From a pneumonia of unknown cause, first reported to the World Health Organization (WHO) on 31 December 2019, the last four months have seen unprecedented governmental interventions around the globe to manage the impact of Covid-19. The response in Saudi Arabia has been well managed with infection levels not increasing at the same rate as many other countries, but the interventions have left many private hospitals with unutilized capacity and many non-Covid-19 urgent elective patients with deteriorating health. Analysis indicates, there could be between 2,300 and 7,000 urgent elective cases per month not receiving much needed care while a cessation of five months could lead to a backlog of 11,500 to 34,000 patients. A number of these will become emergency patients over this period, increasing pressure on a system already dealing with unprecedented demand.

With the relaxation of some interventions, now is the time to consider resuming some elective care services and the use of private sector capacity provides an ideal opportunity to maintain access whilst retaining the maximum capacity in government hospitals to manage the emergency response.

With Ministry of Health activities still focused on containment and reduction in transmission, there will be no quick fix, and interventions are likely to continue for months to come. Modern health systems have never had to deal with a disease with such a large timeframe where transmission leads to significant numbers of unwell patients and, for high risk groups, the need to provide significant ICU capacity to support recovery. The extended duration of the outbreak will mean a prolonged period when hospitals can no longer perform all elective surgery. For many patients, this will be an inconvenience, or possibly extend a period of pain and suffering, but it will not adversely affect longer term outcomes. For other patients, especially those who require urgent treatment requiring post-surgical ICU care, the lack of access to healthcare could literally mean their condition deteriorates significantly or they become a collateral casualty of Covid-19.

Everyone recognizes that the focus of government healthcare provision should be on Covid-19 response, and that mixing ‘hot’ Covid-19 hospitals with ‘cold’ elective care patients impacts the quality and outcomes of both patient groups. The use of private sector capacity and medical teams to provide treatment for urgent elective patients, ensures that access to care is maintained, whilst lowering the risk of cross infection for patients requiring treatment. The use of private sector capacity also reduces immediate demand for urgent treatment post Covid-19, staff groups already physically and psychologically stretched by demands of preceding months.

The Kingdom already has structures in place that could be used to clinically assess need and appropriately transfer patients to the private sector for treatment. The development of a single national framework agreement with the private sector, like those used in other countries (e.g. UK), with an agreed single fee schedule recognizing the value this revenue stream would deliver to the sustainability of many organizations could be quickly developed. This would then be supplemented by robust contract oversight allowing urgent patients to access much needed healthcare and reducing the risk of misuse.

The focus to date has been on emergency response and although there is a risk this could continue for many months to come, now is the time for health policymakers to consider how partnership with the private sector could, as part of a portfolio of initiatives, improve access to urgent interventions. As part of this blog series, we will explore a number of interventions that will support the delivery of appropriate healthcare to the whole population.

Graham Jelley

Director - Healthcare
KPMG in Saudi Arabia