Impact of Economic Restructuring on Healthcare in KSA

Research Topic
Impact of Recently Economic Restructuring on Healthcare Decision
Making Behavior in KSA.
Master in MBA-IM Thesis
Geneva Business School
Master in International Management
Authors:
Mustafa Younis, 449
Qutaiba Mahfouz, 450
Supervisor: Prof. Mokhtar Al Hashmi

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Declaration of Authorship
“I hereby declare:
• That we have written this work on our own without other people’s help and without the use of any aids
other than those indicated;
• That we have mentioned all the sources used and quoted them correctly in based on the academic
quotation rules;
• That the topic or parts of it are not already the object of any work or examination of another course
unless this has been explicitly agreed on with the faculty member in advance;
• That our work may be scanned and electronically checked for plagiarism.”

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Acknowledgements
Firstly, we would like to express our sincere gratitude to Geneva Business School for the continuous support
of our Master study and related research, for its patience, motivation, and immense knowledge. Its guidance
helped us in all times of research.
Besides GBS, we would like to thank the circumstances that brought us (Qutaiba & Mostafa) together in
work, study and of course friendship. Our presence with each other was a strong motive to work hard and
persist in studying and seeking knowledge.
Our sincere thanks also goes to our families who provided us this great opportunity and created for us the
healthy climate to finish the master study, without their precious support it would not be possible to conduct
this research.

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Table of Content
Acknowledgements…………………………………………………………………….3
Chapter 1: Introduction……………………………………………………………….7
1.1. Chapter Objective…………………………………………………………………7
1.2. Research Background……………………………………………………………..9
1.3. Research Model …………………………………………………………………..9
1.4. Statement of the problem………………………………………………………...10
1.5. Aim of the study …………………………………………………………………10
1.6. Research Objectives ……………………………………………………………..11
1.7. Research Questions………………………………………………………………11
1.8. Significance of the study ………………………………………………………...12
1.9. Scope and Limitations of the study ……………………………………………...12
1.10. Structure of the thesis……………………………………………………………..13
1.11. Definitions of terms ………………………………………………………………15
Chapter 2: Summary of Literature Review………………………………………….16
2.1. Chapter Objectives…..…………………………………………………………...16
2.2. Literature Review………………………………………………………………...16
Chapter 3: Methodology: Summary of Empirical Study…………………………..35
3.1. Chapter Objectives……………………………………………………………….35
3.2. Research Method ………………………………………………………………...35
3.3. Research Designing………………………………………………………………35
3.4. Population & Sampling…………………………………………………………..36
3.5. Sampling Method………………………………………………………………...37
3.6. Questionnaire Designing ……………………………………………………….37
Chapter 4: Presentation of Data: Empirical Study ………………………………...38
4.1. Introduction…...…………………………………………………………………..38
4.2. Sample Analysis…………………………………………………………………..38
Chapter 5: Analysis of Data ………………………………………………………....52
5.1. Introduction……………………………………………………………………...52
5.2. Statistical Analysis………………………………………………………………52
5.3. Data Reliability …………………………………………………………………52
5.4. Reliability Statistics...…………………………………………………………...52
5.5. Frequencies……………………………………………………………………...53
Chapter 6: Discussion and Interpretation of Findings ……………………………..60
6.1. Introduction……………………………………………………………………….60
6.2. Findings…………………………………………………………………………...60
Chapter 7: Conclusion and Recommendations……………………………………...65
7.1. Introduction………………………………………………………………………65
7.2. Summary of the finding …………………………………………………………65
7.3. Conclusion ………………………………………………………………………67
7.4. Contribution to the body of knowledge …………………………………………67
7.5. Result limitations ………………………………………………………………..68
7.6. Recommendations ……………………………………………………………….68
7.8 Suggestion for further studies …………………………………………………...70
8. Bibliography………………………………………………………………………...71
Appendix……………………………………………………………………………….75
ResearchQuestionnaire……………………………………………………………….75

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Figure List
Figure 1- Respondents’ Relationship to healthcare sector ………………………….....39
Figure 2- Respondents’ Type in healthcare sector (Public or private)………………....40
Figure 3- Respondents’ Location in KSA……………………………………………....41
Figure 4- Providers’ Market Share in KSA…………………………………...………...42
Figure 5- Providers’ Type (Local or Foreigner)………………………………...........…43
Figure 6- Providers’ Job in HCS…………………………………………...…………...44
Figure 7- Patients ‘Age in HCS…………………………………………………………45
Figure 8- Patients ‘Gender in the study survey……....…………………………………46
Figure 9- Patients’ Type (Cash or Insurance)………………………..…………………47
Figure 10-Patients’ Type (Saudis or Residents)…...……………………………………48
Figure 11- Patients’ quality of life levels ………………………………………………49
Figure 12- Impact of Economy Restructuring on Patients……………………………...50
Figure 13- Impact of Economy Restructuring on Healthcare Providers………………..51
Figure 14- Question Orders (Impacts on Patients) ……………………………..………58
Figure 15- Impacts on Providers…………………………………………..……………59
Table List
Table 1-Definitions of Terms…………………………………………………………...15
Table 2- Saudi Population 2017…………………………………………………….......19
Table 3- Reliability Statistics …………………………………………………………..52
Table 4- General Respondents’ Profile…………………………………………………54
Table 5- Providers Respondents’ Profile ……………………………………………….55
Table 6- Receivers ‘Respondents’ Profile (Patients Profiling)…………………………56
Table 7- Impact on Receivers (Patients)………………………………………………..57
Table 8- Impact on Providers …………………………………………………………58

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Abstract
In a world of increasing production of oil and its alternative solutions worldwide while
decreasing oil prices, Saudi Arabia has to worry about as Saudi Arabia is a country which
its economy is reliant on oil revenues, but this expectations was before this research time
as the research describes below, how Saudi Arabia is exposed to some serious economic
challenges which call for economic restructuring and what is its response to this crises to
counteract this economic uncertainty.
This research investigated the Impact of Recently Saudi Economic Restructuring on
Healthcare Decision Making Behavior in KSA market to have a clearly overall view of
the risk challenging KSA and the actions which could counteract or dilute this risk.
“Saudi Arabia Changed its economic strategy to meet these challenges, so the Saudi
government engages into many actions, which focus on diversification of its economy,
strengthen the importance in the global market and creates jobs for young Saudis.”
(essaylib, 2016)
As a reaction to these challenges Saudi government has announced about vision 2030, The
“National Transformation Program 2020”, the 1st implementation program in the Saudi
Vision 2030’s aims to privatize the Saudi healthcare sector, establish the public private
partnerships, develop newly local healthcare programs and encourage the Saudi’s partners
abroad to invest in local healthcare. (Sterling, 2016)

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Chapter 1: Introduction
1.1 Chapter Objectives
This chapter presents the research problem and its background. It discusses the
introduction about the research topic which is Impact of Recently Economic Restructuring
on Healthcare Decision Making Behavior in KSA market in. A description of the research
problem, the significance of the study, scope, and study limitations are also included in
this chapter.
1.2 ResearchBackground
“The healthcare industry is an aggregation and integration of sectors within the economic
structure that supply goods and services to treat patients with curative, preventive,
rehabilitative care.”(CNA International, 2016). “It includes the generation and
commercialization of goods and services to maintain and re-establish health, the modern
healthcare industry is divided into many several and depends on interdisciplinary teams
of trained professionals to meet health needs of individuals and populations, the healthcare
industry is one of the fastest-growing industries which consumes Consuming more than
10 percent of gross domestic product (GDP) of developed nations.” (CNA International,
2017)
“The United Nations International Standard Industrial Classification (ISIC) categorized
the healthcare industry as consists of hospital activities, medical and dental activities and
"Other human health activities." (World Population Review, 2017)
“The country has the 2nd largest oil stock in the world, which account for about 70% of
the government’s revenue and 95% of its exports annually. It also has the 4th largest
natural gas stock.” (Hassan, 2012)

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“When oil prices fallen in November 2014, Saudi Arabia has begun creative strategy of
focusing on mainainance its oil market share rather than decreasing production, with the
Implementation of austerity measures across many sectors, all stakeholders need to know
what impact of these cuts will have on the healthcare sector.” (decisionresourcesgroup,
2016)
“With the detailing of the 2015, 2016 and 2017 Saudi Arabia budgets can help supply an
answer, the comparison of the year-to-year variation in budget shows modest changes but
significant cuts were in the Healthcare sector allocation over the past year, Budget of
Health and Social Development fell from SR 160 billion in 2015 to SR105 billion in 2016.
Which represented 34% cut.” (decisionresourcesgroup, 2016)
“Despite, it is clear from that the strategic cuts the Saudi government is committed to
protect healthcare sector during economic uncertainty but this confirms that the coming
days will witness a huge change in the mindset and behavior of the strategic decisions
makers within this sector, Security of healthcare services in Saudi Arabia is mandatory to
stability as many of the recent civil revolutions in the region have been initiated by low
levels of social services.” (decisionresourcesgroup, 2016)
“On 25 April 2016 Saudi Arabia unveiled an ambitious plan called Saudi Vision 2030
(“Vision 2030”) to transform its economy and diversify the country’s sources of income
away from its current dependence on oil, In addition to this the National Transformation
Program 2020 (“NTP”) was approved in June 2016 by the Saudi Cabinet as the interim
medium for realizing the goals laid down in Saudi Vision 2030.” (Al Tamimi, 2017)
Plans are including 80 projects costing at least $3.7 million and also up to $20 million to
implement the Saudi Vision 2030. (Saudi Government, 2016)
Healthcare is a major focus area of Saudi Vision 2030 and this research considers all
details of this sector. (Al Tamimi, 2017)
This research aims to investigate the impact of the recently Saudi economy restructure
due to low global energy prices on the healthcare sector decision making behavior and
how the decision makers will dilute the risk or maximize the benefits emerging from this
change.

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1.3 ResearchModel
This research hypothesize a relationship between the low global oil prices and healthcare
sector decision making behavior in Saudi Arabia, the research will examine each item and
present the methodology along with the results using the data analysis.
1.4 Statement Of The problem
There are many studies in different countries about the relationship between the low global
oil prices and the healthcare sector performance and quality, many researchers showed
correlation between the low global oil prices and the quality of healthcare, some of
researchers showed mild difference and others showed no relationship at all.
“For example, Alberta; the province producing 80% of Canada’s oil has maintained stable
budget for healthcare sector, For its 2016 budget, the province increased the healthcare
budget by 3% over the previous year.” (decisionresourcesgroup, 2016)
“There is another study showed that Saskatchewan has followed the similar approach to
Alberta as its public healthcare system as a whole has not been subjected to severe cuts,
The province increased the healthcare budget by 1.5% over the previous year, generally
speaking, no significant cuts have been made to any of the health sector of Alberta nor
Saskatchewan as a result of the oil revenue falling.” (decisionresourcesgroup, 2016)
Although, the low global oil prices has become a critical issue to concern the future of
Saudi Arabia at all, no clear studies till now are conducted to show the current and the
expected impact of the low price oil on healthcare sector future.
So, the research is adopting the concept that there is an absolute correlation between the
recently Saudi economy restructuring and the healthcare sector decision making behavior.
“Despite of many efforts made by Saudi government to face the health care needs there
are certain challenges which need to be sort out by proper management and planning, the
cost of healthcare is increasing, with high life expectancy, the old age health care is
increasing and Saudi Arabia is also facing lifestyle related disease,

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the population growth rate is high, All these are putting a lot of pressure on the Saudi
healthcare system.” (decisionresourcesgroup, 2016)
The decline of oil revenues in such situation increases the burden on the governmental
spending on the public healthcare sector.
The problem is determining the clear impact of the recently economy restructuring due to
the global low oil prices on the healthcare sector decision making behavior in Saudi
Arabia.
So, it is imperative on the governmental decision makers in the healthcare sector to know
this expected impact to provide the healthcare services effectively and efficiently ways.
1.5 Aim of the study
The purpose of this thesis is to investigate the Impact of Recently Economic Restructuring
on Healthcare Decision Making Behavior in KSA. This research is studied to clarify
negative and positive consequences of the recent restructure of Saudi economy and its
impact on healthcare sector. To discover the challenges facing the country in
implementing such decisions in a country was making everything is available for
satisfying everyone needs. This research will try to close the gap of having a non-oil
economy based economy and ensuring high quality service of healthcare sector in a
country where everyone has used to find everything available.
Furthermore, the research will try to clarify the reasons of suddenly huge changes in the
healthcare sector behavior and if they succeed or not. So, the study has to understand
Ministry of Health budget and quality of healthcare sector service for patients in Saudi
Arabia to rationalize this research.

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1.6 Researchobjectives
This research will find out the following objectives:
1. Exploring the literature reviews and theories related to Recently Saudi Economic
Restructuring and Healthcare Decision Making Behavior in KSA.
2. To clarify the Impact of Recently Economic Restructuring on Healthcare Decision
Making Behavior in KSA.
3. To discover the challenge the kingdom is facing to implement the economic
decisions in such an oil-based country.
4. To investigate healthcare sector can overcome the situation to counteract the
negative consequences of these decisions or to maximize the benefits of this
restructuring.
5. To investigate if healthcare sector succeed or failed to overcome this situation.
1.7 ResearchQuestions
In addition of analyzing the economy and healthcare sector characteristics of Saudi
Arabia, this research will try to answer the following questions:
1. What is impact of the recently Saudi economic restructuring on healthcare
sector decision making behavior?
2. What are the Saudi governmental responses to accommodate the global oil
prices decrease?
3. What are the healthcare sector decision maker’s responses to accommodate the
recently Saudi economic restructuring?
4. To what extent Saudi Arabia will succeed to implement its decisions?

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1.8 Significant of the study
The research will provide knowledge about the significant of this study to all stakeholders,
healthcare care decision makers, healthcare companies and society. The study will explore
the benefits that Saudi Arabia will gain from non-oil based economy vision. The research
will help healthcare companies in forecasting, risk management, investment planning, cost
estimation and budget allocation. Stakeholders in this sample are appeared to have more
interest in enriching their awareness about what is going on around them. The economic
restructuring will lead citizens and expatriates to manage their expenses effectively and
efficiently and direct their psychological needs toward the necessities rather than luxuries
and toward long term plans rather than short term ones. It appears that having a new trends
in healthcare decision making behavior will act positively toward the patient satisfaction,
the more profits of local health companies and the more opportunities to Saudis. This
economic restructuring and its impact on healthcare sector will create a serious need for
more development and improvement of Saudis to coop with the new vision as it will be a
basic demand for achieving their objectives. This research results will provide healthcare
companies especially pharmaceutical companies with a useful tool that is very important
for its continual presence in such a highly dynamic market. (Movahed, 2013)
1.9 Scope and limitations of the study
The area and scope of this thesis focus only on healthcare sector decision making behavior
in Saudi Arabia due to the recently Saudi economic restructuring during due to the global
low oil prices.
The main limitation of this study is the constraint of time, political regulations and there
the difficulty of data gathering and analysis. Also there are no previous adequate reports
in such a recent topic.

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1.10 Structure of the thesis
The structure of the thesis is designed and will be elaborated in below described Chapters:
Chapter I (Introduction)
This chapter presents the research problem and its background. It discusses the
introduction about the research topic Impact of Recently Economic Restructuring on
Healthcare Decision Making Behavior in KSA market in 2016. A description of the
research problem, the significance of the study, research null hypotheses, scope, and
limitations are also included in this chapter.
Chapter II (Summary of Literature Review)
This chapter presents the review of related literature to Impact of Recently Economic
Restructuring on Healthcare Decision Making Behavior in KSA market in 2016. It
discusses the related literature and theories about the research topic. This includes the
Saudi economy profile, the demographic characteristics of the country, the healthcare
sector contribution and decision making behavior trends and also, this chapter points out
the related theories of countries which shifted from oil-based economies to non-based
economies and provides a comparison for them.
Chapter III (Methodology: Summary of Empirical Study)
A similar structure presented in chapter II is carried out in this chapter. It discusses related
empirical studies within the research topic domain. Those studies are summarized and
subjected to objective critique by presenting the different methods and empirical tools
used by researchers to analyze the similar problem to this research. This chapter is very
important since it provides the required guidelines which will be followed in this study.
Chapter IV (Presentation of Data Empirical Study)
This chapter presents the research methodology such as the research approach to be used,
the research design and the techniques that are utilized, and the respondents of the study.
It also includes the description of the population and research instruments.

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Chapters V (Analysis of Data)
This chapter presents the results obtained from the data gathering process with the use of
the research instruments. It includes a description of the demographic characteristics of
the respondents, their perception towards study main aspects; Saudi economic
restructuring, its impact on healthcare sector decision making behavior and how they
succeed to accommodate this risk. Also, it highlights the profile of each aspect’s variable
in relation to the conceptual framework.
Chapters VI (Discussion and interpretation of the finding)
This chapter interprets the descriptive results obtained from the previous chapter. It also
discusses the summary of hypotheses testing. This chapter provides a vital link between
the results and their implication on Saudi health care sector.
Chapters VII (Conclusions, implications, and recommendations)
This chapter reflects the conclusions and recommendations of the study based on the
findings presented. It also discusses the contribution of this study to the body of
knowledge, the results limitations, and proposed future studies. Finally, tables, graphs,
and maps will precede references.

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1.11 Definitions of Terms
Term Definition
KSA “Kingdom of Saudi Arabia”
NTP “National Transformational Plan”
MOH “Ministry Of Health”
GDP “Gross Domestic Product”
US “United States“
ISIC “United Nations International Standard Industrial Classification”
CPSA “Council of Political and Security Affairs”
CEDA “Council for Economic and Development Affairs”
OPEC “Organization of the Petroleum Exporting Countries.”
IFC “International Finance Corporation”
PIF “Public Investment Fund”
KACARE “King Abdullah City for Atomic and Renewable Energy”
RCJY “Royal Commission for Jubail and Yanbu”
GCC “Gulf Cooperation Council”
PIF “Public Investment Fund“
IPO “Initial Public Offerings”
Table 1- Definitions of Terms

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Chapter 2: Summary of Literature Review
The following literature focuses on the research articles, journals, and theories related to
the main variables of the study. This includes literature on Kingdom of Saudi Arabia
including, Saudi Economy, Saudi Healthcare sector, impact of the global low oil prices
on the healthcare sector, actions taken by Saudi government and healthcare sector decision
makers to counteract this restructuring and finally, how Saudi Arabia has succeed in
implementing its planned actions.
2.2 Literature Review
2.2.1 Kingdom of Saudi Arabia
2.2.1.1 Modern Saudi Arabia
“Kingdom of Saudi Arabia, is an Arabic country in a land area of 2,150,000 km2 (830,000
sq. mi), Saudi Arabia is geographically the 5th-largest state in Asia, Saudi Arabia is
bordered by Jordan, Iraq, Kuwait, Qatar, Bahrain, Kuwait, the United Arab Emirates,
Oman and Yemen to the south. The area of modern Saudi Arabia formerly consisted of 3
distinct regions; Central region, western region and Eastern region.”
(FastLaneImmigrationServices, 2017)
2.2.1.2 History of Kingdom Saudi Arabia
“In 1932 Hejaz and Nejd kingdoms united as the Kingdom of Saudi Arabia, the new
kingdom was a poor county, reliant on limited agriculture and pilgrimage revenues.”
(World Heritage Encyclopedia, 2014)
“In 1938, huge reserves of oil were discovered in the Al-Ahsa region and high level of
development of the oil fields began in 1941 under the control of Aramco, Oil provided

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Saudi Arabia with economic prosperity, during this time a large number of foreign workers
has come to Saudi Arabia in the oil industry, Also, the government become wasting and
extravagant attitude, By the 1950s this wasting had led to huge deficits and extra foreign
borrowing.” (davishunter, 2017)
“In 1976, Saudi Arabia had become the largest producer of oil worldwide.” (revolvy,
2016)
“King Fahd succeeded King Khalid in June 1982, the vast wealth of oil revenues had a
greater impact on Saudi society, and it led to rapid technological modernization,
urbanization, mass public education and the creation of new media.” (revolvy, 2016)
“King Abdullah succeeded King Fahd In 2005, who continued the reform and clamping
down on protests, the king introduced many economic reforms to reduce the country's
dependence on oil revenue as encouragement of foreign investment and privatization.”
(revolvy, 2016)
“On 23 January 2015, Prince Salman, succeeded as king after his half-brother Abdullah
died, one of the first tasks the King and his son did was to simplify the government
bureaucracy, The eleven government secretariats were reconstituted as only two, the
Council of Political and Security Affairs (CPSA), and the Council for Economic and
Development Affairs (CEDA.” (revolvy, 2016)

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2.2.1.3 Saudi Population 2017
2.2.1.3.1 Saudi Population
Year Population Male Female Density (km²) Density Rank Growth Rate
World
Rank
2017 32,742,664 (56%) (44%) 15 203 1.69% 41
Table 2- Saudi Population 2017. (World Population Review, 2017)

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2.2.2 Saudi Economy
2.2.2.1 History
“Saudi Arabia was an economy based on agriculture until the discovery of oil in the 1930s,
for raise the oil prices, Saudi Arabia and the other major exporters founded the
Organization of the Petroleum Exporting Countries (OPEC), to regulate production, the
1st 5-years "Development Plan" have been initiated in 1970, and these have continued
gradually with 2015 being the 1st year of the 10th plan.” (science.gov, 2015)
“During the 1973 oil crisis OPEC production cuts raised the price of petroleum from $3
per barrel to nearly $12, So Saudi Arabia became one of the fastest-growing economies
worldwide, and it had a substantial surplus in its overall trade with other
countries.”(Velson, 2015)
“But higher prices of oil led to development of oil fields worldwide and reduced global
consumption, As a result, in the mid-1980s, oil price dropped from US$40 per barrel to
around US$5, Which led to budget deficits, and the government drew down its foreign
assets, during this period Saudi oil policy target to maintain its market shares.” (OMICS
International, 2014)
“In June 1993, Saudi Aramco absorbed the state marketing and refining company, and
became the world's largest fully integrated Oil Company.” (Global Tenders, 2016)
“But, in1997, Saudi Arabia faced the crises of low oil prices again.” (OMICS
International, 2014)
“But in 1999, Saudi Arabia has succeeded through OPEC to raise oil price to its highest
level, in the same year, Saudi Arabia established the Supreme Economic Council to
formulate the economic development policies in order to accelerate institutional and
industrial reform, then oil prices recovered till 2008.” (OMICS International, 2014)

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2.2.2.2 Economy Diversification and Developmental plans
“In 2000, the kingdom allowed 100% foreign-owned businesses.” (OMICS International,
2014)
“Oil wealth has increased the quality of life of most Saudis, High reliance on petroleum
revenues continued, the gap between the job skills of Saudi graduates and the needs of the
private job market at all levels remains the main obstacle to economic diversification and
development.” (Conservapedia, 2017)
“Saudi Arabia's first two development plans of the 1970s, emphasized infrastructure, the
results were impressive, for the 3rd plan (1980–85), Spending on infrastructure decreased,
but it has been rose on education, health, and social services, the target of diversifying and
expanding productive sectors of the Saudi economy hasn't been achieved.” (World Library
Foundation, 2017)
“During the 4th plan (1985–90), the kingdom's basic infrastructure was complete, but,
education and training still were areas of concern, private business and foreign investment
in the form of joint ventures with Saudi public and private companies were encouraged,
the private sector raised to 70% of non-oil GDP by 1987.” (World Library Foundation,
2017)
“During the 5th plan (1990–95) Saudi Arabia emphasized on the improvement of
government social services and creating private-sector employment opportunities through
saudization.” (World Library Foundation, 2017)
“During The sixth plan (1996–2000), the kingdom focused on decreasing the cost of
governmental services without cutting and expansion of educational training
programs.”(Global Tenders, 2016)

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“During The seventh plan (2000–2004), the kingdom focused on economic diversification
and the important role of the private sector in the Saudi economy, the kingdom projected
a target of creating 817,300 new jobs for Saudis.” (revolvy, 2016)
“During the 8th plan (2005-2016) Saudi Arabia a planned to invest about $46 billion in
several petrochemical projects, Ras Tanura integrated refinery and petrochemical project,
Saudi Kayan petrochemical complex at Jubail Industrial City and Petro Rabigh refinery
upgrade project with creation of more than 150,000 job through this companies.” (revolvy,
2016)
“The kingdom planned to launch 6 economic cities as King Abdullah Economic City, to
be completed by 2020.” (Global Tenders, 2016)
2.2.2.3 Vision 2030
I. Description of Vision 2030
“The kingdom announced Vision 2030 in April 2016 which represented Saudi Arabia’s
map for diversification of its economy to counteract low global energy prices, in June
2016 the National Transformation Program 2020 has been launched by the Government
as a part of the implementation of the Saudi Vision 2030 to meet interim targets by 2020
via different strategic initiatives through 24 Saudi governmental bodies.” (Reardon , 2016)
II. Goals of Vision 2030
“The Saudi Vision 2030 has targeted economic goals to decrease the reliance on oil
production, as part of these goals the healthcare sector get a special concern as part of
vision 2030.” (Reardon , 2016)

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III. The National Transformation Plan
The National Transformation plan targeted strategic objectives to be achieved by 2020,
The NTP listed the various tasks to be done by each Governmental body in Saudi Arabia.
IV. Health Sector Objectives of Vision 2030
“Health Sector budget in the national transformation plan is SAR 23 billion to increase
the private sector contribution to heath care expenditure, increase localization of
pharmaceutical manufacturing and encourage the public to private partnerships in the
health sector.” (Al Tamimi Consultants, 2016)
V. Investment Opportunities
“These opportunities included healthcare sector. Investments will take the frame of public
private partnerships, it is also expected that there will be a number of privatizations with
opportunities for foreign and local investors.” (Al Tamimi Consultants, 2016)
2. 2. 2. 3Vision2030
I . [ 4] Descripti onof Vision2030
The kingdom announcedVision2030inApri l2016whichrepresent edSaudi Arabi a's
m ap f or diver si ficationofit seconomytocount er act lowglobalenergypr ices. [27] I nJune
2016 t heNati onalTransformati onPr ogram 2020hasbeenlaunchedbyt heG overnment
2.2.2.4 Non-petroleum sector
“Regarding non-petroleum sectors in Saudi Arabia; Saudi Arabia has small mineral
deposits of gold, silver, iron, others, also, KSA is one of the world's largest producers of
dates, As of 2009, livestock population amounted to 7.4 million sheep, 4.2 million goats,
500,000 camels and a 250,000 of cattle.” (Glass House Management , 2016)
“Although jobs created by the annual hajj pilgrims do not last long, the hajj employs more
people than the oil industry 40,000 temporary jobs.” (Glass House Management , 2016)
2.2.2.5Demands for economic restructuring in Saudi Arabia
In recent years, a number of critical events have driven the ruling Saudi family for
structural reforms in the economic domains as follows:

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1. Total reliance on oil revenues, which account for 80 per cent of state revenues.
2. The huge amount spent on education with a result of poorly trained students, most of
them in non-technical fields
3. High rate of unemployment among Saudis.
4. Failure of local factories to produce export-quality goods
5. The national debt of SR700 billion ($187 billion), approximately equal to the annual
GNP.
6. Many bureaucratic and legal barriers to direct foreign investments [other than in the oil
sector. (Raphaeli, 2005)
2.2.3 SaudiHealthcare Sector
2.2.3.1 History of Healthcare sector
“Prior establishment of Saudi Arabia that health care was provided by local healers, before
the discovery of oil the Saudi social structure was more towards traditional values, Society
was poor, there was no specific health care system and health care was mainly based on
traditional practice, in 1925 first public health department was established, its role was to
provide free health care to the population and pilgrimage by establishing many
dispensaries and hospitals.” (Indian Journal of Applied Research, 2016)
“Though it was the great effort in the field of health care but the national income was not
sufficient to achieve advance health care as a result majority of population depends on the
traditional health care.” (Indian Journal of Applied Research, 2016)
“The establishment of Ministry of Health was in 1950 which led to the advancement of
health care system in Saudi Arabia. During that time MOH operated 11 hospitals and 25
polyclinics in the country, till 1970, the country had 74 hospitals and till 2002 there were
331 hospitals.” (Indian Journal of Applied Research, 2016)
“1971th was the year of Planning for country’s wide health care system which began
with the developed successive five year national health care program, the first 4
development plans [1970-1989) brought crucial changes to the Saudi health care system
as establishing the necessary infrastructure of hospitals, clinics and pharmacies followed

24
by improving the quality of medical care and services.” (Indian Journal of Applied
Research, 2016)
2.2.3.2 Budget and spending behavior
“The Saudi health care sector Imports more than 92 % of the market and American
companies contribute to 21 % share of the total imports.” (International Trade
Administration, 2016)
“Healthcare sector is a top priority for the Saudi government, Budgeted expenditures for
the healthcare and social affairs sectors in 2015 were SAR 160 billion, a huge 48 % growth
versus 2014 figures, But, Budgeted expenditures for the healthcare and social affairs
sectors in 2016 were SAR 105 billion, a huge 34.5 % minus growth versus 2016 figures,
However, in a way of correction SAR 120 billion; which will enable the construction and
subsequent equipping of healthcare centers and 38 new hospitals are already in the process
of being built.” (International Trade Administration, 2016)
“Currently the MOH is the major government provider and financer of health care services
in Saudi Arabia, these services represent 60% of the total health services in Saudi Arabia,
in addition to financing and care delivery; MOH exercises regulatory authority including
price control for services rendered in the private sector plus pricing of healthcare products,
With the MOH facilities being restricted to only Saudi national, Private healthcare sector
offers services in cities and large town with 125 hospitals, clinic and dispensaries, the
government also encourages greater private sector engagement by attractive long term
interest free loan, Private sector accounts for 27% of Saudi healthcare, the MOH provides
health services at three levels; primary, secondary and tertiary.” (Indian Journal of Applied
Research, 2016)
“Despite of many efforts made by Saudi government to face the health care needs there
are certain challenges which need to be sort out by proper management and planning, the
cost of healthcare is increasing. With high life expectancy, the old age health care is

25
Increasing, the Saudi Arabia is also facing lifestyle related disease, the population growth
rate is high, and all these are putting lot of pressure on the Saudi healthcare system.”
(Bassi , 2015)
2.2.3.3 Current Climate of Healthcare in Saudi Arabia
“Saudis and religious pilgrims are enrolled in free health care, however, in 2014, the
government announced that the private sector expatriates workers and nationals will enroll
into insurance at the expense of the private employers away from the government
hospitals, healthcare market has increasing demand for services due to the following
factors; The rapidly growing population, The Rising of life expectancies; and The high
incidence of chronic diseases.” (Bassi , 2015)
“The functions and staff training of private healthcare are supervised and supported by the
MOH, which runs the country’s health care program.” (Arazy Group, 2016)
“Saudis receive their healthcare from one of several ways from a public, Ministry of
Health-funded service, from a military hospital, of which there are two branches (the Saudi
Arabian National Guard and the Ministry of Defense and Aviation), from a hospital for
government employees or from a subspecialized referral hospital or from private, for-
profit hospital and from a private hospital for employees of a specific industry.” (Helen
Ziegler and Associates, 2017)
2.2.3.4 Healthcare Markets
“Saudi Healthcare Market consist of different markets; Polyclinic Market which is the
largest contributor in the overall revenues of healthcare as majority of people in the
kingdom are preferring polyclinics over hospitals due to convenience and lower cost care
services, Pharmacy Retail Market which is segmented to hospital Based Pharmacies and
Standalone Pharmacies, Hospital Market which has huge potential to grow in the
upcoming future and Medical Devices Market.” (Bassi , 2015)

26
2.2.3.5 The growth areas within Saudi Healthcare sector
The Saudi healthcare sector has several areas of growth as follows:
 Generic pharmaceuticals; Local manufacturing is encouraged and open to foreign
investors to distribute their products in KSA
 Medical devices,
 “Healthcare IT; healthcare will continue to develop parallel to Saudi technology
improvement.” (Bassi , 2015)
 “Medical Education due to the gap between the requirements of healthcare sector
and the graduates in KSA.” (Bassi , 2015)

27
2.2.3.5 The major problems of Saudi healthcare system
1. Health Workforce
“Healthcare system is reliant on expatriates, Majority of healthcare professionals are
expatriates due to shortage of Saudi medical professionals, Attempts are being made to
increase the number of Saudi medical professionals, By 2000 there were 5 medical
colleges in Saudi Arabia, Those institutes were not enough to full fill the requirement of
the Saudi Arabia, To overcome this problem many new government and private institutes
were opened, 21 medical colleges by 2012 in Saudi Arabia were not enough, Still there is
serious need for medical colleges.” (Indian Journal of Applied Research, 2016)
2. Underutilization of Resources
“In Saudi Arabia the free healthcare is available to all citizens that sometimes lead
patients demand unnecessary health services.” (Indian Journal of Applied Research, 2016)
“Several hospitals are equipped with sophisticated equipment, however sometimes the
equipment is used for minor problems, Highly cost equipment is lying idle due to shortage
of trained person, Because of no proper coordination between hospitals; so same
equipment’s are available in both hospitals which in some cases may be avoided by proper
coordination., Absence of accountability is also a reason for this problem.” (Indian Journal
of Applied Research, 2016)
“In Saudi Arabia several government agencies are involved in providing healthcare
services, these agencies have no well-defined mechanism for coordination; so there are
duplication of effort that leads to waste of resources, therefore, costly medical resources
are underutilized in Saudi Arabia.” (Indian Journal of Applied Research, 2016)

28
3. Unequal Distribution of Resources
“The majority of the specialized hospitals, government and private hospitals which highly
equipped, highly qualified and professional staff are located in big cities where as
hospitals in rural areas do not have proper infrastructure.” (Indian Journal of Applied
Research, 2016)
4. Language
“High number of health professional are expatriates, a high number of these expatriates
do not speak Arabic, and English is not very common among Saudis so there is a language
barrier between patients and professions, Arabic language courses could be useful for
professionals who do not speak Arabic.” (Indian Journal of Applied Research, 2016)
5. Cultural Effects
“As mentioned above most of the medical professionals are expatriates who are from
different cultural backgrounds, in sometimes expatriates are not able to understand the
Saudi culture correctly, that leads to cultural misunderstanding and conflicts between
healthcare professionals and patients, For example, In Saudi Arabian society, families are
very important, Families are of an extended nature, The family involvement in the care of
a patient creates a conflict with nurses and other medical professionals, Proper cultural
education programs should be the part of the recruitment process to avoid the cultural
sensitivity.” (Indian Journal of Applied Research, 2016)

29
6. Decentralization of Healthcare Decision Making
“According to some voices in Saudi Arabia; Ministry of Health takes the majority of the
decisions in the public healthcare system which creates inefficiency and waste of
resources in the system, Decentralization of authority is possible solutions to overcome
this problem, Power should be given to Regional centers to make policies appropriate for
their regions that will have better management of resources and ensure more
accountability and excellent services, Autonomy may be given to big hospitals so that
they can plan their recruitment process, short term and long term strategies, no one can
deny that the Financial Autonomy with proper accountability is the key to better decision
making.” (Indian Journal of Applied Research, 2016)
“Adequate autonomy to hospitals will help the public hospitals to develop in private
hospitals and give public hospitals more knowledge in the management of their budgets,
health care quality and workforce.” (Indian Journal of Applied Research, 2016)
7. Unequal Distribution of Healthcare Services
“There is an unequal distribution of health services in Saudi Arabia, Some hospitals in
urban areas are providing high class facilities whereas hospitals in rural areas and remote
areas do not have the same facilities, Some hospitals are overcrowded and there is a long
waiting list for many health care services and facilities, Hospitals in remote areas are not
well equipped to provide services to elderly people and people with special needs, Special
efforts are required to distribute the resources equally to overcome overcrowded hospitals
and provide quality health services.” (Indian Journal of Applied Research, 2016)
8. Prevalence of Chronic Diseases
“Life style related diseases such as diabetes, hypertension, and heart diseases are
increasing, that represent a lot of financial burden on Saudi healthcare system, Preventive
steps are necessary to reduce this problem, Health education should be provided for health
life, The people should be made aware of the problems a poor life style can create.” (Indian
Journal of Applied Research, 2016)

30
2.2.3.6 Impact of Economic Restructuring on Healthcare Decision Making
Behavior
Longman Dictionary of Contemporary English defined impact as the effect or influence
that an event or a situation has on someone or something.
(Longman, 2017)
Economy also defined as the wealth and resources of a country or region, especially in
terms of the production and consumption of goods and services.
(Merriam, 2017)
Restructure is to make a basic change in the economy.
(Farlex, 2017)
Regarding these definitions, this research try to investigate the influence of intended
change in the basics of the wealth and resources of Saudi Arabia to decrease the reliance
of Saudi Arabia on petrol income on the healthcare decision making behavior.
Key Government Regulators in the Sector
“The Ministry of Health and the Food and Drug administration are responsible for
the administration of the healthcare industry in Kingdom, while the Council of
Cooperative Health Insurance supervise the insurance sector, The Ministry of Health
supervises healthcare service providers.” (Sterling, 2016)
“The Saudi Arabian General Investment Authority (“SAGIA”) is responsible for the
foreign direct investment.”(Sterling, 2016)
“The MOH is working with SAGIA to coordinate a strategy to create an efficient
regulatory system and cultivate a healthy atmosphere to attract private health investors
from abroad which is a major key outcomes that Saudi Vision 2030 is aiming at.”
(Sterling, 2016)

31
2.2.3.6.1. Vision2030 is supporting Healthcare despite Economic
Deceleration
“The kingdom is counteracting the fall in oil prices by decreasing the governmental
spending and formatting the structural changes to the economy. The research expect that
the kingdom will be committed to maintaining of healthcare services.” ( BMI , 2016)
“Vision 2030 is planning to reform the Saudi healthcare system to improve quality of care
services, the public sector will have the greater involvement, there will be focus on
diseases prevention, Healthy lifestyles that include sports and exercise will be encouraged
to prevent chronic diseases. Furthermore, areas of investment as clinics and home care
will be improved to reduce the burden on hospitals, Competition among providers, both
public and private, will be created. The government intends to reduce its involvement in
first-line medical care and reinforce its supervisory roles.” ( BMI , 2016)
2.2.3.6.1.2. Impactof Saudi Vision 2030 onhealthcare sector
Healthcare sector is a major concern so “The National Transformation Program 2020”
aims to:
 Substantial privatization of the public sector of healthcare as the Kingdom’s
medical cities,
 Establishment of partnerships between the public and private sectors,
 Development of the new domestic healthcare programs and
 Encouragement of the foreign partners to invest in local healthcare,
Vision 2030 shows many challenges to the healthcare sector as Saudization targets, as the
sector is dependent on the expatriates who are the majority of the professional workforce.
(Sterling, 2016)

32
Currently, the majority of healthcare products as the pharmaceuticals and the medical
equipment are mostly imported. An objective of Vision 2030 is to improve the local
industries including domestic pharmaceutical companies. (Sterling, 2016)
A. Focus on Privatization
“Saudi Arabia has experienced much costs along with concerns about quality of care in
its public facilities, to address these issues the country is currently restructuring their
healthcare system to privatize public hospitals and introduce insurance coverage for both
foreign workers and citizens, the changes provide an interesting case for the challenges in
radically changing a country’s healthcare system, the situation also demonstrates a unique
case in the Middle East for greater dependence on the private sector to address rapidly
increasing healthcare costs and deteriorating quality.” (Arab News, 2016)
“The Kingdom’s health care sector transformation is being guided by the Saudi Vision
2030 and National Transformation Plan, along with the Ministry of Health. Therefore, the
Saudi health care market, the largest in the GCC, is set to grow by 69 percent from $16
billion in 2015 to $27 billion by 2020, according to a recent report by Alpen Capital.”
(Arab News, 2016)
B. Focus on Ministry of Health
“Saudi Vision 2030 is aiming at; efficient use of resources, use of information technology,
more training, attractiveness of medical support staff as a preferred career for Saudis,
improve healthcare provision, development of the primary care, enhancement of
accountability with regards to quality issues and patient safety, adoption a national plan
for emergency response to public threats in line with international standards, Improve the
quality of life and healthcare service provided to patients, increasing the capacity and
quality of healthcare education (through partnership with the Ministry of Education) and
Ensure sufficient supply of basic medicines.” (Al Tamimi Consultants, 2016)

33
C. Focus on SAGIA
“Vision 2030 aims at localizing the healthcare industry.” (Al Tamimi Consultants, 2016)
D. Focus on SFDA
“Vision 2030 aims at establishment a Centre for Standardization of Medical Products and
Equipment.” (Al Tamimi Consultants, 2016)
E. Focus on the Foreign Investor
“Vision 2030 offers areas of investment for foreigner investors several as follows;
increasing the coverage of medical insurance, digital transformation, increase the
Healthcare Education, improvement of the training facilities and professional
development and.” (Al Tamimi Consultants, 2016)
F. Focus on Healthcare Education and Training
“Vision 2030 emphasize on healthcare education and training due to the recognized need
for qualified Saudi healthcare practitioners and support staff.” (Al Tamimi Consultants,
2016)
G. Focus on Pharmaceutical Industries
“Saudi vision 2030 aims at localization of the pharmaceutical industries to ensure
adequate supply of medicines. Foreign pharmaceuticals are being encouraged to establish
plants in Saudi Arabia through public-private partnerships.” (Al Tamimi Consultants,
2016)

34
H. Budget of Health and Social Development
“Budget of the healthcare and social affairs in 2015 were 160 billion Saudi Riyal, a huge
48 percent growth from 2014 figures. But, Budgeted expenditures for the healthcare and
social affairs sectors in 2016 were set at SAR 105 billion, a huge 34.5 percent minus
growth from 2016 figures. However, in a way of correction SAR 120 billion with 14.2
Percent growth versus 2016 was the Budget of the healthcare and social affairs in year
2015.” (International Trade Administration, 2016)
2.2.4 Summary
The theoretical framework of the study will be designed based on the
understanding of different and related literature reviews.
Chapter 3: Methodology: Summary of Empirical Study

35
The main objective of this chapter is to introduce the used method followed by sampling,
questionnaire, method of data collection, and finally the statistical analysis tools.
3.2 ResearchMethod
The aim of this research to clarify the impact of the globally low oil prices on Saudi
healthcare sector decision making behavior. The research approach is a blended of
qualitative and quantitative approach, the qualitative one to study the impact of the
recently Saudi economy restructuring on the short and long term plans within the Saudi
healthcare sector. The quantitative approach to study the impact that the stakeholders have
received as a consequences of this restructuring.
Survey and sampling method used for collection data and analysis, secondary is a highly
supportive tool, survey and interviews were conducted to collect the needed information
for this research.
3.3 ResearchDesigning
Questionnaire and survey were used as the tools to generate the primary data related to the
quantitative approach, this survey clarified the impacts that have affected the healthcare
sector as result of the recently Saudi economy restructuring following the globally low oil
prices and the corrective actions planned by the Saudi governmental decisions makers.
Also, multi interviews have been conducted to acquire the needed information to close the
gap between the idea and the current situation to show a clear picture about the new model
of Saudi healthcare sector.
3.4 Population & Sampling

36
“A population is a collection of people, items, or events about which you want to make
inferences.” (Minitab Inc, 2016)
“A sample is a subset of people, items, or events from a larger population that you collect
and analyze to make inferences, to represent the population well, a sample should be
randomly collected and adequately large.” (Minitab Inc, 2016)
The sample for this research include:
1. healthcare sector representatives
2. Patients
3. Sales managers in pharmaceutical company
4. Pharmacists in standalone pharmacy
5. Purchasing managers
6. Polyclinics Owners
7. Physicians
8. Insurance Companies Representatives
The scope of selection is focused on the Saudi healthcare sector as it is crucial sector
determining the quality of life and its needed annual budget increase year by year and has
a very important role in society establishment.
Through healthcare providers, healthcare companies, patients receiving services,
Physicians, pharmacists and polyclinics owners, the study survey contains closed
questions to obtain a directly general idea about the impact of the recently economic
restructure on the Saudi healthcare sector.
Due to time, cost, limited accesses and other constraints the size of the sample is focused
only on the above mentioned healthcare stakeholders.
3.5 Sampling Method

37
The researcher used the stratified random sampling method as a sampling plan for this
survey. The researchers categorized the populations into categories as healthcare
providers, pharmaceutical companies, polyclinics owners, community pharmacies
insurance companies, patients and physicians. Under each category, a random sample was
selected for the study survey. The focus on respondents was the healthcare stakeholders
in different centers who are related to decision making or evaluation of quality of service
or impacted by the new approach of the Saudi healthcare sector.
Due to the time, cost and restricted accessibility, the chosen samples was 500 healthcare
stakeholders.
3.6 Questionnaire Designing
The sources of data are primary and secondary and it was collected through quantitative
and qualitative research techniques. The primary date was gathered by survey and the
secondary one was gathered through various literature reviews and online articles. Both
data were subjected to the further analysis process. The questionnaire design is based on
different variables that are raised in the problem statement. A well-designed questionnaire
should make it easy and clear for respondents to provide the necessary information which
will affect the research result and output.
As this research will clarify the impact of the recently Saudi economic restructuring on
Saudi healthcare sector, specific questionnaire is designed for this study.
There are 300 persons from different occupational areas interacted with this questionnaire.
Chapter 4: Presentation of Data: Empirical Study

38
4.1 Introduction
This chapter present the collected data during this study through the survey, the data is
collected randomly irrespective of the different categories of persons interacted with the
survey in the form of questionnaire. The sample size is 500 respondents and the
researchers collected data through online survey, face to face interviews and phone calls,
after collection of data of different channels in one poll, the analysis tools of the study are
applied.
4.2. Sample Analysis
4.2.1. Respondents ‘Profile Sample Analysis
4.2.1.1. Total Respondents’ Sample Analysis
4.2.1.1.1. Respondents’ Relationship to the healthcare sector

39
Respondent’s relationship to the healthcare sector is one of the factors that may affect on
the point of view of respondents to clarify the impact of the recently economic
restructuring on the healthcare sector. So the interviewees is requested to exposure their
nature of interactions with the healthcare sector and the statistics are shown in the below
chart (Figure-1)
Figure-1 Respondents’ Relationship to healthcare sector
Source: Research Data
Statistics refer that the majority of the respondents are healthcare receiver (70 %) while
the healthcare providers represent (30 %) of the interviewees.
4.2.1.1.2. Respondents’ Type (Public or Private)
It is a crucial factor in this study to determine if the respondents are from the public or
private sector as each part will have its own point of view which by end will contribute to
general picture of this research, the statistics are shown in the below chart (Figure-2)

40
Figure-2 Respondents’ Type in healthcare sector (Public or private)
Statistics refer that the majority of the respondents belongs to private healthcare sector (90
%) while the public healthcare sector represents (10 %) of the interviewees.
4.2.1.13 Respondents’ Province
No one can deny that Respondent’s location is one of the factors that may affect the
clarification of the changes in the healthcare sector as each region has its different
demographics which finally will affect the research result. So the interviewees is requested
to exposure their locations, the statistics are shown in the below chart (Figure-3)

41
Figure-3 Respondents’ Location in KSA
Statistics refer that the majority of the respondents are in Riyadh (70%) while (20%) are
resident in Jeddah and (10 %) are resident in Dammam.
4.2.1.2. Providers Respondents’ Sample Analysis
4.2.1.2.1. Providers Respondents’ Market Share
The healthcare Provider’s market share is one of the factors that may affect the extent of
the impact of the recently economic restructuring on the healthcare sector. So the
researchers classified the healthcare sector providers according their market share to high
and low market share, the statistics are shown in the below chart (Figure-4)

42
Figure-4 Providers’ Market Share in KSA
The statistics refer to that (60 %) of the interviewees acquire high market share while the
low market share providers represent 40 % of the interviewees.
4.2.1.2.2. Providers Respondents’ Type (Local or Foreigner)
Type of one of the factors that may affect the clarification of the impact of the recently
economic restructuring on the healthcare sector. So the interviewees is requested to
exposure their relationships to the healthcare sector and the statistics are shown in the
below chart (Figure-5)

43
Figure-5 Providers’ Type (Local or Foreigner)
4.2.1.2.3. Respondents’ Job (Providers) in the healthcare sector
Respondent’s Job of providers the healthcare sector is one of the factors that may affect
the clarification of the impact of the recently economic restructuring on the healthcare
sector. So the interviewees is requested to exposure their Job in the healthcare sector and
the statistics are shown in the below chart (Figure-6)

44
Figure-6 Providers’ Job in HCS
The statistics refer to that 75 % of the interviewees are physicians and Pharmacists, the
remaining participants were Pharmaceutical Sales managers, Polyclinics’ Owners and
Insurance Companies’ Representatives.
4.2.1.3. Receivers Respondents’ Sample Analysis
4.2.1.3.1 Respondents ‘Patient Age (Elder & Younger)
Respondent’s relationship to the healthcare sector is one of the factors that may affect the
clarification of the impact of the recently economic restructuring on the healthcare sector.
So the interviewees is requested to exposure their relationships to the healthcare sector
and the statistics are shown in the below chart (Figure-7)

45
Figure-7 Patients ‘Age in HCS
4.2.1.3.2. Respondents’ Patients Gender
The gender of the interviewee is very important factor in such a conservative country, also
services they receive and decision they take are different rather than male, that is why it
may affect the clarification of the impact of the recently economic restructuring on the

46
Healthcare sector. So the interviewees is requested to exposure their gender, and the
statistics are shown in the below chart (Figure-8)
Figure-8 Patients ‘Gender in the study survey
Statistics refer that the majority of the respondents are males while females represent only
(9 %) of the interviewees.
4.2.1.3.3. Respondents’ Patients (Insured & Uninsured)
Insurance is one of the factors that may affect the clarification of the performance of the
healthcare sector so the interviewees is requested to exposure if they are insured or
uninsured, the statistics are shown in the below chart (Figure-9)

47
Figure–9 Patients’ Type (Cash or Insurance)
The statistics refer to that 75 % of the interviewees are insurance patients while the
minority of the patients are cash patients.
4.2.1.3.4. Respondents’ Patients (Saudis & Residents)
The impact of recently economic restructuring on the healthcare sector differs from the
citizens to Residents. So the interviewees is requested to exposure if they are Saudi or
resident, and the statistics are shown in the below chart (Figure-10)

48
Figure–10 Patients’ Type (Saudis or Residents)
Statistics refer that the majority of the respondents are Residents (70 %) while the Saudis
patients represent (30 %) of the interviewees.
4.2.1.3.5. Respondents’ Patients quality of life
Quality of life of patients will affect the way they receive the changes in the healthcare
sector, so the researchers classified the interviewees according their quality of based on
asking them about their monthly income, and the statistics are shown in the below chart
(Figure-11)

49
Figure–11 Patients’ quality of life levels
Statistics refer that the majority of the respondents are of median level of life quality, (20
%) of low level and only (10 %) of the interviewees represent the high level of quality of
life.
4.2.2. Impact of emergent changes through HSC on Respondents as a result of the
global low oil prices.
As a result of the decline in global oil prices, Saudi Arabia has launched a series of
austerity plans, which in turn have affected the health sector with radical changes affecting
the receivers and providers of health services in the sector, so the respondents are
requested to mention the impacts touched as a clear changes in the sector starting with
most important impact, the results were as shown in chart (Figure-12)

50
In this type of survey the researchers divided the questions to two groups; one for the
respondents ‘receivers (Patients) and the other for the respondents ‘providers (other
stakeholders) as follows:
4.2.2.1. Impacts on Respondents’ Receivers (Patients)
Figure–12 Impact of Economy Restructuring on Patients
Statistics refer that the majority of the respondents are suffering from increased insurance
cost (252 Patient) and 170 patients are suffering from shortage of long term therapy
products, however, 120 patients of the respondents are happy with the clear improvement
of quality of care and majority of patients (250 Patients) admitted that their behavior has
been influenced by the austerity trends in the kingdom.
4.2.2.2. Impacts on Respondents’ Providers

51
Figure–13 Impact of Economy Restructuring on Healthcare Providers
The statistics refer to that all healthcare providers are suffering from decrease in profit
margin, sales drop and Saudi regulations ‘barriers and they are requested to follow
saudization trends. Also the majority of patients are in tough competition and they had a
shortage in cash flow. Monthly incentives of 23 % of respondents have been cut. However,
23 % of healthcare providers agree with the privatization trends of healthcare sector in the
kingdom, 50 % of respondents agree that there are a lot of opportunities for GCC
Companies and 53 % of respondents are optimistic of the Saudi healthcare future.

52
Chapter 5: Analysis of Data
5.1. Introduction
This chapter will present the results of the sample analysis, tables and charts are used to
present the data as an output of SPSS data processing results, following by data analysis.
The objective of this chapter to define the relationship between the research methodology
elements and the impact of economy restructuring on healthcare sector and its
consequences on all healthcare stakeholders.
5.2. Statistical Analysis
“A descriptive analysis technique was used to analyze the survey output, this research
used the software of SPSS to analyze the exploratory factors, SPSS gave the scales of
items for a construct, the reliability of those items has been assessed based on the
calculation of the Cronbach’s alpha, Cronbach's alpha is one e of the most popular
reliability statistics in use today, Cronbach's alpha determines the internal consistency or
average correlation of items in a survey instrument to gauge its reliability.” (Extension
Journal, Inc, 1999)
5.3. Data Reliability
The respondents of this survey were 500 persons from whom the researchers got complete
feedback. It was crucial to measure the internal reliability of each construct with all
different items as the sample population was of different relations to healthcare sector.
5.4. Reliability Statistics
Cronbach’s Alpha No of Items
0.778 35
Table-3 Reliability Statistics

53
For testing the reliability of the survey, Cronbach’s alpha was calculated for the items of
each construct. If the Cronbach’s alpha is more than 60 % that means the reliability is
accepted so as the Cronbach’s alpha of this survey was 0.778 the reliability of this research
is accepted.
5.5. Frequencies
5.5.1. Respondents ‘Profile
The first section of questionnaire include profiling of respondents, profiling was divided
into 3 parts; the first was about all the respondents one shot (500 respondents), the second
part was about all healthcare receivers (Patients) (350 respondents) and the third part was
about of profiling of healthcare providing (150 respondents).
The second section of questionnaire was about the impact of the recently economy
restructuring on healthcare sector which was divided into two parts; one about the patients
and the other about the providers.
5.5.1.1. General Respondents’ Profile:
In this part the questionnaire was about the sample population generally regarding
interaction type with the healthcare sector, nature of the sector whatever private or public
and finally, the location of the respondents to the survey.
Item Type Frequency Percentage
Relations of
Respondents
to
Healthcare
Sector
Healthcare Providers 45 30 %
Healthcare
Receivers(Patients)
105 70 %
Public 50 10 %

54
Type of
Healthcare
Sector
Private 450 90 %
Regions of
Respondents
Riyadh City 350 70 %
Jeddah City 100 20 %
Dammam City 50 10 %
Table-4 General Respondents’ Profile
It seems that the majority of the respondents were receivers of healthcare sector services
with 70% of the total participants while 30% are healthcare services providers, It is clear
that the dominant participants in the questionnaire were from private healthcare sector
while only 10% were from the pubic healthcare sector, and finally the majority of
respondents were from Riyadh by 70%, 20% from Jeddah and 10% from Dammam.
5.5.1.2. Providers ‘Respondents’ Profile:
In this part the questionnaire was about the provider’s category of the respondents
regarding their market share, nationality of provider and finally the nature of the sector
whatever private or public.
Market
Share
High Market Share 90 60 %
Low Market Share 60 40 %
Local or
Foreigner
Local Provider 120 80 %
Foreigner Provider 30 20 %

55
Type of
Healthcare
Sector
Public 50 10 %
Private 450 90 %
Table-5 Providers Respondents’ Profile
This table shows the majority of the providers were from private healthcare sector (90%)
and they are from local businesses (80%). It shows also that 60% of the providers acquire
high market share while 40% of them have a low market share.
5.5.1.3. Receivers ‘Respondents’ Profile (Patients Profiling)
In this part the questionnaire was about the receivers (patients) category of the
respondents regarding some demographics as age, gender, cash of or insurance, Saudi or
resident patient ended by level of quality of life of patients who are receiving the
healthcare services.
Patient Age
Older Patient 210 60 %
Younger Patient
140 40 %
Patient Gender
Male
315 90 %
Female
35 10 %
Insurance
Insured Patients
252 72 %
Uninsured Patients
98 28 %
Saudi Patient
70 20 %

56
Patient
Saudi/Resident Resident Patient
280 80 %
Patient’s
Quality of life
High
35 10 %
Median
245 70 %
Low
70 20 %
Table-6 Receivers ‘Respondents’ Profile (Patients Profiling)
It seems that the dominants of the patients were males (90%), the majority of the patients
were residents (80%) while 20 % represented the Saudi patient who participated in this
survey, also the Insured patients represented (72%) but the Uninsured patients were
(28%), 60% of the patients were youngers while 40 % were elders. and finally the majority
of respondents were of median level of life quality(70%),20% represented the low level
while the high level of life quality was represented by only 10% of the patients who
participated in the survey.
5.5.2. Impact of emergent changes through HSC on Respondents as a result of the
global low oil prices.
In this part the questionnaire was about Impact of emergent changes through HSC on
Respondents as a result of the global low oil prices which had two categories the 1st on
receivers and the 2nd on the providers group as follows:
5.5.2.1. Impact on Receivers (Patients)
Impact No of Affected Patients Percentage
Increase of Insurance Cost 252 72 %
Shortage of Long Term Therapy 170 49 %

57
No Equity of Resources 50 14 %
Waiting for Medical Attention 35 10 %
Refuse Of Urgent Cases 13 4 %
Patient Behavior(Austerity) 250 71 %
Decreased Cash Services Cost 100 29 %
Improved of quality of Care 120 34 %
Table-7 Impact on Receivers (Patients)
In table no-9 the researchers asked the patients about the positive and negative changes
they felt in the healthcare sector which are synchronized with economy restructuring due
to the global low oil prices, 72% of patients were suffering from annually increased
insurance cost, 49% of patients suffered from shortage of long term therapy, 14% of
patients noticed that there was no equity of services, 10% of patients suffered from waiting
for medical attention and 4 % suffered from refuse their urgent cases. 71% of patients
have changed their behavior parallel to the austerity trends in the kingdom. However, 29%
of patients were happy with the decreased cost of cash services and 34% of them were so
happy with the improved quality of care.

58
Figure-14 Question Orders (Impacts on Patients)
5.5.2.2. Impact on Providers
Impact No of Affected Providers Percentage
Decreased Profit Margin 150 100 %
Tough Competition 120 80 %
Sales drop 150 100 %
Regulations Barriers 150 100 %
Saudization 150 100 %
Decreased Cash Flow 110 73 %
Monthly Incentives Cut 35 23 %
Crises Recovery 3 2 %
Privatization Trends 35 23 %
GCC Companies Opportunities 50 33 %
Optimists 80 53 %
Table-8 Impact on Providers
In table-10 the researchers asked the healthcare providers about the positive and negative
changes they felt in the healthcare sector which are synchronized with economy
restructuring due to the global low oil prices, all providers suffered from decreased profit
margin, sales drop, regulations barriers and saudization obligations, 80% of providers
suffered from tough competition, 73% of them suffered from decreased cash flow, 23%
of providers suffered from incentives cut. However, 2% of providers had counteracted the
crises and the cover the loss, 33% of them see brilliant opportunities for GCC companies

59
and finally, 53% of providers are optimistic as they consider this period as transient stage
for a powerful economy and golden stage for of healthcare sector in Saudi Arabia.
Figure-15 (Impacts on Providers)

60
Chapter 6: Discussion and Interpretation of Findings
6.1. Introduction
This chapter provides the facts and complications of the results obtaining from the
respondents in the questionnaire questions. The questionnaire was distributed, during the
month of November 2016, on targeted sample of healthcare respondents who live in Saudi
Arabia.
6.2. Findings
Based on the main objective of this research, the findings is about the impacts of the
recently economy restructuring on the Saudi healthcare sector decision making behavior
regarding all its stakeholders whatever the receivers of the healthcare services or the
services providers as follows:
6.2.1. Impacts of changes through healthcare sector on Patients
The increased insurance cost, Shortage of Long Term Therapy and waiting for medical
attention are the main challenges facing patients in Saudi Arabia in the past months, also
few numbers of patients are suffering from non-equal distribution of resources which are
focused on central region rather than other cities.
Based on this survey, few numbers of patients suffered from refuse of admission due to
full capacity of hospitals, and also some patients in remote areas complained of unbalance
of resources distribution over the areas.
“A crucial issue has emerged from this survey, majority of patients (71%) have been
influenced by the austerity trends launched by kingdom of Saudi Arabia as a result of
the recently economy restructuring due to the global low oil prices.”
“The austerity means policies to reduce government spending and or higher taxes in order
to try and reduce government budget deficits.” (Pettinger, 2015)

61
this Saudi austerity trends have led patients to follow individual austerity which means
(the condition of living without unnecessary things and without comfort, with limited
money or goods, or a practice, habit, or experience). (Cambridge Dictionary, 2017)
Economic uncertainty affects people’s behavior, including how they spend money on
health care and on other commodities or activities that can affect health outcomes. Such
type of austerity led patients to seek the healthcare services only in serious needs. The
recession has kept patients from seeking inpatient and elective services although the
majority of those patients haven’t change in their monthly income, but have been affected
unintentionally by Saudi austerity trends
Impacts on quality were expressed at the time as the healthcare providers are trying to
attract more patient flow, so improved of care quality is a notable competitive edge of
the current time, because healthcare providers know that the patients want to be assured
that they will receive the services with high quality.
It is well known that insured patients flow is always more than uninsured patients flow in
any hospital or polyclinic, so, based on this survey, large number of patients who
participated in the questionnaire are happy with the decrease of the cost of cash services
which is consider a competitive edge to attract more patients in such a tough competition.

62
6.2.2. Findings of changes through healthcare sector on Healthcare Providers
The recently economy restructuring in Saudi Arabia shaped the complex interactions
among employment, health coverage and costs, and financial access to care and health
outcomes. The effects of economic stress and surges can be observed directly and
markedly across Saudi markets.
Based on this survey, Sales drop in a toughly competitive market which led to decrease
the cash flow which negatively affected the profit margin is the most challengeable issue
for all healthcare providers in kingdom of Saudi Arabia. There is falling revenues due to
decreased demand for less non-urgent or elective care, more patients unable to pay their
medical bills, significant losses in investment income, less charitable giving, and cuts in
health care funding by states and localities. Saudi healthcare plans are concerned with
providing care using the most cost effective way, so there is priority in purchasing of
healthcare services from the least expensive qualified provider which in turn increased the
cost of service decreasing the provider’s profit margin.
Based on the answers of the questionnaire, Regulation barriers and Saudization are crucial
obstacles against all healthcare providers; all healthcare providers have complained of the
Restricted regulations as in case of registration of new products in Saudi Food and Drug
Administration.
“Saudization is a big challenge for healthcare companies as the healthcare sector has high
number of expatriate’s workforce, qualified Saudi workers is the biggest challenge that
Saudi Arabia are challenging nowadays as, need for foreign workers will remain
mandatory in the coming years.” (Arab News, 2016)

63
Companies that do not achieve Saudization measures are not allowed to hire the required
competencies to achieve their objectives, although there are not enough Saudis qualified
to fill a large number of diverse jobs in the private sector, the Saudi government is forcing
companies to achieve Saudization whatever the their situations. In addition to what
mentioned above, Saudi applicants for jobs do not accept the same salaries as foreigners,
all this leads to increase cost of service and decrease the company’s competencies. All of
this reduces the attractiveness of the Saudi health sector to foreign investment.
“These legislative trends reflect broader changes in health care delivery. Also,
Occupational regulation has implications for quality of health care, labor supply and
mobility, and cost. However, the existing system of occupational regulation is complex
and cumbersome, dominated by professional interests, and slow to adapt to changes in the
health care system. As managed care expands, increasing competition and cost
containment in the health care sector, state regulatory bodies and third-party payers will
face the challenge of collaborating to ensure that economic incentives do not undermine
the quality of care or access to qualified providers.” (Nancy M. Pindus, 1997)
A considerable number of employees who participated in this survey have complained of
cutting their monthly incentives, this is due to the concept of employers who responded
to the pressures of economic downturns by shifting premium costs to employees. Also
employers intended to find ways to reduce their costs by changing benefits and cost-
sharing provisions.
As for the bright side of this survey;
 2 % of the healthcare providers participated in the questionnaire have recovered
the economic crises, and by face to face interview, it was clear that they had a clear
crises management plan to counteract this the crises and maximize the benefits As
much as possible.

64
 Based on this survey, a considerable number of healthcare stakeholders notice a
serious actions on the ground toward the privatization which has been approved
as an effective step to improve the economy of any state. “The kingdom offers
financial incentives to attract private-sector investment in its healthcare sector.”
(kojok, 2016)
 Gulf companies have an excellent opportunities due to the attractive incentives
offered by the Saudi government for these companies apart from others. Saudi
Arabia offers Gulf companies extraordinary facilities in Banking services, export
and import, establishment of new factories and flexibility in registration of new
products in Saudi food and drug administration which in turn show a wonderful
opportunities which must be exploit by these lucky companies.
 High percentage of the participants in this survey showed optimism about the
future of the Saudi economy, especially with regard to the health sector and its
positive impact on receivers and providers of healthcare services.

65
Chapter 7: Conclusion and Recommendations
1.1. Introduction
The main aim of this chapter is conclusion of the research objectives and findings,
discussion of findings ‘consequences, mention of the results limitations, offering the valid
recommendations and suggestions for future studies.
7.2 Summary of the finding
This research investigated the impact of recently Saudi economy restructuring due
to the global low oil prices on healthcare sector decision making behavior order to
have a clearer picture of the healthcare sector under the Saudi economy
restructuring. The results showed that there was a significant impact on all
healthcare stakeholders due to this restructuring.
The low global oil prices affected the Saudi economy which lead the Saudi
government to restructure its economy to convert it to non-oil based economy, this
restructure had a clear impact on the healthcare sector decision making behavior
representing by healthcare receivers and healthcare providers.
Regarding the impacts on the patients;
They were greatly affected by the austerity trends launched by Saudi government,
these trends have kept patients from seeking inpatient and elective services. Due to
excessive use of medication, increased Saudi labor cost due to saudization and
spread of chronic diseases; Insurance companies increased the prices of the
insurance policies. Budget cut of purchasing of pharmaceutical drugs led to
shortage of long term therapy which negatively affected patients of chronic
diseases. In contrast, a lot of patients were satisfied due to improved quality of care
they received. The patient has become more aware of the quality of service and
want to be assured that they will have access to the services they need and that

66
Services will be delivered by high quality, Uninsured patients received high quality
care with lower cost than previous due to tough competition among healthcare
providers and the increase of patient’s awareness.
Regarding the impacts on healthcare providers;
The results of the study revealed that most of change has done with the healthcare
providers, the economy restructuring led to highly dynamic changes in the Saudi
healthcare market followed by reallocation of providers’ positions in the market,
sales drop is a commonly major change occurred with the majority of healthcare
providers, And this is of course led to decreasing cash flow and profit margin.
Tough competition converted the market area of many companies and hospitals
from the blue ocean area to red ocean area, some providers were ready with
alternative plans to compete with these changes and others weren’t, this toughness
and the variation among providers regarding the talent of crises management were
the mean reasons of reallocation of healthcare providers in the Saudi healthcare
market. Some providers maximized their market share, some loss part of their share
and the others are surviving.
Saudization remains a barrier against development of many sectors for years,
especially in such sector which makes heavy use of foreign manpower. Restricted
regulations based on the survey were one of the major difficulties the providers
complained of. Cutting monthly incentives was also a problem for the employees
which was due to the concept of providers who responded to the pressures of
economic downturns by shifting premium costs to employees. In contrast, providers
which had a crises management plan have covered the crises. There is a strong
tendency for privatization which will create great opportunities for investment and
maximizing of market share of providers especially gulf companies which have
been offered special facilities rather others. The good conclusion in this survey
appears in the form of optimism that exists among participants as a large number
of them believe that the Saudi economy and the health sector in particular is moving
in the right direction.

67
7.3 Conclusion
The health sector is a very vital sector in any country's economy. When the health
sector succeeds in providing high-quality services, public health improves and
happiness among the citizens increases. Thus, the productivity of individual
increases and the economy improves significantly. The health sector has been
particularly affected by the impact of the Saudi economy. As for patients, they have
responded strongly to the austerity trends in the Kingdom even if their income is
not affected, reduce procurement budgets cause the shortage of some important
medicines, lack decreased profit margin of insurance companies led to raise of
prices of insurance policies, The severe competition in the Saudi health market has
contributed significantly to improving the quality of services offered and reducing
the prices of services provided to uninsured patients. Saudization and restricted
regulations were barriers against some healthcare providers. Privatization is a major
trend in Saudi Arabia in vision 2030 which will open new channels for
improvement and growth for healthcare providers especially gulf companies.
Vision 2030 gives special attention to the health sector in the Kingdom, which in
turn will reflect positively on the Saudi economy.
7.4 Contribution to the body of knowledge
The research has contributed to the knowledge in a way that it helps in clarification
of the full picture of the impact of the recently Saudi economy restructuring on the
healthcare sector. Thus, the research found that there is significant impacts on the
healthcare sector behavior nowadays.
In addition, the findings of the study will benefit many stakeholders particularly the
Ministry of health which manage the delivery of healthcare services to patients and
supervise the way the providers they deliver these services and establishes the
future plan based on market demand on varies aspects of health requirements.
Moreover, the research opened a new window for further studies under the same
topic.

68
7.5 Result limitations
The main constraint of this research was data collection which is observed from
low response of public sector due to shortage of access to governmental date. Due
to the conservative culture; only 9% females contributed to the survey. The
researchers utilized all possible facilities to get the feedback from healthcare
providers and patients.
There were barriers against collecting data from hospitals and other healthcare
providers due to confidential data of companies and privacy of patients. The
research is qualitative with less quantitative measures so quantitative studies should
be carried out to evaluate the situation in-depth. There were no previous studies to
help the researchers to be compared with this research.
7.6 Recommendations
Health is a key concern of all stakeholders. Based on the findings of this study, the
following tips of recommendations have been developed in this context for the health
sector in relation to governmental decision makers, healthcare providers and patients:
1. Investment (Healthcare Providers)
There is a huge opportunities for foreign investment as follows:
A. Expansion of medical insurance in the Kingdom due to insufficient coverage of health
insurance.
B. Medical training due to Limited number of doctors the scarcity of local talent.
C. Infrastructure development due to insufficient infrastructure and medical facilities.
D. Geographical expansion due to insufficient medical coverage.
So local and foreigner investors should exploit these opportunities in such an attractive
area of investment.

69
2. Saudi Government
 The research recommends the Saudi government to emphasize on privatization and
implementing its plans regarding the privatization as soon as possible to improve the
level of production to reduce the costs and burden on the public sector.
 While increasing financial resources, spending must be rationalized, health care
activities and services must be increased, and the demands for increased demand for
this service must be met. Also, Health Insurance & medical services purchase must
have schemes and sufficient supply of basic medicines must be ensured.
 Instead of imposing Saudization on the sector now which will take years to be achieved
based on the survey, government must first prepare and develop the health workforce
in both quantity and quality. In order to achieve the highest quality and efficient use
of the health sector. And reach the stage of approaching self-sufficiency of the national
workforce. And to ensure the training and good preparation of expatriate workers.
 The research recommends the government to emphasize its supervision on equal
distribution between regions inside the kingdom So that the required service is close
to the reach of those in need and It will be easy to obtain and work to minimize
disparities in service-based population equations between regions, taking into account
the participation of all sectors in the health service delivery network. And all above
should be According to standards approved by the Saudi Health Council and follow
up their application.
 The research recommends the government to launch incentives plans as soon as
possible to encourage the local manufacturing of generic pharmaceuticals and medical
devices.

70
3. Patients (Healthcare Receivers)
 Patient think that large hospitals have an advantage over the medium, but they are
constructive and as a result of the simple difference between them, the average
hospitals are more attractive, the cost is less and all that is needed is simple
improvements in the service department to become more competitive. In the case of
small clinics and hospitals, the results are easy to observe and indicate the preference
of clinics as a business opportunity. They have an advantage over staff and workers
who are covered by small hospitals and may be preferred among patients. The middle
class is targeted at low income (often with basic health insurance) to provide patients
quickly and distribute them easily in all areas and neighborhoods compared to small
hospitals.
 Patients should be aware of their rights and always educate themselves, follow health
instructions away from customs and traditions and give health the first attention in
their lives.
 Patients should ensure that they are fully insured for medical emergencies.
 Patients should dedicate a budget for awareness and improvement their life style and
to avoid the burden of the chronic diseases.
 Finally, Patients should follow the standard international basic lines of treatment in
both austerity and prosperity.
7.7 Suggestion for further studies
For future studies, it is suggested to conduct the research on a bigger sample to get
generalized results. Also to utilize more than one technique for data collection;
questionnaire and interview; Also, more perception dimensions shall be explored
even if previous studies do not exist. Furthermore, this study can be focused on
public sector and other cities. .
Researchers can go further and study this situation in depth by working on the limitations
discussed earlier, therefore, the research will be more useful.

71
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