What is The Health Insurance?

1. What is The Health Insurance? Lecture 1

2. GOALS • Recognize the common factors among the best health care systems. • Recognize Health insurance definitions. • Recognize History of Health Insurance. • Recognize Health care in Saudi Arabia

3. Introduction: Health care and health insurance are some of the most controversial topics in recent years, where the right of every citizen to have access to health care in his country, it is one of the most important pillars of society and the fundamental basis for stability.

4. Introduction: Most of the countries have extended the concept of health care to include: diagnosis, curative and rehabilitation services for their citizens to preserve the public health within the society’s framework of human development.

5. Introduction: The common factors among the best health care systems all over the world is to achieve the following objectives:

6. Introduction: • Fully comprehensive coverage for all citizens. • Fair coverage for all citizens. • Reasonable cost of coverage for both: the state and citizens. • A health coverage based on scientific tools.

7. What is The Health Insurance? Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure,

8. What is The Health Insurance? such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement.

9. What is The Health Insurance? The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

10. What is The Health Insurance? According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment"

11. What is The Health Insurance? According to (Black and Skipper, 1999) health insurance can be defined as encompassing a broad range of benefit arrangements that can cover virtually any expenses connected with hospital and medical care and related services for the insured and covered family members.

12. What is The Health Insurance? Plans may be limited to basic benefits for specific kinds of medical services or may provide comprehensive benefits for all major medical expenses associated with severe injury or long-term illness.

13. What is The Health Insurance? Benefits may be paid directly to the health care provider or institution of actual expenses incurred. Some benefits are paid as fixed amounts without regard to the actual costs of care.

14. History of Health Insurance Benefits Germany has the world's oldest national social health insurance system,with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889.

15. History of Health Insurance Benefits Bismarck stressed the importance of three key principles; are: • Solidarity, • The government is responsible to ensure access by those who are in need, • Subsidiarity

16. Health care in Saudi Arabia: The health care system in Saudi Arabia can be classified as a national health care system in which the government provides health care services through a number of government agencies. In the meantime, there is a growing role and increased participation from the private sector in the provision of health care services.

17. Health care in Saudi Arabia: The beginning of emphasis on prevention and environmental health was in 1925 by establishing a public health department. It was made by a royal decree from King Abdul Aziz Al-Saud. By 1926 the first school of nursing was opened and followed by the school of health and emergencies in 1927.

18. Health care in Saudi Arabia: The health services expanded in 1951 by establishing the ministry of health. A ministerial ordinance in 1980, led to the establishment of the administration integrating the existing dispensaries, health centers, health offices and Maternal and Child Health (MCH) centers into one unit.

19. Health care in Saudi Arabia: By the end of the 1980s there were 253 hospitals, 38,955 hospital beds and 1,640 primary health centers. The proportion of these positions filled by Saudi nationals is very low. Saudi nationals represent 13% doctors (22,633 doctors), 11.2% nurses (45,840 nurses) and 38% health technicians (25,192 health technicians).

20. Health care in Saudi Arabia: • In 1993, the total number of hospitals was 281, 41,789 hospital beds and 1,707 primary health centers and the positions filled by Saudi nationals increased to 22.7% doctors, 24.5% nursing staff and 41.8% health technicians.

21. Health care in Saudi Arabia: In the end of the 2000, the major indicators provided by the private sector were: • 87 hospitals with 8,485 beds. • 273 pharmaceutical stores and 3,208 pharmacies. • 622 dispensaries, 785 clinics, 45 medical laboratories and 11 physiotherapy centers

22. Basic Characteristics of Major Medical Insurance: • Broad coverage • High maximum limits • Deductible (typically calendar year) • Coinsurance (typically 80-20 percent) • Stop-loss limit • Exclusions