Kholod Saleh Huneiti Ahmed AlHasan
Background: Saudi Arabia is in the process of moving towards a Unified Health Insurance (UHI) system as part of the health transformation agenda of Vision 2030. Problem: The Cooperative Health Insurance System (CHIS) has been expanding coverage but there are limited studies to date showing its economic efficiency, measured as highest health outcomes per dollar spent. This study incorporates a strategic communication and digital governance lens by asserting that the fiscal dimension is not enough to insure the success of an insurance-led health reform.Goal: To measure the economic efficiency of Saudi Arabia's UHI system between 2018 and 2025 and see how it is progressing in relation to the Vision 2030 goals. Methods: We used publicly available data reports from the Council of Cooperative Health Insurance (CCHI), Ministry of Health (MOH), General Authority for Statistics (GASTAT), Vision 2030 dashboards, WHO Global Health Expenditure Database (GHED) and World Bank for our secondary data analysis. The key indicators were: proportion of health expenditure to GDP, out-of-pocket (OOP) payments, cost per beneficiary, claims-to-premiums ratio and coverage equity. Results: In 2024, at least ~62% of population was covered by CHIS. Health insurance premiums are the highest in the insurance market at 59% of the total insurance market premiums (Ameen, 2025). OOP payments declined from 33% (2018) to 26% (2023) (WHO GHED). It was found that the average cost per insured individual was SAR 2,720/year with a ratio of claims/premiums of 75%. However, rural coverage rate was less than 12% (GASTAT, 2024) and the average of premium inflation was 15% per year (Alzahrani et al., 2025). Said to lag behind the UAE (OOP: 22%) and Bahrain (OOP: 18%) in terms of financial protection.In summary, CHIS has improved access and alleviated fiscal pressure, but has also experienced challenges with efficiency issues, such as affordability, geographic access, and fragmentation of services. The reforms should focus on premiums that are sensitive to income, quality standards and investment in rural infrastructure. Ongoing monitoring of efficiency indicators is critical to make sure the fiscal sustainability of strengthening UHC and equity.