The result also showed that individuals with private health
insurance spent more on outpatient care than those who did
not have private health insurance.
Private health insurance also influenced the probability of
inpatient care utilization. The analysis showed that people
who had private health insurance were significantly more
likely to utilize inpatient care than people who did not have
it. When an alternative independent variable of the number
of private health insurance was used, people with more
private health insurance contracts had a higher tendency to
seek inpatient care. In addition, analysis for those who used
inpatient care services at least once showed that private
health insurance status, regarding whether or not enrolled in
private health insurance, and the number of private health
insurance purchased, had little impact on the number of
inpatient days and total inpatient expenditure. These results
implied that private health insurance had a positive effect on
the initiation of inpatient care utilization.
In Germany, Patrick Hullegie and Tobias J. Klein estimated the effect of private health insurance on the number of
doctor visits, the number of nights spent in a hospital, and
self-assessed health in Germany (Patrick and Tobias 2010).
They found a significant unfavorable influence of private
health insurance on the number of physician visits for people
who see the doctor at least once. At the same time, they
noticed no impact on private health insurance on the number
of nights of hospitalization and a positive effect on
self-assessed health. They suggested that private health
insurance either had a positive influence on finance in prevention, because of the economic encouragements that were
given to the insured or that privately insured patients
received more favorable services every time to visit the
health facility.
Linda J. Blumberg in New Zealand measured path to
care, use of health services produced by particular kind of
service providers, and use of specific types of examinations
and preventive steps (Blumberg 2006). People with private
health insurance are markedly likely than those without
private health coverage to having a usual source for
receiving therapeutic care. The individuals with private
health coverage were less likely to report having a problem
reaching GP services in the prior month; however, that may
be associated with the insured having more substantial salary
and no health care needs.
There was no statistical discrepancy between the percentages of each group having at least one GP appointment
in the last 12 months, nor did they vary in the percentage
having at least one nursing visit or having had one prescription for their use. However, the privately insured were
more likely to report having had at least one specialist visit
in the last 12 months than those without private health
coverage.
4 Study Design
A review of the relevant literature was carried out to select
important variables that may have influenced the respondent’s choice while filling out the survey (Deborah and
Helen 2005). Three groups of independent variables were
used in the study: sociodemographic, health-related and
health services utilization, which may influence the dependent variable, which is whether having private health
insurance coverage or not. These variables were selected
based on several similar studies in the research literature on
the use of health services from different countries around the
world.
The study was conducted among citizens living in Riyadh
city, the capital of the Kingdom of Saudi Arabia. According
to the last official national statistic, the number of citizen in
Riyadh reached eight million. The study population involved
adult individuals (20 years of age and older). A random
sampling size equation was used to collect data from this
population and the sample size was 384 respondents with a
confidence level of 95%. We distributed 400 questionnaires
by manual handling or electronically as weblink via SMS
and e-mails. The response rate was 74.22% (285
respondents).
We applied an analytical study using a self-administered
questionnaire (Arabic and English). The survey was
designed to collect data on different variables, which will
help to meet the purpose of this study. The questionnaire
was divided into two sections: seven questions on the
sociodemographic variables and health-related variables
including: availability of private health insurance, gender,
age, educational level, marital status, income, chronic diseases and health status, and nine questions for health services utilization including: number of dentist visit, number
of health care provider visits, number of ER visits, time
spent in the hospital, number of nights spent in the hospital,
X-ray, blood analysis or lab test, and prescription of medicine used. All of these questions cover a period over the past
12 months (Aman and Todd 2006).
Descriptive statistical analysis, Mann–Whitney test, and
Kruskal–Wallis test were used to determine whether there
are statistically significant differences between the individuals who have private health insurance coverage and those
who do not have and if there are, what is the effect on the
utilization of health care services.
We tested 17 hypotheses: H o : there is no statistically
significant difference in the medical service utilization
between individuals with and without private health insurance coverage for all the following variables: nationality
(Saudi, Non-Saudi), age, gender, marital status, educational
status, having private health insurance, general health status,
having chronic disease, number of dentist visit, number of
258
M. H. Ahmed and T. Abdullah AL Amri
insurance spent more on outpatient care than those who did
not have private health insurance.
Private health insurance also influenced the probability of
inpatient care utilization. The analysis showed that people
who had private health insurance were significantly more
likely to utilize inpatient care than people who did not have
it. When an alternative independent variable of the number
of private health insurance was used, people with more
private health insurance contracts had a higher tendency to
seek inpatient care. In addition, analysis for those who used
inpatient care services at least once showed that private
health insurance status, regarding whether or not enrolled in
private health insurance, and the number of private health
insurance purchased, had little impact on the number of
inpatient days and total inpatient expenditure. These results
implied that private health insurance had a positive effect on
the initiation of inpatient care utilization.
In Germany, Patrick Hullegie and Tobias J. Klein estimated the effect of private health insurance on the number of
doctor visits, the number of nights spent in a hospital, and
self-assessed health in Germany (Patrick and Tobias 2010).
They found a significant unfavorable influence of private
health insurance on the number of physician visits for people
who see the doctor at least once. At the same time, they
noticed no impact on private health insurance on the number
of nights of hospitalization and a positive effect on
self-assessed health. They suggested that private health
insurance either had a positive influence on finance in prevention, because of the economic encouragements that were
given to the insured or that privately insured patients
received more favorable services every time to visit the
health facility.
Linda J. Blumberg in New Zealand measured path to
care, use of health services produced by particular kind of
service providers, and use of specific types of examinations
and preventive steps (Blumberg 2006). People with private
health insurance are markedly likely than those without
private health coverage to having a usual source for
receiving therapeutic care. The individuals with private
health coverage were less likely to report having a problem
reaching GP services in the prior month; however, that may
be associated with the insured having more substantial salary
and no health care needs.
There was no statistical discrepancy between the percentages of each group having at least one GP appointment
in the last 12 months, nor did they vary in the percentage
having at least one nursing visit or having had one prescription for their use. However, the privately insured were
more likely to report having had at least one specialist visit
in the last 12 months than those without private health
coverage.
4 Study Design
A review of the relevant literature was carried out to select
important variables that may have influenced the respondent’s choice while filling out the survey (Deborah and
Helen 2005). Three groups of independent variables were
used in the study: sociodemographic, health-related and
health services utilization, which may influence the dependent variable, which is whether having private health
insurance coverage or not. These variables were selected
based on several similar studies in the research literature on
the use of health services from different countries around the
world.
The study was conducted among citizens living in Riyadh
city, the capital of the Kingdom of Saudi Arabia. According
to the last official national statistic, the number of citizen in
Riyadh reached eight million. The study population involved
adult individuals (20 years of age and older). A random
sampling size equation was used to collect data from this
population and the sample size was 384 respondents with a
confidence level of 95%. We distributed 400 questionnaires
by manual handling or electronically as weblink via SMS
and e-mails. The response rate was 74.22% (285
respondents).
We applied an analytical study using a self-administered
questionnaire (Arabic and English). The survey was
designed to collect data on different variables, which will
help to meet the purpose of this study. The questionnaire
was divided into two sections: seven questions on the
sociodemographic variables and health-related variables
including: availability of private health insurance, gender,
age, educational level, marital status, income, chronic diseases and health status, and nine questions for health services utilization including: number of dentist visit, number
of health care provider visits, number of ER visits, time
spent in the hospital, number of nights spent in the hospital,
X-ray, blood analysis or lab test, and prescription of medicine used. All of these questions cover a period over the past
12 months (Aman and Todd 2006).
Descriptive statistical analysis, Mann–Whitney test, and
Kruskal–Wallis test were used to determine whether there
are statistically significant differences between the individuals who have private health insurance coverage and those
who do not have and if there are, what is the effect on the
utilization of health care services.
We tested 17 hypotheses: H o : there is no statistically
significant difference in the medical service utilization
between individuals with and without private health insurance coverage for all the following variables: nationality
(Saudi, Non-Saudi), age, gender, marital status, educational
status, having private health insurance, general health status,
having chronic disease, number of dentist visit, number of
258
M. H. Ahmed and T. Abdullah AL Amri