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Najwa Ali Huraysi,1,2 Waleed M Kattan,1 Mohamed A Alqurashi,1 Bodour Ayman Fadel,1 Mohammed Khaled Al-Hanawi1,3 1Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia; 2Human Resources Planning Department, King Abdulaziz Hospital, Makkah, Saudi Arabia; 3Health Economics Research Group, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Mohammed Khaled Al-Hanawi, Tel +966 556522222, Email mkalhanawi@kau.edu.saBackground: Escalating global health expenditures pose a threat to healthcare financing sustainability, requiring the exploration of alternative financing policies and resource allocation strategies to curb their adverse effects. The aim of this study was to gather insight into the preferences of healthcare workers, including physicians, nurses, allied healthcare professionals, and healthcare administrators, as well as academics in the field of healthcare management and health sciences in Saudi universities, regarding policy options that can secure the financial sustainability of healthcare services in Saudi Arabia.Methods: A cross-sectional research design was employed, and data were collected through an online self-administered survey from August 2022 to December 2022 in Saudi Arabia. The survey garnered responses from 513 participants hailing from all 13 administrative regions in Saudi Arabia. Analyses were performed using non-parametric statistical tests, specifically the two-sample Mann–Whitney U-test and Kruskal–Wallis test, to determine the statistical significance of differences in the policy ranking and policy feasibility options.Results: The study findings reveal a consensus among stakeholders on the most and least preferred policies. All stakeholders expressed opposition to financing healthcare by diverting resources from defence, social protection, and education, while they favoured policies that entail imposing penalties on health-related issues such as waste management and pollution. Nevertheless, variations among stakeholders were evident in regard to the rankings for specific policies, particularly between healthcare workers and academics. Moreover, the results highlight that tax-based policies are the most feasible approach to generating healthcare funds, despite ranking lower in terms of preferred policies.Conclusion: This study provides a framework for understanding stakeholder preferences on healthcare financing sustainability by ranking 26 policy options according to stakeholder groups. The appropriate mixture of financing mechanisms should be informed by evidence-based and data-driven approaches that consider relevant stakeholder preferences.Keywords: healthcare financing, healthcare policy, preferences, Saudi Arabia, sustainability

Mohammed Khaled Al-Hanawi,1 Martin Limbikani Mwale,2 Noor Alshareef,1 Ameerah MN Qattan,1 Khadijah Angawi,1 Rasha Almubark,3,4 Omar Alsharqi1 1Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 80200, Saudi Arabia; 2Department of Economics, Faculty of Economic and Management Sciences, University of Stellenbosch, Cape Town, South Africa; 3Research and Studies Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia; 4Sharik Association for Health Research, Riyadh, Saudi ArabiaCorrespondence: Mohammed Khaled Al-HanawiDepartment of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 80200, Saudi ArabiaEmail mkalhanawi@kau.edu.saBackground: The rapid spread of COVID-19 worldwide has confined millions of people to their homes and has caused a substantial degree of psychological distress. This study aims to investigate the psychological distress impact of the COVID-19 pandemic among the Saudi population.Methods: This is a cross-sectional study, using data collected from 3036 participants via an online self-reported questionnaire. The psychological distress was constructed using the COVID-19 Peritraumatic Distress Index to classify individuals in the sample as having normal, mild or severe distress levels. The study used descriptive analysis and multinomial logistic regressions to examine the sociodemographic factors associated with psychological distress levels during the COVID-19 pandemic.Results: The evidence showed that 40% of the Saudi population are distressed due to COVID-19, of whom approximately 33% are mildly distressed, while 7% are severely distressed. The distress levels are particularly high amongst the young, females, private sector employees and health workers, especially those working on the frontline.Conclusion: The COVID-19 pandemic is associated with increased distress amongst people living in Saudi Arabia. In support of evidence found in other countries, the study has established that the distress levels vary across different sociodemographic characteristics. Therefore, limiting people’s psychological damage demands both medium- and long-term policy strategies, which include mapping the rates of stress and anxiety for effective psychological treatment allocation and establishing innovative online methods of heightening people’s mental wellbeing.Keywords: COVID-19, distress, health workers, psychological, public, Saudi Arabia

Mohammed Khaled Al-Hanawi,1 Martin Limbikani Mwale,2 Tony Mwenda Kamninga3 1Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Cape Town, South Africa; 3Department of Economics, Faculty of Social and Health Sciences, Millennium University, Blantyre, MalawiCorrespondence: Mohammed Khaled Al-Hanawi Email mkalhanawi@kau.edu.saBackground: Saudi Arabia’s healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia.Materials and Methods: The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods.Results: The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups.Conclusion: The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.Keywords: healthcare financing, health insurance, health sector, national health programs, Saudi Arabia