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Improving health systems and services in the 21st century
Although this issue of International Journal of Health Governance (IJHG) is not a themed issue, a common thread can be identified running through the articles. Each article, from a unique perspective and focusing on a different issue, struggles with the challenge of delivering more effective and efficient health care as we move into the third decade of the twenty-first century. This era poses many challenges that will have a direct impact on health care. War and conflict are a major threat to well-being; climate change is making some parts of our globe drier, other areas wetter, and everywhere warmer; agriculture, fishing, and clean water supplies are endangered; finally, human populations, unsurprisingly, are suffering from increased anxiety and other mental health issues. If there was ever a time when creating the best and most efficient health care systems was critical, that time is now.
Privatization of academic medical centers in the KSA
In many countries, increased efficiency in health care services is equated with privatization of various sections of the service or of support services such as cleaning, catering, and security. In the Kingdom of Saudi Arabia (KSA), until recently, all healthcare services have been government owned and operated. Al Kuwaiti and Al Muhanna (2019) report on an initiative to privatize Saudi Arabia's academic medical centers (AMCs) as a means to reduce costs centrally and improve efficiency. Their research involved a systematic review of the literature to identify the potential benefits and detriments that might arise from privatization. The authors considered two models of hospital privatization: for profit and not for profit. Data, largely gained from an evaluation of hospital privatization in Germany, demonstrated that both forms of privatization could increase bed turnover, reduce staffing levels, and improve efficiency. However, for-profit hospitals were able to create a profit as well. One way to do this is to accept patients who are not state-funded. In Saudi Arabia, that could mean admission of nonuniversity staff and provision of services to expats and other foreign residents.
However, the authors found that privatization is not without problems. In teaching hospitals such as AMCs, patients might be more likely to refuse care from medical and nursing students if they were...