Transformation of Saudi Arabia’s Health System and Its Impact on Population Health: What Can the USA Learn?

Objective: The objective of this study was to describe the historic transformation of the Kingdom of Saudi Arabia (KSA) health system and analyze the impact of transformation on selected health outcomes in KSA. Methods: Secondary data from the following standard repositories were compiled for analysis: WHO, UN, UNICEF, and the Saudi Arabia Ministry of Health. The 6-part WHO health system framework was used to structure the analysis. The USA was chosen as a comparator country because KSA and the USA are both high-income OECD countries with predominantly Western-trained physicians and similar health outcomes, yet the 2 nations diverge in 2 important ways: the KSA is a single payer, and its percent GDP healthcare spending is one-half that of the USA. Results: Life expectancy at birth increased nearly 30 years (from 45.6 years in 1960 to 74.9 years in 2019) among KSA citizens, narrowing the gap with the USA, which gained 8.7 years, from 69.8 to 78.5, during the same period. KSA had identical infant mortality to the USA (2/1,000 live births in both countries) and lower maternal mortality rates (17 vs. 23/100,000 live births) than the USA. Conclusion: The rapid improvement of selected health outcomes in KSA may be attributable to improved access to care provided by the universal healthcare system. Healthcare spending in the USA is 18% GDP, nearly twice that of KSA (9.2% GDP), yet important health outcomes are largely indistinguishable. Future research should evaluate which elements of the KSA system might inform improvements to decentralized systems in the USA.