The Saudi MOH has served the traditional role of the chief governmental health coordinator. These include regulating health products and quality of services, and setting prices. It also allocates global budgets for each hospital through each regional health directorate. However, one significant difference is the lack of comprehensive authority.
Unlike many countries where the healthcare ministry exercises authority over all segments of their healthcare systems, the Saudi MOH lacks authority over two important public sector health systems. The university teaching hospitals and the military hospitals fall outside of their purview. Also, the MOH exerts only indirect control over the growing private sector. The vast wealth generated by oil revenues was beginning to have an even greater impact on Saudi society. It led to rapid technological modernization, urbanization, mass public education, and the creation of new media.
This and the presence of increasingly large numbers of foreign workers greatly affected traditional Saudi norms and values. Although there was a dramatic change in the social and economic life of the country, political power continued to be monopolized by the royal family leading to discontent among many Saudis who began to look for wider participation in government. This year, nationalist voices on social media have set about attacking the state for its seemingly lenient attitude towards discussions of social issues on television programme The Dawood Show, calling such debates a threat to national security. The talk show began airing in early 2019 and its first episode addressed the growing problem of Saudi women fleeing the country.
Contesting such topics on air caused a backlash which resulted in suspending the program for one week. At the time is was not clear what was happening – many Saudis thought it a stunt by the state, perhaps to increase viewer numbers. In addition, online accounts are also pushing back against entertainment events and government bodies such as the Ministry of Media, arguing that people are being stripped of their values in a manner that weakens their loyalty to the leadership. From 2003 to 2013, "several key services" were privatized—municipal water supply, electricity, telecommunications—and parts of education and health care, traffic control and car accident reporting were also privatized. In November 2005, Saudi Arabia was approved as a member of the World Trade Organization.
Saudi Arabia maintains a list of sectors in which foreign investment is prohibited, but the government plans to open some closed sectors such as telecommunications, insurance, and power transmission/distribution over time. The government has also made an attempt at "Saudizing" the economy, replacing foreign workers with Saudi nationals with limited success. As of October 2018, Saudi Arabia is the largest economy in the Middle East and the 18th largest in the world.Saudi Arabia has the world's second-largest proven petroleum reserves and the country is the largest exporter of petroleum. It has the second highest total estimated value of natural resources, valued at US$34.4 trillion in 2016.Saudi Arabia's command economy is petroleum-based; roughly 63% of budget revenues and 67% of export earnings come from the oil industry.
The purpose of that spat was to show the world Saudi Arabia's intolerance of criticism of its regional policies. The Saudi government is also willing to push back internationally on any external interference in its domestic issues. In August 2018, the Canadian embassy in Riyadh tweeted a call in Arabic urging Saudi Arabia to release women's rights activists.
The Kingdom retaliated, expelling the Canadian ambassador, calling Saudi students home from Canadian universities, stopping flights between the countries, and freezing trade. At home, the nationalist narrative celebrated the Kingdom's fast and resolute action. Adel Al-Jubeir, former Saudi foreign minister and current minister of state for foreign affairs, declared that Saudi Arabia was not to be treated as a "banana republic". The episode sent a message to other nations, with Canadian interests becoming collateral damage in this. Following recognition in 1931, the United States and Saudi Arabia established full diplomatic relations, with exchange of credentials and the first U.S. ambassadorial posting to Jeddah, in 1940.
Saudi Arabia's unique role in the Arab and Islamic worlds, its holding of the world's second largest reserves of oil, and its strategic location all play a role in the long-standing bilateral relationship between the Kingdom and the United States. The United States and Saudi Arabia have a common interest in preserving the stability, security, and prosperity of the Gulf region and consult closely on a wide range of regional and global issues. Saudi Arabia plays an important role in working toward a peaceful and prosperous future for the region and is a strong partner in security and counterterrorism efforts and in military, diplomatic, and financial cooperation.
Its forces work closely with U.S. military and law enforcement bodies to safeguard both countries' national security interests. The United States and Saudi Arabia also enjoy robust cultural and educational ties with some 37,000 Saudi students studying in U.S. colleges and universities and scores of educational and cultural exchange visitors each year. The United States also provides promising youth and emerging Saudi leaders the opportunity to experience the United States and its institutions through the International Visitor Leadership Program and various other exchange programs. At the time the Kingdom of Saudi Arabia was founded in 1932, education was not accessible to everyone and limited to individualized instruction at religious schools in mosques in urban areas.
By 2007, Saudi Arabia's public educational system comprised 20 universities, more than 24,000 schools, and a large number of colleges and other educational and training institutions. Open to every citizen, the system provides students with free education, books and health services. Over 25 percent of the annual State budget is for education including vocational training. The kingdom has also worked on scholarship programs to send students overseas, mainly to the United States, Canada, the United Kingdom, Australia, Japan, Malaysia and other nations. Obesity is a problem among middle and upper-class Saudis who have domestic servants to do traditional work but, until 2018, were forbidden to drive and so are limited in their ability to leave their home.
The religious police, known as the mutawa, imposed many restrictions on women in public in Saudi Arabia. The restrictions include forcing women to sit in separate specially designated family sections in restaurants, to wear an abaya and to cover their hair. However, in 2016, the Saudi cabinet has drastically reduced the power of the religious police and barred it "from pursuing, questioning, asking for identification, arresting and detaining anyone suspected of a crime". According to the BICC, Saudi Arabia is the 28th most militarized country in the world and possesses the second-best military equipment qualitatively in the region, after Israel.
By the late 2010s, there have been continual calls for halting of arms sales to Saudi Arabia, mainly due to alleged war crimes in Yemen and especially following the assassination of Jamal Khashoggi. The implementation of private healthcare insurance for all Saudi citizens and expatriates is now taking place. In reality, all Saudi citizens currently have national health insurance.
The major change for Saudis will be to allow them to opt out of the traditional governmental facilities. Adding private health insurance will probably not change the healthcare utilization substantially, unless concurrent changes are made to the provider payment systems and/or the addition of patient deductibles, coinsurances, and utilization review. If these changes are made, the effect upon the market structure, patients, and providers will be significant.
If these changes are made and a more competitive market ensues, the existing private hospitals in Saudi Arabia may be best prepared to act and benefit by taking sizable volumes of patients from the market. Initially the loss of patients may be welcomed by the public facilities, as waiting lists would be reduced. However, when the demand drops below capacity levels and vacant beds ensue, public healthcare facilities will then become concerned. The transition to a national health insurance program is expected to reduce the government's share of healthcare expenditures by beginning wage-based contributions toward healthcare premiums. The third phase was implemented in 2005 and expatriates, making up about 25% of the population, have been required to have health insurance coverage.
Requiring insurance will have the direct effect of allowing the risk of annual healthcare expenditures to be shifted from the government to an insurance company. This will permit the government to better project the annual healthcare expenditures, and potentially, reduce costs if insurance companies introduce co-payments, deductibles, and utilization review mechanisms. The introduction of health insurance is intended to free the Kingdom from some of the financial burden of providing free medical care to all nationals and some foreign workers in the country. Furthermore, this will ensure that expatriates have medical care coverage and allow greater freedom of choice. The private healthcare sector has grown rapidly since the advent of interest free loans from the government to construct private facilities.
The private sector grew rapidly over the past several years and expanded its services, especially in large cities. In 1971 there were only 18 private hospitals, but this number had grown to 75 by 1996 and to 113 by 2005, accounting for approximately 21% of all hospital beds.3 The private sector has been the primary service for foreign workers. Foreign workers, until recently, have not been allowed to use MOH facilities, except for emergencies. However, the private sector has also primarily served Saudi citizens.
In 1995 approximately 80% of all private healthcare services provided were given to Saudi citizens, who were eligible for free services through the MOH. Healthcare in Saudi Arabia currently is provided free of charge to all Saudi citizens and expatriates working in the public sector, primarily through the Ministry of Health and augmented by other governmental health facilities. The government requires that expatriates working in the private sectors have some level of healthcare coverage paid by their employers. Healthcare in Saudi Arabia has been funded primarily by public (75%) or out-of-pocket expenditures (about 25%).
What has been distinctive has been the low level of private insurance involved in the provision of healthcare. Almost all of the private expenditures have been out-of-pocket payments for services in private hospitals and clinics. Governmental funding is allocated through annual budgets to individual ministries and programs. Royal decrees may be issued for allocations of additional funding for special health programs and projects. With the "Saudi First" foreign policy in full swing, these developments drove the government to pour further fuel on the nationalist fire. For instance, Awwad Al-Awwad, minister of media at the time, declared that no person should remain neutral in their media coverage.
He was referring to the coverage of the ongoing war in Yemen, but this rhetoric quickly became common currency for the multiple regional and international issues the Kingdom found itself drawn into. Social media accounts now frequently publish hashtags condemning "neutrality". It aims to embed the nationalist narrative at the grassroots level by urging citizens to voice their support for these top-level aims. But the third wave of arrests signified that the state is firmly against any form of mobilisation or grassroots demands for reform. Social activism, especially that related to the position of women, began as early as the 1990s, but the state did not consider it to be a threat to its position or interests. On the contrary, for decades, the dominant religious discourse presented women's rights activists as tools used by foreign powers to break up the family unit, and they emphasised the need to maintain the role of women within the domestic sphere.
However, the third wave of arrests demonstrated how the state was assuming responsibility for providing social reforms – based on its own assessment of what to do and when to take action. This was a departure from the previous leadership, which balanced competing demands, sometimes fulfilling those of activists and sometimes standing with the conservatives. And those at the top have made clear that grassroots activists are not to request or demand change. From that point onwards, the newly minted nationalist narrative accelerated the rise of Mohammed bin Salman, promoting him from an unknown son of the new king to the most well-known royal figure. In April 2016, support for him reached its pinnacle when he unveiled his cornerstone strategy for economic diversification, Vision 2030.
What country does Saudi Arabia belong to This became the symbol of Mohammed bin Salman's domestic ambitions and his bid to address young people's concerns about the sustainability of an oil-dependent economy. Indeed, in implementing the vision, he has made sure to constantly underline the importance of young people, identifying them as the real vehicle for change. Overall, the leadership has broken from the old social contract by emphasising that Saudi Arabia has now entered a new era in which citizens must contribute to the good of the country, as opposed to simply receiving benefits as their forebears did. The government's response to another uprising that occurred in 1979, led by the Islamic radical Juhayman al-Otaybi, was markedly different.
Increasing resentment of the government's corruption and close relationship with the US as a betrayal of Islamic principles culminated in an attempted coup towards the end of the year, with hundreds of militants calling for an end to Saudi rule. However, though the uprising itself was suppressed and its leaders executed, King Khaled subsequently took steps to increase rather than diminish the influence of Wahhabi doctrine over the country's political and social life. This was manifested in almost every aspect of life, including media censorship, cultural restrictions and increased gender segregation. The ensuing years also saw the expansion of religious universities, Islamic centres and the religious police, as well as the entrenchment of extremist perspectives in educational materials and curricula. According to Robert Lacey, now that 'the House of Saud had executed Juhayman … they were making his program government policy'.
Protests spread to other cities in the Eastern Province with large Shi'a populations, resulting in similar responses from security forces. In the aftermath, while channelling more resources into the underdeveloped eastern region of the country, authorities intensified their surveillance of the Shi'a population. Saudi Arabia's absolute monarchy restricts almost all political rights and civil liberties. The regime relies on extensive surveillance, the criminalization of dissent, appeals to sectarianism and ethnicity, and public spending supported by oil revenues to maintain power. Women and religious minorities face extensive discrimination in law and in practice.
Working conditions for the large expatriate labor force are often exploitative. The Saudi government requires all citizens to be Muslim, and most of the population adheres to Wahhabism. The Shia population is estimated at around 15 percent, primarily in the eastern provinces, and larger cities. The country allows Christians and Hindus to enter the country as temporary workers, but does not allow them to practice their faiths. The public practice of any religion other than Islam, the presence of churches, and the possession of non-Islamic religious materials is not allowed. The U.S. State Department suggests that there are 500,000 to one million people who adhere to the Catholic faith.
Human Rights Watch, Amnesty International and the United Nations Human Rights Committee have issued reports critical of the Saudi legal system and its human rights record in various political, legal, and social areas. The Saudi government dismisses such reports as being outright lies or asserts that its actions are based on its adherence to Islamic law. In 2002, the United Nations Committee against Torture criticized Saudi Arabia over the amputations and floggings it carries out. The Saudi delegation responded, defending its legal traditions held since the inception of Islam in the region 1400 years ago and rejected "interference" in its legal system. In its Corruption Perceptions Index for 2010, Transparency International gave Saudi Arabia a score of 4.7 (on a scale from 0 to 10 where 0 is "highly corrupt" and 10 is "highly clean").
A number of prominent Saudi Arabian princes, government ministers, and businesspeople, including Prince Al-Waleed bin Talal, were arrested in Saudi Arabia in November 2017. The king combines legislative, executive, and judicial functions and royal decrees form the basis of the country's legislation. The king is also the prime minister, and presides over the Council of Ministers of Saudi Arabia and Consultative Assembly of Saudi Arabia. The family's vast numbers allow it to control most of the kingdom's important posts and to have an involvement and presence at all levels of government. The number of princes is estimated to be at least 7,000, with most power and influence being wielded by the 200 or so male descendants of Ibn Saud.
The key ministries are generally reserved for the royal family, as are the 13 regional governorships. Many countries across the world are struggling to improve healthcare quality, contain or control costs, and provide access to healthcare for their citizens. Much has been written about United States and European struggles to balance quality, cost, and access to healthcare.
The situation in the Kingdom of Saudi Arabia is less well known, but is distinctly unique, with fascinating reforms taking place that will radically change the way healthcare is provided. There are no political parties, but the royal family is a large grouping with significant political influence. It consists of about twenty thousand people and has several main branches and clans. Some princes are especially influential in politics, while others are active in business.
The ulama also play important leadership roles and consist of members of the Al Sheikh family and several thousand religious scholars, qadis , lawyers, seminary teachers, and imams of mosques. Business and merchant families often exert political influence, but there are no labor unions or syndicates for professional groups. Political upheavals, some of them violent, have taken place, yet the political system has remained relatively stable over decades of rapid economic, social, and demographic change. However, all the regions share traditional ways of life in a harsh desert environment and from a long history that includes the creation of the contemporary state and its culture in the last three centuries.
At the time, prominent cleric Salman Al-Odah tweeted that the war was a "courageous and timely move". He was to become one of the most well-known figures to be caught up in the first wave of arrests, in September 2017. But this initial alignment of media, political, and religious establishments helped transform the crown prince into an emerging royal star, including on regional matters.
