bisha )
appointed by Minister of Health .
Organization
PLANNING: CENTRAL (Ministry of Planning) in cooperation with MOH, every five years , currrent is the
Eighth ( emphasis on PHC, Co-ordination, Manpower
saudization and development ).
FINANCE : government
Organization
MINISTRY OF HEALTH BUDGET
YEAR
BUDGET
BILLION
SAR
SALARIES %
OPERATION
AND
MAINTENANC
E
PROJECTS
1999/2000
12.8
51.4%
46.1
2.5
2000/2001
13.8
52.8
42.3
4.9
-
-
-
-
2001/2002
2002/2003
Organization
MINISTRY OF HEALTH BUDGET
Organization
HEALTH MANPOWER
Problems : mostly expatriate( non Saudis ) , gross maldistribution of Saudi manpower ( mostly in big cities
and in hospitals)
Measures to solve manpower problem : Manpower
Council Deputy Minister for Planning and Development
ADM for health Manpower Development
Organization
sector
Physician
Nurses
Hospitals
MOH
49%
55.5%
60.8%
Other govt
22.8%
25.8%
20.0%
Private
28.2%
18.7%
19.2%
1993
10.4
22.8
27.0
1998
17.1
33.4
23.3
Per 1000 population
Public Health Care System
Key organizational changes over last 5 years in the
public system, and consequences:
There are 13 health regions, each led by a Regional
Director General for Health Services, who is directly
responsible to the Deputy Minister of Health for
Executive Affairs and Deputy Minister for Planning and
development.
Each health regional general directorate supervises one
or more of health provinces through provincial health
directorate.
Each provincial health directorate supervises and
manages at least one general hospital and a number of
health centers, and supervises private health sector.
Public Health Care System
The policies, plans and programs of the MOH are
implemented through this structure.
The health directorates are reasonably autonomous in
terms of staff recruitment and welfare, training,
discipline, supervision and evaluation.
However, some responsibilities are shared with the
MOH when necessary.
Public Health Care System
Each region has a dental centre that acts as a referral
centre for the dental clinics attached to the health
centers and hospitals.
There are medical rehabilitation centers for speech and
hearing therapy, accident injury repair and
physiotherapy.
there is at least one anti-smoking clinic in each health
directorate for counseling, health education and
rehabilitation.
Public Health Care System
Under ‘other government’ sectors are grouped the
health facilities of the military, National Guard,
universities (and affiliated teaching hospitals), large
multinational corporations such as Saudi Aramco oil
company, and a number of specialist hospitals.
The ‘other government’ facilities carry out similar
functions to those of the MOH with respect to
ambulatory care and inpatient care.
Public Health Care System
Planned organizational reforms in the public system:
1. Administrative reforms including restructuring the MOH
organization structure, policies procedure, and
regulations.
2. Implementation of the Saudi Health System.
3. Implementation of the cooperative health insurance
system.
4.The Primary Health Care strengthening and expansion
5. Strengthening quality assurance in health care.
6. Privatization and corporatization of some of MOH
hospital.
Levels of health care
Primary health care : Secondary health care : Tertiary health
care :
First contact of persons with the health system" This is
usually in PHC units found near residence or work
Secondary health care is referral care from PHC This takes
place in hospitals Tertiary health care is specialized /
rehabilitation care .
ALMA ATA CONFERENCE :PHC is essential heath care made
universally accessible to individuals and families through
their full participation , by means acceptable to them at a
cost that the country can afford and it forms an integral part
of the national health system of which it is the nucleus and
of the overall social and economic development"
Levels of health care
ORGANIZED BY W.H.O. AND U.N.C.E.F. IN 1978 IN ALMA
ATA IN KAZAKHASTAN SOLOGAN " HEALTH FOR ALL BY
YEAR 2000" HFA/2000 .
COMPONENTS :
1- food/ nutrition
2- Basic sanitation / Water supply
3- Health promotion
4- Maternal and child health care
5- Control of common diseases
6- Immunization
7- Treatment of common diseases and injuries
8- Provision of essential drugs
Levels of health care
“The promotion and protection of the health of
the people is essential to sustained economic and
social development and contributes to a better
quality of life and to world peace.
• Governments have a responsibility for the health of
their people.
• Primary health care is the key to attaining this
target as part of development in the spirit of social
justice.”
Levels of health care
IMPORTANCE OF PHC :
1. solves majority of health problems
2. - cheap
3. - convenient . near home or work suitable working
hours
4. - family record / socioeconomic data
5. - hospitals will concentrate on secondary care
Levels of health care
MINIMUM
GLOBAL
INDICATORS
FOR
PHC
PROGRAMMES: These are the minimum requirements
for successful PHC programme)
HFA received endorsement (approval) as policy by
highest official level.( KING, PRESIDENT, COUNCIL OF
MINISTERS)
Formation, strengthening and actually functioning
mechanisms for involving people in implementation of
strategies ( PHC friendship societies and committees)
At least 5 % of GNP (general national production) is
spent on health
Levels of health care
A reasonable amount of the GNP is spent on primary
health care.
Resources are Equitably Distributed .( ACCORDING TO
NEEDS)
PHC is available to the whole population with at least
within 15 minutes walking distance
Adequate Sanitary Facilities ( refuse collection and disposal
) in home or vicinity ( near home )
Immunization with DPT , MMR , BCG
Primary Health Care (PHC) with at least 20 drugs within
one hour walk.
Levels of health care
Trained Attendants (Midwives) for pregnancy, delivery,
infants health.
Adequate Nutritional Status of Children: - At Least 90 %
newborns have birth weight of 2.5 kg + and 90 % of
children have within normal weight for age.
Infant Mortality Rate Not Exceeding 50 / 1000 live
births.
Life Expectancy at birth Not Less than 60 years.
Private Health Care System
Modern, for-profit: The private health sector includes
private hospitals, clinics, dispensaries and pharmacies. The
facilities are mostly located in urban centers. The private
sector has grown rapidly in recent years. Health services
vary from basic medical care to highly organized specialist
services.
Traditional: There is a recently established traditional
medicine department in MOH to supervise and control
traditional medicine in the market.
Key changes in private sector organization: MOH fully
cooperates, and coordinates with the private health sector,
either directly or through the medical units in chambers of
commerce and industry in the kingdom.
Private Health Care System
Public/private interactions (Institutional),
Participation in joint committees.
Plays a major role in cooperative health insurance
system.
Privatization and corporatization projects.
Public/private interactions (Individual),
Under-development.
Finance and regulations of health
care system in Saudi Arabia
Contents
Health care financing
Health insurance governance principles
Types of insurance in Saudi Arabia
Council of Co-operative Health insurance Financing
Strategies for Health Industry Development Policy
Health care funding and subsidy
Health Regulators
Finance and regulations of health care
system in Saudi Arabia
Saudi citizens comprise around 68.9% of the total
population; 50.2% are males and 49.8% females.
67.1% of the population are under the age of 30 years
and about 37.2% are under 15 years;
The population over the age of 60 years is estimated at
5.2%
According to United Nation projections, it is estimated
that the population of Saudi Arabia will reach 39.8
million by 2025 and 54.7 million by 2050.
This is a natural outcome of the high birth rate (23.7 per
1000 population), increased life expectancy (72.5 years
for men, 74.7 years for women).
Finance and regulations of health care
system in Saudi Arabia
Health care financing
In Saudi Arabia, the health service is in general publicly
funded
The percentage of GDP spent on health was 3.4% in
2005. In the same year the percentage of private GDP
spent on health was 0.8%
The government expenditure on health as a percentage
of total expenditure on health was 76.2, and private
expenditure was therefore 23.8.
This is higher than the percentage of GDP spent on
health in the neighbouring country of the United Arab
Emirates, where public expenditure was 2% of GDP and
private expenditure was 0.9% of GDP
Finance and regulations of health care
system in Saudi Arabia
Health care financing
This can be compared with other public expenditure
within Saudi Arabia, in order to get an insight into the
priorities of the government.
There has been an improvement over the years, and it is
hoped that the government continues to move in the
same direction
Saudi Arabia could greatly improve its health system by
investing more money in this sector.
Despite the disproportionate expenditure on health, the
government appears to have a fairly positive health care
strategy, and looks to be constantly improving its health
system.
Finance and regulations of health care
system in Saudi Arabia
Health care financing
The Health System is monitored and improved by the
Ministry of Health, and the progress made in this area, as
well as other socio-economic factors has been vast over
the past thirty years.
Despite the progress already made there are still many
further developments required which will become
apparent as the system is explored further.
Finance and regulations of health care
system in Saudi Arabia
Availability, accessibility, acceptability and quality
The ‘AAAQ’ is an element that is enshrined in General
Comment 14 on the highest attainable standard of health.
The concepts of ‘availability, accessibility, acceptability
and quality’ are used to tell whether the highest attainable
standard of health is being reached
Availability. Functioning public health and health care
facilities, goods and services, as well as programmes in
sufficient quantity
Finance and regulations of health care
system in Saudi Arabia
Accessibility covers a wide range of aspects, and as a
result has four over lapping dimensions; affordability,
information accessibility, physical accessibility, and non–
discrimination of health services.
1. Affordability
Historically, the health system was publicly funded by the
government.
Finance and regulations of health care
system in Saudi Arabia
Affordability
However, providing free medical care to all was
beginning to place a great financial burden on the state, as
there is no tax system.
In order to improve the situation the Shoura Council
passed a law in 2004 to implement mandatory health
insurance for all foreign workers in the Kingdom.
The law is to be implemented in a three-phase .The first
phase covers all foreign workers working in large
companies, and the second covers workers in small
establishments. Both these phases have now been
implemented.
Finance and regulations of health care
system in Saudi Arabia
The third phase will cover all remaining foreign workers
2. Information accessibility
Another aspect of the ‘AAAQ’ that Saudi Arabia is
having problems meeting is a feature of the concept of
accessibility: the so-called ‘information accessibility’.
WHO believes the country needs to establish an efficient
National Health Information System (NHIS)
Finance and regulations of health care
system in Saudi Arabia
3. Physical accessibility
A further concern is the physical accessibility of health
care.
It is recommended that primary health care centres
should be appropriately situated throughout a country
and a citizen should not live more than one hour away
from their closest medical centre.
Saudi Arabia is a member of the Gulf Council
Cooperation – “2009 for primary health care
promotion”, and has implemented a family practice
residency programme, to integrate care at primary health
centres.
Finance and regulations of health care
system in Saudi Arabia
Acceptability: All health facilities, goods and
services must be respectful of medical ethics and
culturally appropriate, as well as sensitive to
gender and life-cycle requirements.
•Quality: Health facilities, goods and services must
be scientifically and medically appropriate and of
good quality.
Finance and regulations of health care
system in Saudi Arabia
Types of insurance in Saudi Arabia
Property and casualty 34%
Aviation
Marine
Medical Malpractice
Car 34%
Health 32%
Finance and regulations of health care
system in Saudi Arabia
Council of Co-operative Health insurance Financing
The Council of Cooperative Health Insurance (CCHI) is
working to educate the private sector about the benefits
of health insurance.
The after-effects of the recession, which has negatively
affected most of the world, have had less of an impact on
Saudi Arabia’s insurance industry, which has been
thriving over the past few years
Health insurance is leading as one of the fastest growing
segments in the country’s insurance sector, becoming a
key growth driver for the overall market
Finance and regulations of health care
system in Saudi Arabia
Council of Co-operative Health insurance Financing
There has been much interest in investing in Saudi
Arabia’s private medical care since the Cooperative
Health Insurance Act in 1999.
This act has provided medical insurance to all private
sector workers within Saudi Arabia, successfully insuring
over 8.6 million Saudi and expatriate employees and
their families to date.
There are many benefits of insurance for both workers
and the insurance industry. Due to the surge in the
number of insured workers, insurance companies have
advanced their products and services to serve the target
market.
Finance and regulations of health care
system in Saudi Arabia
Council of Co-operative Health insurance Financing
The role of the Council of Co-operative Health insurance
is to work towards educating the private sector about the
many benefits health insurance has for their
workers. The CCHI certifies 26 insurance firms, five
third-party administration companies, and over 2400
healthcare providers.
There is a big future of growth for private medical care in
Saudi Arabia, with supporting factors such as low
penetration, strong governmental support, and rising
awareness of insurance.
Finance and regulations of health care
system in Saudi Arabia
Strategies for Health Industry Development Policy
•
Establishment of National health Related References
Saudi Food and Drug Authority
Saudi Commission of Health Specialties
Council of Co-operative Health Insurance
National Center for Health care Quality and Accreditation
The National Health Council
•
Involve Direct and Indirect Health Industry Stake Holders
• Major Health Providers
• Private Sector
• Ministry of civil service, labor, Finance etc.
•
Staging of Health industry Policy Development
Finance and regulations of health care
system in Saudi Arabia
Health Regulators
• The National Organizations:
The National Health Council
The Saudi Food and Drug Authority
Council of Co-operative Health Insurance
The Saudi Commission for Health Specialties
Ministry of health
Finance and regulations of health care
system in Saudi Arabia
The National Health Council
Most important achievements of the Committee during
the last period were :
1. Contribute to raise loans to the hospitals (200) million.
2. Participate in the amendment of the Regulations of the
health system to meet with Undersecretary of the
Ministry of Health for Executive Affairs.
And hopefully more regulations and effort will be made in
the process of Saudi health care development.
Finance and regulations of health care
system in Saudi Arabia
The Saudi Food and Drug Authority
The Saudi Food and Drug Authority (SFDA) was
established under the Council of Ministers resolution no
(1) dated 07/01/1424 H, as an independent body
corporate that directly reports to The President of
Council of Ministers
The main purpose of the SFDA establishment is to
regulate, oversee, and control food, drug, medical
devices, as well as to set mandatory standard
specifications thereof, whether they are imported or
locally manufactured.
The control and/or testing activities can be conducted in
the SFDA or other agency's laboratories
Finance and regulations of health care
system in Saudi Arabia
The Saudi Food and Drug Authority
The main objectives of SFDA can be outlined as follows:
1. Observe the safety, security, and effectiveness of food
and drug for humans and animal.
2. Observe the safety of complementary biological and
chemical substances, cosmetics and pesticides.
3. Observe the safety of medical devices and its impact on
public health.
4. Ensure accuracy and safety of medical and diagnostic
devices.
Finance and regulations of health care
system in Saudi Arabia
The Saudi Food and Drug Authority
5. Launch clear policies and procedures for food and drug,
and plan to achieve and implement these policies.
6. Control and supervise licenses procedures for food,
drugs and medical devices factories.
7. Conduct research and applied studies to identify health
problems, their causes, determine its impact on public,
with the consideration of methods for research / studies
evaluation.
8. Disseminate and exchange information with local and
international scientific and legal agencies, and setting up a
database for food and drug.
Finance and regulations of health care
system in Saudi Arabia
Council of Co-operative Health Insurance
Funding health care services is a central challenge faced
by the government.
To meet the growing population demands for health care
and to ensure the quality of services provided, the
Council for Cooperative Health Insurance was
established by the government in 1999.
The main role of this Council is to introduce, regulate
and supervise a health insurance strategy for the Saudi
health care market
Finance and regulations of health care
system in Saudi Arabia
The Saudi Commission for Health Specialties
Saudi Commission for Health Specialties (SCHS) is body
corporate scientific commission aims at development of
professional performance and encouraging skills and
enriching scientific intellect and suitable practical
application in the field of various health specialties. It was
established under the Royal Decree No. M/2 dated
6/2/1413H
In compliance to (SCHS) objectives, it has undertaken
the following:
1. To set up professional health specialist programs and
approving and supervising the same.
Finance and regulations of health care
system in Saudi Arabia
The Saudi Commission for Health Specialties
2. And to set up programs for ongoing medical education in
health specialties within the frame of general policy of
education
3. To form health scientific boards and sub-committees
required for performing work and supervising and
approving recommendations thereof.
4. To recognize health institutions for the purpose of
training and specializing after evaluating the same.
5. To supervise specialist examinations and approve results
thereof through specialist scientific committees and
boards
Finance and regulations of health care
system in Saudi Arabia
The Saudi Commission for Health Specialties
6. To issue professional certificates such as Diploma, Fellowship,
and Membership either the examination conducted by it
directly or through collaboration with it.
7. To coordinate with professional health boards, commissions,
societies and colleges inside and outside the Kingdom.
8. To evaluate and equalize health certificates.
9. To encourage preparing researches and publishing scientific
articles in the field of specialty and issuance of journals or
periodicals.
10. Participation in proposing general plans of preparing and
development of manpower in health fields.
Finance and regulations of health care
system in Saudi Arabia
The Saudi Commission for Health Specialties
11. To organize forums and press conferences for discussing
internal health problems and proposing suitable solutions and
following up implementation of recommendations and
resolutions issued in relation thereto.
12. To set up principles and standards including ethics for
practicing health professions.
13. To encourage preparing health scientific researches and
proposing subjects and supporting such researches and
financing the same either in whole or part.
14. To give approval to establishing scientific societies for health
specialties.
Finance and regulations of health care
system in Saudi Arabia
Ministry of health
Ministry of health is the responsible for health care system in
Saudi Arabia .
Currently the MOH is the major government provider and
financer of health care services in Saudi Arabia, with a total of
244 hospitals (33 277 beds) and 2037 primary health care .
The MOH is responsible for managing, planning and
formulating health policies and supervising health
programmes, as well as monitoring health services in the
private sector.
It is also responsible for advising other government agencies
and the private sector on ways to achieve the government’s
health objectives
Finance and regulations of health care
system in Saudi Arabia
Ministry of health
The MOH supervises 20 regional directorates-general of
health affairs in various parts of the country.
Each regional health directorate has a number of
hospitals and health sectors and every health sector
supervises a number of PHC centres.
The role of these 20 directorates includes implementing
the policies, plans and programmes of the MOH;
managing and supporting MOH health services;
supervising and organizing private sector services;
coordinating with other government agencies
The role of insurance and private sector in
health care system in Saudi Arabia
Contents
Country Facts and Current Health System
Health insurance in Saudi Arabia
Staging of Health Insurance
Types of Insurance In Saudi market:
Key Players of health care in Saudi Arabia
Budget Allocations
Sector Overview
Key Stakeholders view points
The role of insurance and private sector in health
care system in Saudi Arabia
Country Facts and Current Health System
KSA has the largest and fastest growing population in the
GCC.
The last official census in 2010 placed the population of
Saudi Arabia at 27.1 million, compared with 22.6 million
in 2004.
The annual population growth rate for 2004 to 2010 was
3.2% per annum.
Fertility rate was 3.04
The role of insurance and private sector in health
care system in Saudi Arabia
The role of insurance and private sector in health
care system in Saudi Arabia
Saudi citizens comprise around 68.9% of the total
population; 50.2% are males and 49.8% females.
67.1% of the population are under the age of 30 years
and about 37.2% are under 15 years; the population over
the age of 60 years is estimated at 5.2%
According to United Nation projections, it is estimated
that the population of Saudi Arabia will reach 39.8
million by 2025 and 54.7 million by 2050.
This is a natural outcome of the high birth rate (23.7 per
1000 population), increased life expectancy (72.5 years
for men, 74.7 years for women)
The role of insurance and private sector in health
care system in Saudi Arabia
Current Health System:
The Healthcare sector in the Kingdom of Saudi Arabia is
primarily managed by the Government through the
Ministry of Health (MOH) and number of semi public
organization who specifically operate hospitals and
medical services for their employees.
In addition, private sector operators are also playing a key
role in providing quality healthcare services in the
Kingdom.
The role of insurance and private sector in health
care system in Saudi Arabia
Current Health System:
KSA
WHO Data 2013
General Government Health Expenditure (GGHE) as
% of Gross Domestic Product (GDP)
2
General Government Health Expenditure (GGHE) as % of
General government expenditure (GGE)
5
General Government Health Expenditure (GGHE) as
% of Total Health Expenditure
64
Out of Pocket Expenditure (OOPS) as % of Private
Health Expenditure (PvtHE)
55
Out of Pocket Expenditure (OOPS) as % of Total
Health Expenditure (THE)
20
Private Health Expenditure (PvtHE) as % of Total
Health Expenditure (THE)
36
Private Insurance as % of Private Health Expenditure
22
WHO Data 2013
The role of insurance and private sector in health
care system in Saudi Arabia
Main Health Providers:
Health Facilities
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia :
Funding health care services is a central challenge faced
by the MOH.
Since the total expenditure on public health services
comes from the government and the services are free-ofcharge.
This lead to considerable cost pressure on the
government, particularly in view of the rapid growth in
the population, the high price of new technology and the
growing awareness about health and disease among the
community.
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia :
To meet the growing population demands for health care
and to ensure the quality of services provided, the
Council for Cooperative Health Insurance was
established by the government in 1999.
The main role of this Council is to introduce, regulate
and supervise a health insurance strategy for the Saudi
health care market.
The implementation of a cooperative health insurance
scheme was planned over 3 stages
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
In the first stage, the cooperative health insurance was
applied for non-Saudis and Saudis in the private sector,
in which their employers have to pay for health cover
costs.
In the second stage, the cooperative health insurance is to
be applied for Saudis and non-Saudis working in the
government sector.
The government will pay the cooperative health
insurance costs for this category of employee.
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
In the final stage, the cooperative health insurance will be
applied to other groups, such as pilgrims.
Only the first stage has been implemented to date, with
the cooperative health insurance being implemented
gradually in a 3-phase programme to employees of the
private sector and their dependants.
The first phase covered companies with 500 or more
employees, while the second phase applied to employers
with more than 100workers
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
The third phase included employees of all companies in
Saudi Arabia as well as domestic workers.
The government is now working systematically to apply
the remaining 2 stages—for employees in the government
sector and for pilgrims— before they privatize the stateowned health care facilities
While the market for cooperative health insurance in
Saudi Arabia started with only one company in 2004.
It currently involves about 25 companies
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
The introduction of the scheme is intended to decrease
the financial burden on Saudi Arabia due to the costs
associated with providing health services free-of-charge.
It will also give people more opportunity to choose the
health services they require.
No information is available yet regarding the cooperative
health insurance scheme for the population of Saudi
Arabia other than employees and expatriates.
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
Backed by new regulations, the health insurance market
in Saudi Arabia is expected to experience a healthy
growth rate. Health insurance Gross Written Premium
(GWP) stood at around SAR 8.7 Billion (US$ 2.35
Billion) in 2010. It is expected to reach SAR 21.1 Billion
(US$ 5.70 Billion) by the end of 2015, growing at a
CAGR of around 19% during 2011-2015.
In terms of health insurance premiums, the market is
dominated by three companies: Tawuniya (22%),
Medgulf (19%) and Bupa (22%) who are estimated to
capture 63% of the total Gross Written Premium.
The role of insurance and private sector in health
care system in Saudi Arabia
Health insurance in Saudi Arabia:
This indicates a potential threat to healthcare providers,
i.e. it restricts their bargaining
power to set discount levels with the insurance
companies.
Concurrently this provides an opportunity to healthcare
providers to reduce administration costs rather than
having to deal with a myriad of differing forms and
administration systems from a large number of insurance
companies.
The role of insurance and private sector in health
care system in Saudi Arabia
Staging of Health Insurance:
Co-operative Health Insurance for non-Saudis
and
Saudis in Private Sector
National Health Insurance System for Saudis
And
Non-Saudis in the Governmental Sector
Other Groups e.g. Religious visitors
The role of insurance and private sector in health
care system in Saudi Arabia
Types of Insurance In Saudi market:
Property and casualty 34%
Aviation
Marine
Medical Malpractice
Car 34%
Health 32%
The role of insurance and private sector in health
care system in Saudi Arabia
Key Players of health care in Saudi Arabia:
Ministry of Health (“MOH”):Approximately 60% of all
hospitals within the Kingdom are owned and operated by
the MOH.
These hospitals provide basic healthcare services, as well
as, in certain cases, specialized facility centres.
MOH facilities are increasingly being made available
mostly to Saudi Nationals only with accessibility to
expatriates in majority of cases restricted to specialized
treatments except in rural areas where private sector
facilities are not present.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Players of health care in Saudi Arabia:
Other Governmental Organizations: Health treatment in
other government and quasi organizations is effectively
free for employees, typical organizations would include
The National Guard, Ministries of Defence and Aviation
and the Royal Commission.
Private Sector: Historically most of the outpatient
treatments were provided by the private sector. However,
increasingly inpatient treatments are also being provided
by the private sector due to the high demand and the
restrictions placed on entry to MOH facilities.
The role of insurance and private sector in health
care system in Saudi Arabia
Budget Allocations:
Between 2005 and 2008 Saudi Arabia allocated
approximately SAR 23.5 billion per annum with a
cumulative amount of SAR 94 billion investment in the
healthcare sector.
However, in 2010 and 2011 there was a substantial
increase in the healthcare budget which increased from
SAR 30 billion (6.3% of total Government Budget) in
2008 to SAR 52 billion in 2009 (11% of total
Government Budget) and to SAR 61.2 billion in 2010
(11.3% of total Government Budget).
The role of insurance and private sector in health
care system in Saudi Arabia
Budget Allocations:
The budget allocation was further increased to SAR 68.7
billion (11.8% of total Government Budget) in 2011, a
cumulative allocation of SAR 113 billion in last two years
compared to SAR 94 billion in the previous four years.
In order to maintain the network of healthcare facilities,
the Saudi Government has implemented a two tier health
service plan; Tier 1 includes a network of primary
healthcare centres and clinics established throughout the
Kingdom. These clinics and centres are backed by a
network of secondary care hospitals and specialized
treatment facilities.
The role of insurance and private sector in health
care system in Saudi Arabia
Budget Allocations:
(Tier 2) located mainly in major urban areas across the
country.
Moreover, comparing the healthcare indicators of Saudi
Arabia to other developed countries such as the US, UK
and Germany demonstrates there is a shortage of
doctors, nurses and beds in Saudi Arabia. The shortage is
prevalent across all GCC countries, however, Saudi
Arabia has the lowest number of beds, nurses and
doctors per population within the GCC.
The role of insurance and private sector in health
care system in Saudi Arabia
Sector Overview:
There are currently over 369 hospitals, both within the
public and private sectors provide various healthcare
facilities and treatment throughout the Kingdom. In
2009, the total number of doctors and nurses was
approximately 62,805 with over 20% employed at
hospitals in Riyadh.
Bed Capacity: Total number of beds at MOH hospitals
increased from 28,751 in 2002 to 33,277 in 2008 while
the private sector and quasi government hospitals bed
capacity increased from 10,133 and 10,300 in 2002 to
11,822 and 10,833 respectively for the same period.
The role of insurance and private sector in health
care system in Saudi Arabia
Sector Overview:
The gradual increase in private hospital beds is also due
to influx of expatriate patients seeking medical treatment
who previously had access to MOH hospitals.
total number of hospital beds in Saudi Arabia increased
from 49,148 in 2002 to 55,932 beds in 2008, an increase
of 13.7% over the six year period and the total number of
hospitals increased from 350 in 2002 to 408 in 2008, an
increase of 16.6% during the same period.
The bed capacity at MOH hospitals is by far the largest,
accounting for 59% of cumulative hospital bed supply in
Saudi Arabia.
The role of insurance and private sector in health
care system in Saudi Arabia
Sector Overview:
inpatients and Outpatients: The number of outpatients is
considerably higher than in-patients. This is in line with
the nature of outpatient treatments which are less than a
day long with a high percentage of cases consisting only of
consultations.
On average residents of KSA visit healthcare facilities five
times a year, from which 31% are to Private sector
facilities.
The role of insurance and private sector in health
care system in Saudi Arabia
Sector Overview:
Keeping abreast of the increasing healthcare demands
and the limited supply of hospitals & specialized
treatments, the Ministry of Health in Saudi Arabia has
embarked on ambitious plans to establish 195 healthcare
projects including thirty-three new hospitals with five
hospitals having a bed capacity of over 500 beds.
These five hospitals are expected to be constructed in
East Riyadh, North Jeddah, Makkah, Balijurashi and
Tabuk.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
Extracted and combined from questionnaires and
interviews the following represents the views of key
stakeholders (investors and operators) in Saudi Arabia
relating to the healthcare sector.
Market Structure: The current healthcare sector is
dominated by insurance companies (25 companies listed
on the Saudi Stock Exchange) and is hence driven by cost
versus quality. Unless a set regulation is introduced to
monitor pricing, healthcare access and quality of care in
private hospitals will continue to face lower profit margins
and collection delays which will result in lower quality of
care.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
Shortage of Hospital Beds: The present shortage of beds
which is growing with time, can be overcome by funding
from the public sector to establish new hospitals both in
public and private sectors, as well as, improving and
expanding existing facilities.
Lifestyle related Disease: There is a tremendous increase
in lifestyle related diseases such as diabetes, hypertension,
obesity, heart and kidney Presently, the private sector
plays an important the role in providing care for these
diseases.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
However, government needs to take an active role in
prevention through educating people and offering
preventive services.
Shortage of Healthcare resources: One of the major costs
for healthcare providers is spending on qualified medical
staff. A large number of doctors, nurses, pharmacists and
paramedical staff in KSA migrate to Western Countries
after a few years due to better opportunities and training
facilities.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
In addition, the current Saudi regulations for recruitment
and Saudization continue to further increase the staff cost
due to limited available resources. Government role is
extremely important in establishing career-focused
educational institutions (such as medical, pharmacy and
nursing colleges) to increase the supply of local medical
professionals and to drive qualified Saudi talent into jobs.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
Competition from Public Sector Hospitals: Public Sector
Hospitals are not cost driven and therefore provide
quality healthcare services to the population either free or
at subsidized rates. However, with the current population
growth, access has been a major issue in public sector
hospitals.
This shortage has resulted in an increase in demand for
private healthcare facilities. With increased healthcare
costs and emergence of lifestyle related diseases, public
and private players should form partnerships to create
better provision of care.
The role of insurance and private sector in health
care system in Saudi Arabia
Key Stakeholders view points:
implementation of “best practice”: Implementation of
Information Technology should have greater prevalence
in the sector similar to other developed countries in
which medical files for patients are either unified or
centrally maintained. Improvement in unified or
centralized filing is expected to improve diagnosis and
provision of healthcare services.
Private hospitals will continue to play an even more
important and crucial role within the Kingdom..
The role of insurance and private sector in health
care system in Saudi Arabia
The delivery of healthcare in the Kingdom and around
the world continues to evolve as the needs of healthcare
provider become increasingly complex.
Trends and industry changes requires investors and
operators of healthcare facilities to make challenging
decisions.
Despite improvements in healthcare systems across the
Kingdom, the healthcare sector still offers significant
opportunities for investors / operators.
We believe that due to strong growth fundamentals
coupled with the increasing population and regulatory
changes the sector is expected to experience robust
growth in the foreseeable future .
Medication use and distribution systems in
Saudi Arabia
List of contents
Introduction to medicines
definition of drugs
Use of medications in Saudi Arabia
Drug Distribution Models
Drug distribution systems
(i)Individual Prescription Order System.
(ii) Complete Floor Stock System
(iii)Combination of (i) and (ii).
(iv) The unit dose method.
Introduction to medicines
A medication or medicine is a drug taken to cure and/or
ameliorate any symptoms of an illness or medical
condition, or may be used as preventive medicine that
has future benefits but does not treat any existing or
pre-existing diseases or symptoms.
Dispensing
of medication is often regulated
by government into three categories.
over-the-counter- (OTC)
behind-the-counter-(BTC)
prescription only medicine (POM)
Introduction to medicines
Over-the-counter (OTC) drugs are medicines that may
be sold directly to a consumer without a
prescription from a healthcare professional .
As compared to prescription drugs , which may be sold
only to consumers possessing a valid prescription.
in many countries, OTC drugs are selected by
a regulatory agencies
to ensure that they are
ingredients that are safe and effective when used
without a physicians 's care.
Introduction to medicines
Behind-the-counter (BTC)drugs : which are dispensed
by a pharmacist without needing a doctor's
prescription.
prescription medication: A prescription medication is
a licensed medicine that is regulated by legislation to
require a medical prescription before it can be
obtained.
Medications are typically produced by pharmaceutical
companies and are often patented to give the
developer exclusive rights to produce them, but they
can also be derived from naturally occurring substance
in plants called herbal medicines .
Definition of drugs
A drug, broadly speaking, is any substance that, when
absorbed into the body of a living organism, alters
normal bodily function.
In pharmacology a drug is "a chemical substance used
in the treatment, cure, prevention, or diagnosis of
disease or used to otherwise enhance physical or
mental well-being.
According to Federal Food, Drug, and cosmetic
Act definition of "drug" includes "articles intended for
use in the diagnosis, cure, mitigation, treatment, or
prevention of disease in man or other animals
Use of medication in Saudi Arabia
Drugs are the fastest rising cost in the health care system. All
developed nations are seeking ways to cut down the budgets
allocated for buying drugs.
In Saudi Arabia and other countries, the cost of maintaining
the health care system is escalating out of control.
Governments, health care providers and consumers have to
find ways to reduce these escalating costs while maintaining
the quality of care that these countries have grown to
expect.
Two contributing factors to the increased costs of medicines
are the marketing costs for pharmaceutical firms and the
expenses incurred in the development of new drug
products
Among the major reason behind the increased
expenditure on medication is medication waste which is
an unnecessary burden on an already fiscally restrained
health care system in these countries.
Medication wastage is defined as any drug product,
either dispensed by a prescription or purchased over
Use of medication in Saudi Arabia
the counter (OTC), that is never fully consumed.
Medication wastage may be due to poor compliance
of patients, excessive and irrational prescribing, 6or
the lack of control of the sales of prescription
medications in the community pharmacy.
Use of medication in Saudi Arabia
The problem of wastage is almost universal. In Great
Britain, the scale of the problem of wastage is
enormous, research suggests that as many as 50% of
the patients fail to comply with the terms of their
prescription.
A survey of 111 households was performed in England
to determine the quantity and types of medicines in the
homes and to investigate the incidence of double
prescribing, wastage and hoarding.
Use of medication in Saudi Arabia
The investigators found that 51% of the medicines were
not in current use by the patients and of those 40%
were considered out of date.
In Canada, two studies have sorted through piles of
discarded medications seeking reasons why the waste
of drugs is of "mammoth proportions“.
The top medicines wasted regarding their dollar value
were antihypertensive drugs followed by analgesics and
anti-inflammatory drugs.
Drug distribution system
Traditional methods of distributing drugs in hospitals
are now undergoing reevaluation, and considerable
thought and activity is being directed toward the
development of new and improved drug distribution
systems.
Drug distribution system is a Manner in which
medications are provided from the pharmacy to the
clinical unit
It Includes the period of time from when the drug is
“dispensed” until it is “administered”
Drug Distribution Models
Centralized
Floor Stock
Cart Fill
Nurse Servers
Decentralized
Satellite Services
Automated
Dispensing
Cabinets
Hybrid
Current Models for
Medication Distribution
Drug distribution system
Some of the newer concepts and ideas in connection
with hospital drug distribution systems are centralized
or decentralized (single, or unit-dose) dispending,
automated (mechanical and/or electronic) processing of
medication orders and inventory control, and
automated (mechanical and/or electronic) storage and
delivery devices.
There are four systems in general use for dispensing
drugs for inpatients. They may be classified as follows:
(i) Individual Prescription Order System.
(ii) Complete Floor Stock System.
Drug distribution system
(iii) Combination of (i) and (ii).
(iv) The unit dose method.
Individual prescription order system:
This system is generally used by the small and/or
private hospital because of the reduced manpower
requirement and the desirability for individualized
service.
Inherent in this system is the possible delay in obtaining
the required medication and the increase in cost to the
patient.
Drug distribution system
Advantages of this system:
(i) All medication orders are directly reviewed by the
pharmacist.
(ii) Provides for the interaction of pharmacist, doctor,
nurse and patient.
(iii) Provides closer control of inventory.
Complete floor stock system:
Under this system, the nursing station pharmacy carries
both “charge” and “non-charge” patient medications.
Rarely used or particularly expensive drugs are omitted
from floor stock but are dispensed upon the receipt of
a prescription or medication order for the individual
patient.
Drug distribution system
Although this system is used most often in
governmental and other hospitals in which charges are
not made to the patient or when the all inclusive rate is
used for charging, it does have applicability to the
general hospital.
Advantages of Complete floor stock system:
(i) Ready availability of the required drugs.
(ii) Elimination of drug returns.
(iii) Reduction in the number of drug order transcriptions
for the pharmacy.
(iv) Reduction in the number of pharmacy personnel
required.
Floor Stock Medications
Drug distribution system
Disadvantages of Complete floor stock system:
(i) Medication errors may increase because the review of
medication orders is eliminated.
(ii) Increased drug inventory on the pavilions.
(iii) Greater opportunity for pilferage.
(iv) Increased hazards associated with drug deterioration.
(v) Lack of proper storage facilities on the ward may
require capital outlay to provide them.
(vi) Greater inroads are made upon the nurse's time.
Drug distribution system
complete floor stock system is successfully operated as
a decentralized pharmacy under the direct supervision
of a pharmacist.
Charge floor stock drugs and non-charge floor stock
drugs:
Each pavilion in the hospital, regardless of its size or
specialty care, has a supply of drugs stored in the
medicine cabinet even though the nursing unit is
serviced by a unit dose system.
However, the use of floor stock medications should be
minimized.
Drug distribution system
in addition, research has shown that the system of drug
distribution has an effect upon the incidence of
adverse drug reactions.
These medications may be classified under two
separate headings, each of which serves a specific
purpose.
Drugs on the nursing station may be divided into
“charge floor stock drugs” and “non-charge floor stock
drugs”
Charge floor stock drugs may be defined as those
medications that are stocked on the nursing station.
Drug distribution system
Charge floor stock drugs
represent that group of
medications that are placed at the nursing station.
It is the responsibility of the hospital pharmacist, working in
cooperation with the nursing service, to develop ways and
means whereby adequate supplies of each are always on
hand and, in appropriate situation that proper charges are
made to the patients account.
Combination of Individual prescription order system and
complete floor stock system:
Falling into this category are those hospitals which use the
individual prescription or medication order system as their
primary means of dispensing, but also utilize a limited floor
stock.
Drug distribution system
This combination system
is probably the most
commonly used in hospitals today and is modified to
include the use of unit dose medications.
Unit dose system:
Unit-dose medications have been defined as:
“Those medications which are ordered, packaged,
handled, administered and charged in multiples of
single dose units containing a predetermined amount
of drugs or supply sufficient for one regular dose
application or use.”
Drug distribution system
Advantages of unit dose system:
1. Patients receive improved pharmaceutical service 24
hours a day and are charged for only those doses,
which are administered to them.
2. All doses of medication required at the nursing station
are prepared by the pharmacy thus allowing the nurse
more time for direct patient care.
3. Allow the pharmacists to interpret or check a copy of
the physician’s original order thus reducing medication
errors.
4. Elimination excessive duplication of orders and paper
work at the nursing station and pharmacy.
Drug distribution system
5. Eliminates credits.
6. Transfers intravenous preparation and drug
reconstitution procedures to the pharmacy.
7. Promotes more efficient utilization of professional and
nonprofessional personnel.
8. Reduces revenue losses.
9. Conserves space in nursing units by eliminating bulky
floor stock.
10. Eliminates pilferage and drug waste
11. Communication of medication orders and delivery
systems are improved.
Drug distribution system
Unit dose dispensing procedure:
The characteristic features of centralized unit-dose
dispending are that all in-patient drugs are dispensed in
unit-doses and all the drugs are stored in a central area
pharmacy and dispensed at the time the dose is due to
be given to the patient.
To operate the system effectively, electronic data
processing equipment is not required, however delivery,
systems such as medication carts and dumbwaiters are
needed to get the unit-doses to the patients; also
suction tube system or other means are required to
send a copy of the physician’s original medication order
to the pharmacy for direct interpretation and filling.
Drug distribution system
The decentralized unit-dose system, unlike the
centralized system, operates through small satellite
pharmacies located on each floor of the hospital.
The main pharmacy in this system becomes a
procurement, storage, manufacturing and packaging
center serving all the satellites.
The delivery system is accomplished by the use of
medication carts. This type of system can be used for a
hospital with separate buildings or old delivery
systems.
Drug distribution system
Although each hospital introduces variations, the following is
a step-by-step outline of the procedure entailed in a
decentralized unit-dose system:
Upon admission to the hospital, the patient is entered into
the system. Diagnosis, allergies and other pertinent data are
entered on to the Patient Profile card.
Direct copies of medication orders are sent to the
pharmacist.
The medications ordered are entered on to the Patient
Profile card.
4-Pharmacist chicks medication order for allergies, drug –
interactions, drug-laboratory test effects and rationale of
therapy.
Accreditation of health care system in Kingdom of
Saudi Arabia
Contents
Introduction
History of Accreditation?
Process of Accreditation
What is Joint Commission International (JCI)
accreditation
Accreditation, Licensure and Certification
The main purposes of accreditation?
Rising interest in accreditation in the KSA
Accreditation system suitable for KSA
Comparison of Accreditation systems
The Canadian system
Contents
Saudi Council for Healthcare Accreditation (SCHA)
Steps for implementation of National Accreditation
Program
List of healthcare accreditation organizations in the
United State
Introduction
Accreditation is a self-assessment and external peer review process
used by healthcare organizations to accurately assess their level of
performance in relation to established standards and to improve
the Healthcare Systems
During the past years, healthcare organizations have been faced
with challenges how to improve safety and quality healthcare
services which they are serve to patients.
The voice for healthcare quality improvements comes from key
stakeholder groups, such as government, Ministry of Health, health
care
insurance fund, healthcare associations, healthcare
professionals, patients and their families, public, etc.
Also, international agencies, World Health Organization (WHO)
Introduction
and World Bank clearly promote improvement of quality and safety
introductionnnnn
of healthcare services
Introduction
Investments and simply adding more resources does not always
achieve the desired improvements in healthcare services
Accreditation standard for hospitals present an attractive
methodology for significant improvements in areas of healthcare
Achieving accreditation standards is very important to improve
quality of healthcare services and processes, ensure a safe
environment, and prevent or reduce risk to patients and staff; it
helps healthcare providers to identify their own organizations
strengths and weaknesses.
History OF Accreditation
The process of accreditation originates from the United States.
The American College of Surgeons set up a program of standards
to define suitable hospitals for surgical training in 1917.
This developed into a multidisciplinary program of standardization
and in 1951 led to the formation of the independent Joint
Commission on Hospital accreditation, now the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO), from
which all subsequent national programs have been directly or
indirectly derived.
To identify national accreditation programs, WHO has undertaken
worldwide survey in late 2000, and findings showed that there are
36 national accredited programs
History OF Accreditation
To promote development and compatibility in world, the
International Society for Quality in Health Care (ISQua) launched
Agenda for Leadership in Programs in Healthcare Accreditation
(ALPHA) in 1999.
ALPHA offers services for healthcare standards and accreditation
bodies: survey and accreditation in accordance with international
standards for national healthcare accreditation bodies and
standards assessment against international principles for national
healthcare .
Accreditation standards are available for different types of
healthcare organization, such as hospitals, clinical laboratories,
homecare, and nursing care, ambulatory care providers, transport
care providers, etc.
History OF Accreditation
These standards are applicable in public healthcare
organization as well as in private healthcare sectors.
Many benefits of accreditation, such as establishment of
uniform polices, procedures and records, measurement
of indicators of performances, management system and
clinical system, etc., attract healthcare decision makers
to adopt this program.
History OF Accreditation
Accreditation is a process in which organization outside
the health care organization, usually non-govenmental,
assesses the organization to determine if it meets a set
of standards designed to improve quality of care .
When accreditation standards are implemented,
healthcare organizations are required to continually
monitor structures, processes, and outcomes, measure
indicators, evaluate, and improve the quality of
healthcare services.
Process of Accreditation
Accreditations bodies are independent, non-profit organizations
with main role to help healthcare organizations to examine and
improve the quality and safety of services they provide to their
patients.
They offer healthcare organizations a voluntary, external peer
review to assess quality by developing standards, assessing
compliance with those standards.
The main stages in process of accreditation including: 1.creation of
team project, 2.choosing a model of standard, 3.training of staff
members, 4.self-assessment, 5.selection of priority 6.improving
areas, and 7.survey visit.
Process of Accreditation
Usually, accreditation process comprises a selfassessment, on site survey carried out by a
multidisciplinary team of healthcare professionals, a
detailed report of findings, and periodic review.
Accreditation is awarded when it has been
demonstrated that a healthcare organization meets
agreed standards. But the accreditation process does
not end with the completion of the on-site survey;
monitoring by accredited body continues during limited
accredited period.
What is Joint Commission International (JCI)
accreditation
JCI is a division of Joint Commission Resources, Inc., a
wholly owned subsidiary of JCAHO. The mission of JCI
is to improve the quality of health care in the
international community through the provision of
worldwide accreditation services.
For more than 75 years, the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) ad
its predecessor organization have been dedicated to
improving the quality of health care services.
Focus of the Accreditation
Strategic Directions
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Strategic Directions
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Accreditation, Licensure and Certification, What Are The
Differences
It is important to understand what the difference is between
licensure, certification and accreditation.
Accreditation :
Public recognition by a national healthcare
accreditation body of the achievement of accreditation standards
by a healthcare organization, demonstrated through an independent
external peer assessment of that organization’s level of
performance in relation to the standards .
Certification Formal recognition of compliance with set standards
(e.g. ISO 9000 series for quality systems) validated by external
evaluation by an authorized auditor.
The Role and Benefits of Accreditation
Licensure : Process by which a government authority
grants permission, usually following inspection against
minimal statutory standards, to an individual
practitioner or healthcare organization to operate or to
engage in an occupation or profession .
As above difference accreditation is much more than
licensure or certification;
it signifies the achievement of high quality service
delivery and a certain level of performance
The Role and Benefits of Accreditation
Accreditation does not only indicate compliance with a
set of minimum standards or regulatory requirements, it
focuses on continuous improvement and achievement
of specific quality goals.
The accreditation (or external peer assessment) of
healthcare facilities is vitally important to the overall
operation of a health system.
It is the backbone of service provision in this sector,
foundational to its credibility and continued quality
improvement
The Role and Benefits of
Accreditation
Accreditation usually provides information on (i) the
structure of hospitals or clinics and the type of services
that are offered at each facility (ii) information is given
on the processes followed at the specific institution, and
(iii) information on the expected outcomes of care is
also supplied in some cases .
Additional positive externalities and purposes of
accreditation include the following:
1. Improve the quality of healthcare by establishing optimal
achievement goals in meeting standards for healthcare
organizations.
The Role and Benefits of Accreditation
2. Stimulate and improve the integration and management
of health services .
3. Establish a comparative database of healthcare
organizations able to meet selected structure, process,
and outcome standards or criteria.
4. Reduce healthcare costs by focusing on increased
efficiency and effectiveness of services .
5. Provide education and consultation to healthcare
organizations, managers, and health professionals on
quality improvement strategies and “best practices” in
healthcare.
The Role and Benefits of Accreditation
6. Strengthen the public’s confidence in the quality of
healthcare; and
7. Reduce risks associated with injury and infections for
patients and staff.
8. Hospitals or clinics may want to be accredited for any
of the above reasons, but also because it increases the
public image and accountability of the facility.
For this reason, accreditation is voluntary in most
countries, but there are a few examples of mandatory
accreditation .
KSA- Main features of the required
Accreditation system
A system that enhances continuous improvement
A system that respects and fit within local culture
A system that enhance Saudi citizen participation
A system that is to be built into the existing working
environment
Comparison of Existing Hospital Accreditation
Organizations
Country
Accrediting Body
Standards Manual
Format
Types of
Standards
Using Step-Wise
Approach
United States
Joint Commission
on the
Accreditation of
Health Care
Organizations
Functional
Outcomes
No
Canada
Canadian Council
on Health
Services
Accreditation
Functional +
Departmental
Structure,
Process, and
Outcomes
Yes
United Kingdom
Health Services
Accreditation
Functional
Structure,
Process, and
Outcomes
No
Australia
Australian
Council on
Healthcare
Standards
Departmental
Structure, &
Process
No
The Canadian system
Canadian and Saudi Health care systems are similar
Many of Saudi medical staff are specialized in Canada
Canadian System is flexible as the organization culture
There is a gradation in standards in accordance with the
current status of the organization
◦ 1992: Structural Standards
◦ 1995: Process Standards
◦ 2000: Outcomes Standards
The Canadian system
CCHSA program is one of the most effective tools to
improve quality of care.
by developing capabilities and systems that ensure
continuous measurement and improvement
◦ Self assessment
◦ Team approach
Canadian council provides a range of Technical
assistance for hospitals.
Cost of accreditation is reasonable in comparison with
others
Current Accreditation in South Africa
Accreditation is completely voluntary in South Africa at the
moment .
The Council for Health Services Accreditation of Southern
Africa (COHSASA) is the only local accreditation
organization .
COHSASA is a non-profit, independent organization which
accredits both private and public facilities .
Healthcare facilities are assessed in terms of the
International Society for Quality in Health Care25 (ISQua)
standards which have been modified for South Africa and
comprise of two sections namely (1) healthcare organization
management, and (2) patient care.
Current Accreditation in South Africa
Some of the private hospitals in South Africa are
accredited by the International Organization for
Standardization (ISO) rather than COHSASA.
ISO develops and publishes international standards for
many different product and service delivery areas .
The aim is to facilitate international standardisation
across countries and also between private and public
sectors in manufacturing and service delivery.
ISO accreditation has been very useful in the South
African context in terms of setting standards and
ensuring high quality service delivery in this sector.
Saudi Council for Healthcare Accreditation
(SCHA)
The aims of (SCHA)
1. To develop an accreditation program which could be
used to help guide Healthcare organization
2. To improve the quality of patient care
3. To ensure on safe environment and
4. To reduce risks to patients and staff
What is SCHA?
SCHA is a national accrediting body for organizations
across all health sectors in KSA
Mission is to help organizations improve the services
they provide to their communities
An independent
Semi-government
Non-profit organization
Accreditation program voluntarily
Why Accreditation?
It stimulates the improvement of care delivered to
patients
It strengthens community confidence in accredited
hospitals
It reduces unnecessary costs
It increases efficiency of staff
It provides credentials for continuous education
It can protect against lawsuits
It facilitates acceptance by third-party payers
List of healthcare accreditation organizations in
the United State
The following organizations survey and accredit
hospitals and healthcare organizations in the USA.
A number have deeming power for Medicare and
Medicaid .
Healthcare Facilities Accreditation program (HFAP)
The joint commission (TJC)
National committee for quality Assurance(NCQA)
community health accreditation program (CHAP)
List of healthcare accreditation organizations in the
United State
Accreditation com(mission for Healthcare (ACHC)
The compliance team “Exemplary provider programs”
Healthcare quality association on accreditation(HQAA)
DNV health care
Accreditation Association For ambulatory care
Pharmacy principles for health care reform
The IOM report, Crossing the Quality Chasm: A New Health
System for the 21st Century, identifies six aims for health
care system improvement: safety, effectiveness, patientcenteredness, timeliness, efficiency, and equity.
With these objectives in mind, we have developed three
broad goals related to medication access and use that should
be an integral part of the health reform discussion .
1. Recognizing the role of pharmacists to help ensure that
medication therapy is safe, effective, equitable, patientcentered, and results in quality outcomes;
2. Ensuring that all people have timely access to prescription
medications that are provided accurately and efficiently;
Pharmacy principles for health care reform
3. the use of health information technology to support full
integration of pharmacists as part of the health care
delivery team.
These recommendations are critical to helping patients
make the most effective and safe use of their
prescription medications and to maintaining a critical
pharmacy delivery infrastructure.
Pharmacy and health care
system
Table of content
Major definitions
Introduction to pharmacy
Types of pharmacy practice
Clinical pharmacy practice
Community pharmacy practice
Hospital pharmacy
Goals and standards of hospital pharmacy
Role of pharmacist in health care system
Table of content
Organizational structure of pharmacy
Introduction to health care system
Components of health care system
Overview of health care system in Saudi
Arabia
Overview of healthcare in Canada
Pharmacy principles for health care
reform
Definitions
Pharmacy:
the health profession that links the health
science with the chemical science and it is
charged with ensuring the safe and effective use
of pharmaceutical drugs.
the branch of the health sciences dealing with the
preparation, dispensing, and proper utilization of
drugs.
The word derives from the Greek :pharmakon
meaning "drug" or "medicine
Pharmacy is inversely related to health care system
Definitions
Pharmacist:
◦ health care professionals with specialized education
and training who perform various roles to ensure
optimal health outcomes for their patients through
proper medication use.
Since pharmacists know about the chemical synthesis
mode of action of a particular drug, and its metabolism
and physiological effects on the human body in great
detail, they play an important role in optimization of a
drug treatment for an individual.
Definitions
Pharmacy technician:
◦ Support the work of pharmacists and other health professionals by
performing a variety of pharmacy related functions, including
dispensing prescription drugs and other medical devices to
patients and instructing on their use.
Pharmacy Practice :
◦ The discipline within Pharmacy that involves developing the
professional roles of the pharmacist
Definitions
Acute care :
◦ hospital provide care for serious illnesses that require the
continuous and ongoing attention of physicians, nurses,
pharmacist , and other health care providers . Emergency care
intensive care provided hear
Long term care:
◦ these facilities may be used to provide care to patients after
discharge from the acute care hospital
Immediate care :
◦ Type of care a patient would receive at the physicians office but
have extended hours of operation and do not require an
appointment
Introduction
The practice of pharmacy is a vital part of a complete health care system.
The number of people requiring health care services has steadily increased,
and this trend will likely continue.
pharmacy will face new challenges, expanded responsibilities, and an everincreasing growth in opportunities.
The traditional role of pharmacists is to manufacture and supply medicines.
pharmacists have been faced with increasing health demands which change
their direction and focus to PATIENTS instead of the Product.
Types of pharmacy practice
1-Clinical pharmacy :
◦ is defined as a pharmacy concerned with the science and
practice of rational medication use.
◦ The actual definition of clinical pharmacy is much more
involved than that and entails several aspects.
Pharmacists often collaborate with physician and other
healthcare professionals to improve pharmaceutical care.
Pharmacists are now an integral part of the interdisciplinary
approach to patient care.
Clinical Pharmacist:
◦ Assume responsibility and are accountable for managing
medication therapy for patients, whether acting alone or in
collaboration with other health care professionals
Types of pharmacy practice
Clinical pharmacists are scientists as well as researchers.
They must be knowledgeable in medication and
nontraditional therapies.
They are responsible for regular consultations with patients
and their health care professionals.
They are employed in virtually all health care settings, such
as
hospitals,
clinics
and
educational
facilities.
Types of pharmacy practice
2-Community pharmacy :
◦ are the health professionals most accessible to the public .
◦ they supply medicines in accordance with a prescription or
when legally permitted, sell them without prescription.
Their professional activities also cover
◦ counseling of patients at the time of dispensing of
prescription and non-prescription drugs ,
◦ drug information to health care professionals , patients and
public ,
◦ participation in health promotion
programmes
Types of pharmacy practice
Hospital Pharmacy :
The department or service in a hospital which is
under the direction of a professionally
competent, legally qualified pharmacist, and from
which all medications are supplied to the nursing
units and other services.
Hospital pharmacies can usually be found within
the premises of a hospitals
GOALS FOR HOSPITAL PHARMACY
long-range goals toward which its daily activities are
directed, so must a profession, its members, and their
representative societies.
the American Society of Hospital Pharmacists, in its
Constitution and Bylaws, sets forth the following
objectives:
◦ To assist in providing an adequate supply of such
qualified hospital pharmacists.
◦ To assure a high quality of professional practice
through the establishment and maintenance of
standards of professional ethics, education, and
attainments and through the promotion of economic
welfare.
GOALS FOR HOSPITAL PHARMACY
To provide the benefits of a qualified hospital pharmacist to
patients and health car institutions, to the allied health
professions, and to the profession of pharmacy.
To promote research in hospital pharmacy practices and in
the pharmaceutical sciences in general.
To disseminate pharmaceutical knowledge by providing for
interchange of information among hospital pharmacists and
with members of allied specialties and professions.
More broadly, the Society's primary purpose is the
advancement of rational, patient-oriented drug therapy in
hospitals and other organized health care settings
Minimum Standards For Hospital Pharmacy
Pharmaceutical services in institutions have numerous
components, the most prominent being
(1) The procurement, distribution, and control of all
pharmaceuticals used within the facility.
(2) The evaluation and dissemination of comprehensive
information about drugs and their use to the institution's
staff and patients.
(3) The monitoring, evaluation, and assurance of the
quality of drug use.
Minimum Standards For Hospital Pharmacy
Standard 1:
Administration:
The pharmaceutical service shall be directed by a
professionally competent, legally qualified pharmacist
He or she must be on the same level within the
institution's administrative structure as directors of other
clinical services.
Minimum Standards For Hospital Pharmacy
Standard 1:
The director of pharmaceutical services is
responsible for:
◦ (1) Setting the long- and short-range goals of
the pharmacy based on developments and
trends in health care and institutional pharmacy
practice and the specific needs of the institution
◦ (2) Developing a plan and schedule for
achieving these goals.
Minimum standards for hospital pharmacy
(3) Supervising the implementation of the plan
and the day-to-day activities associated with it.
(4) Determining if the goals and schedule are
being met and instituting corrective actions where
necessary.
The director of pharmaceutical services, in
carrying out these tasks, shall employ an
adequate number of competent and qualified
personnel
Minimum standards for hospital pharmacy
Standard II: Facilities:
◦ There shall be adequate space, equipment, and
supplies for the professional and administrative
functions of the pharmacy.
◦ The pharmacy shall be located in an area (or areas)
that facilitate (s) the provision of services to patients. It
must be integrated with the facility's communication
and transportation systems
Minimum standards for hospital pharmacy
Space and equipment, in an amount and type to
provide secure, environmentally controlled
storage of drugs, shall be available.
There shall be designated space and equipment
suitable for the preparation of sterile products
and other drug compounding and packaging
operations.
Minimum standards for hospital pharmacy
The pharmacy should have a private area for pharmacistpatient consultations.
The director of pharmaceutical services should also have
a private office or area.
Current drug information resources must be available.
These should include appropriate pharmacy and medical
journals and texts and drug literature search and retrieval
resources.
Minimum standards for hospital pharmacy
Standard III: Drug Distribution and Control:
◦ The pharmacy shall be responsible for the
procurement, distribution, and control of all drugs
used within the institution.
◦ This responsibility extends to drugs and related
services provided to ambulatory patients
◦ Policies and procedures governing these functions shall
be developed by the pharmacist with input from other
involved hospital staff (e.g. nurses) and committees
(pharmacy and therapeutics committee, patient-care
committee, etc.).
Minimum standards for hospital pharmacy
Standard IV:
Drug Information:
The pharmacy is responsible for providing the
institution's staff and patients with accurate,
comprehensive information about drugs and their use
and shall serve as its center for drug information
Minimum standards for hospital pharmacy
Standard V:
Assuring Rational Drug Therapy:
◦ An important aspect of pharmaceutical services
is that of maximizing rational drug use.
◦ In this regard, the pharmacist, in concert with
the medical staff, must develop policies and
procedures for assuring the quality of drug
therapy.
Minimum standards for hospital pharmacy
Standard VI:
Research :
◦ The pharmacist should conduct, participate in, and
support medical and pharmaceutical research
appropriate to the goals, objectives, and resources of
the pharmacy and the institution.
How do you become a Pharmacist in Saudi
Arabia
Role of pharmacist in health care
Pharmacist are health professionals who practice
the science of pharmacy
The fundamental role of pharmacists is to
distribute drugs that have been prescribed by a
healthcare practitioner to patients
One of the most important roles that
pharmacists are currently taking on is one of
pharmaceutical care.
Pharmaceutical care involves taking direct
responsibility for patients and their disease states,
medications, and the management of each in
order to improve the outcome for each individual
patient.
Role of pharmacist in health care
ROLE OF PHARMACIST IN GLOBAL HEALTH
:Pharmacist should adequately inform patients and the
general public about unwanted effects of medicines, and
should monitor such unwanted effects and their
consequences in collaboration with other health care
professionals and the appropriate authorities.
Role in Transmitted Diseases Pharmacist can educate
people by giving information that explain disease, its
transmission, risk reduction and prevention against
disease. Patient counseling is one of the important role
that a community Pharmacist can provide.
Role of pharmacist in health care
Role in Epidemiology : Epidemiology is the study of the
distribution and prevention of health related events in
specific population
Role of pharmacist to Provide up-to-date information
about New Guidelines, New Medications , News reports
about medications
Provide answers to patient questions before They are
asked to medical staff , Drug-drug interactions, Drugfood interactions , Drug-disease interactions
Organizational structure of pharmacy
With the selection and categorizing of the employees, it
now becomes essential to develop a chart showing the
flow of administrative authority.
Obviously, in the very small departments, this is usually
generally understood and no problems arise. However, in
the large units with assistant chief pharmacists,
supervisors, and lay personnel, authority must be
delegated by the chief pharmacist.
In large hospitals, departments of pharmacy have a more
complex organization
Organizational structure of pharmacy
Administrative Services Division
1. Plan and coordinate departmental activities.
2. Develop policies.
3. Schedule personnel and provide supervision.
4. Coordinate administrative needs of the Pharmacy and
Therapeutics Committee.
5. Supervise departmental office staff.
Organizational structure of pharmacy
Education and Training Division
1. Coordinate programs of undergraduate and graduate
pharmacy
students.
2. Participate in hospital-wide educational programs
involving nurses, doctors etc.
3. Train newly employed pharmacy department
personnel
Organizational structure of pharmacy
Pharmaceutical Research Division
1. Develop new formulations of drugs, especially
dosage forms not
commercially available, and of research drugs.
2. Improve formulations of existing products.
3. Cooperate with the medical research staff of
projects involving drugs.
Organizational structure of pharmacy
In-Patient Services Division
1. Provide medications for all in-patients of the hospital
on a 24-hour per day basis.
2. Inspection and control of drugs on all treatment areas.
3. Cooperate with medical drug research.
Out-Patient Services Division
1. Compound and dispense out-patient prescriptions.
2. Inspect and control all clinic and emergency service
medication stations.
3. Maintain prescription records.
4. Provide drug consultation services to staff and medical
students
Organizational structure of pharmacy
Drug Information Services Division
1. Provide drug information on drugs and drug therapy to
doctors, nurses, medical and nursing students and the
house staff.
2. Maintain the drug information center.
3. Prepare the hospital's pharmacy newsletter.
4. Maintain literature files.
Departmental Services Division
1. Control and dispense intravenous fluids.
2. Control and dispense controlled substances.
3. Coordinate and control all drug delivery and
distribution systems.
Organizational structure of pharmacy
Purchasing and Inventory Control Division
1. Maintain drug inventory control.
2. Purchase all drugs.
3. Receive, store and distribute drugs.
4. Interview medical service representatives.
Central Supply Services Division
1. Develop and coordinate distribution of medical
supplies and irrigating fluids.
Assay and Quality Control Division
1. Perform analyses on products manufacturered and
purchased.
2. Develop and revise assay procedures.
Organizational structure of pharmacy
Sterile Products Division
1. Produce small volume parenterals.
2. Manufacture sterile ophthalmologic, irrigating solutions
etc.
3. Prepare aseptic dilution of lyophylizal and other
"unstable" sterile injections for administration to patients.
Radiopharmaceutical Services division
1. Centralize the procurement, storage and dispensing of
radioisotopes used in clinical practice.
Thank you