Adequate access to health care systems is considered a fundamental human right. Therefore, governments should provide these resources fairly and away from political influences. In Saudi Arabia, the Ministry of Health(MOH) is responsible for 60% of the health services. However, the private sector served more than 11 million beneficiaries (80% are Saudi){1,2}.
Many studies applied Gini index to assess inequality of resources distribution. Gini Coefficient is used to measure the inequality magnitude in the health resources distribution. Where zero represents perfect equality, and one represents perfect inequality{3). While Lorenz curve is the graphical representation of the Gini index. Masoudi in 2015 used the coefficient in 22 regions in Tehran province. The result was (0.4), meaning un equality in hospital beds distribution in relation to the population of each region{4}. Shwaekh Mansour, in his study in 2016, found significant clustering of health care facilities in central Riyadh{5}.
This study aimed to evaluate the allocation of hospital beds across Saudi Arabia from 2015 to 2019 and examine the correlation and trends associated with the evaluation. This is a cross-sectional study for a Secondary dataset from the annually published statistical book by MOH from 2015 to 2019{1}. All MOH, other governmental and private hospitals, and all papulation (Citizen and resident) are involved. For the statistical analysis, we calculate the bed rates\ 100,000 population. The change in the healthcare service and the most affected region. Gini index and the Lorenz curve. The Pearson's correlation coefficient (r).
The mean total number of beds increased with the mean population, from 3,469.70 beds for 1,576,070.90 population in 2015 to 3,849.40 beds for 1,710,908.45 population in 2019 in all the 20 health regions. The total rate of beds improved from 237.04 in 2015 to 246.84 in 2019. The total rate of change in both sectors was found to be 10.9%.
A noticeable increase in the availability of public sector-sponsored hospital beds \100,00 population over time in Tabouk, Hail, and Taief from 186.34,171.33, and 222.73 in 2015 to 259.26, 253.71 and, 257.28 in 2019, respectively. We observed a significant increase for the hospital beds sponsored by the private sector in Hafr-Al batin, Hail,
and Najran from 11.18,16.04, and 25.78 in 2015 to 32.11,23.25, and 41.09 in 2019, sequentially. The total ratio of hospital beds improved from 2015 to 2019 in areas such as Ha'il, Tabouk, and Ta'if, which increased by 89.6, 72.5, and 32.5, respectively.
Gini index for the public, private sectors, and the total (Table 1).
Lorenz curve for the public, private sectors, and total (Figure 1).
The Pearson's correlation coefficient r calculated for public hospitals in Riyadh, Qaseem, Eastern, and Hail regions revealed a strong positive correlation. While in Taif and Hafer AL-baten regions, the correlation was weak positive.
Dr.Taghreed Hawsawi, Dr. Nora Abouammoh.
Editor notes: World Bank classifies Saudi Arabia among the high-income regions with a mean of 356.13 and the G20 countries with a mean of 450 beds, which means that we lag behind regional averages with our 2019 bed rate of 246.84 hospital bed/100,000 population.
The greatest improvement in hospital bed rates has been due to the public health sector in regions characterized by small populations, as a study analyzing the timeline of health reforms in Saudi Arabia mentioned{7}.
Gini index of the public sector showed good indicators of equality in the distribution of hospital beds among the 20 health regions, but for the private sector translated to a severe equality gap. Two studies conducted in Iran reached the same conclusion{3,6}.
The study included the centralization of inpatient services only.
Saudi Arabia is lagging behind in terms of beds rate. Policymakers should pay attention to the empirical data, as these are needed to achieve the Saudi Vision 2030 and to sustain the demands of the still-growing population of Saudi Arabia.
Figure 1. Lorenz curve for the distribution of the hospital beds among the 20 health regions in Saudi Arabia in 2019
Table 1. Gini indices for the 20 health regions for 2015
| Beds Rates |
Year |
Mean + SD |
95%CI of Mean |
|||||
|
2015 |
2016 |
2017 |
2018 |
2019 |
Lower |
Upper |
||
| Public Sector |
0.205 |
0.215 |
0.213 |
0.211 |
0.206 |
0.210±0.004 |
0.205 |
0.215 |
| Private Sector |
0.532 |
0.517 |
0.538 |
0.534 |
0.539 |
0.532±0.009 |
0.521 |
0.543 |
| Total |
0.158 |
0.164 |
0.169 |
0.164 |
0.158 |
0.163±0.005 |
0.157 |
0.168 |
References:
1.Saudi Arabia Ministry of Health. Statistical yearbook; 2019 (https://www.moh.gov.sa/Ministry/Statistics/book/Pages/default.aspx, accessed 17 August 2020).
2.Sebai ZA, Milaat WA, Al-Zulaibani AA. Health care services in saudi arabia: past, present and future. Journal of family & community medicine. 2001;8(3):19-23.
3. Bellù LG, Liberati P. Inequality analysis: The Gini Index; 2005 (http://www.fao.org/docs/up/easypol/329/gini_index_040en.pdf accessed 10 August 2020).
4. Asl IM, Abolhallaje M, Raadabadi M, Nazari H, Nazari A, Salimi M, et al. Distribution of hospital beds in Tehran Province based on Gini coefficient and Lorenz curve from 2010 to 2012. Electronic physician. 2015;7(8):1653-7.
5.Mansour S. Spatial analysis of public health facilities in Riyadh Governorate, Saudi Arabia: a GIS-based study to assess geographic variations of service provision and accessibility. Geo Spatial Inform Sci. 2016;19(1):26-38.
6.Chavehpour Y, Rashidian A, Woldemichael A, Takian A. Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran. BMC health services research. 2019;19(1):614.
7.Rahman R, Alsharqi OZ. What drove the health system reforms in the Kingdom of Saudi Arabia? An analysis. Int J Health Plann Manage. 2019;34(1):100-10.