Healthcare finance in the Kingdom of Saudi Arabia:a qualitative study of householders’ attitudes

Background: The public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and ‘free at the point of delivery’, is coming under increasing strain due to escalating expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term. Objectives: This study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system. Methods: A total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences. Results: The evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme. Conclusions: Quality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences

Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia:A Cross-sectional Stated Preference Approach

Background: The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is ‘free at the point of delivery’ (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households’ willingness to pay (WTP) for a contributory national health insurance scheme. Methods: Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP. Results: Over two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP. Conclusions: This study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing

Interleukin-6 and Cyclooxygenase-2 downregulation by fatty-acid fractions of Ranunculus constantinopolitanus

<p>Abstract</p> <p>Background</p> <p>Medicinal plants represent alternative means for the treatment of several chronic diseases, including inflammation. The genus <it>Ranunculus</it>, a representative of the Ranunculaceae family, has been reported to possess anti-inflammatory, analgesic, antiviral, antibacterial, antiparasitic and antifungal activities, possibly due to the presence of anemonin and other. Different studies have shown the occurrence of unusual fatty acids (FAs) in Ranunculaceae; however, their therapeutic role has not been investigated. The purpose of this study is to characterize potential anti-inflammatory bioactivities in <it>Ranunculus constantinopolitanus </it>D'Urv., traditionally used in Eastern Mediterranean folk medicine.</p> <p>Methods</p> <p>The aerial part of <it>R. constantinopolitanus </it>was subjected to methanol (MeOH) extraction and solvent fractionation. The bioactive fraction (I.2) was further fractionated using column chromatography, and the biologically active subfraction (Y₂₊₃) was identified using infrared (IR) spectroscopy, nuclear magnetic resonance (NMR) and gas chromatography-mass spectrometry (GC-MS). The effects of I.2 and Y₂₊₃on cell viability were studied in mouse mammary epithelial SCp2 cells using trypan blue exclusion method. To study the anti-inflammatory activities of I.2 and Y₂₊₃, their ability to reduce interleukin (IL)-6 levels was assessed in endotoxin (ET)-stimulated SCp2 cells using enzyme-linked immunosorbent assay (ELISA). In addition, the ability of Y₂₊₃to reduce cyclooxygenase (COX)-2 expression was studied in IL-1-treated mouse intestinal epithelial Mode-K cells via western blotting. Data were analyzed by one-way analysis of variance (ANOVA), Student-Newman-Keuls (SNK), Tukey HSD, two-sample t-test and Dunnett t-tests for multiple comparisons.</p> <p>Results</p> <p>The chloroform fraction (I.2) derived from crude MeOH extract of the plant, in addition to Y₂₊₃, a FA mix isolated from this fraction and containing palmitic acid, C18:2 and C18:1 isomers and stearic acid (1:5:8:1 ratio), reduced ET-induced IL-6 levels in SCp2 cells without affecting cell viability or morphology. When compared to fish oil, conjugated linoleic acid (CLA) and to individual FAs as palmitic, linoleic, oleic and stearic acid or to a mix of these FAs (1:5:8:1 ratio), Y₂₊₃exhibited higher potency in reducing ET-induced IL-6 levels within a shorter period of time. Y₂₊₃ also reduced COX-2 expression in IL-1-treated Mode-K cells.</p> <p>Conclusion</p> <p>Our studies demonstrate the existence of potential anti-inflammatory bioactivities in <it>R. constantinopolitanus </it>and attribute them to a FA mix in this plant.</p

A review of self-healing concrete for damage management of structures

The increasing concern for safety and sustainability of structures is calling for the development of smart self-healing materials and preventive repair methods. The appearance of small cracks (<300 µm in width) in concrete is almost unavoidable, not necessarily causing a risk of collapse for the structure, but surely impairing its functionality, accelerating its degradation, and diminishing its service life and sustainability. This review provides the state-of-the-art of recent developments of self-healing concrete, covering autogenous or intrinsic healing of traditional concrete followed by stimulated autogenous healing via use of mineral additives, crystalline admixtures or (superabsorbent) polymers, and subsequently autonomous self-healing mechanisms, i.e. via, application of micro-, macro-, or vascular encapsulated polymers, minerals, or bacteria. The (stimulated) autogenous mechanisms are generally limited to healing crack widths of about 100–150 µm. In contrast, most autonomous self-healing mechanisms can heal cracks of 300 µm, even sometimes up to more than 1 mm, and usually act faster. After explaining the basic concept for each self-healing technique, the most recent advances are collected, explaining the progress and current limitations, to provide insights toward the future developments. This review addresses the research needs required to remove hindrances that limit market penetration of self-healing concrete technologies