Diagnostic packages: A health system to control waste and increase efficiency
The Council of Cooperative Health Insurance in Saudi Arabia announced a pivotal step in the national healthcare transformation: the implementation of the "Diagnostic Packages" system. This smart system aims to revolutionize payment mechanisms and interactions between insurance companies and healthcare providers. This initiative underscores the Council's commitment to promoting "value-based healthcare," which prioritizes patient health and the quality of treatment outcomes, rather than solely focusing on the quantity of services provided.
What is a diagnostic package system?
The Diagnostic Related Groups (DRGs) system is an advanced global standard for classifying medical conditions. It groups cases with similar clinical diagnoses and treatment resource consumption into standardized categories. This approach aims to enable the health insurance sector to manage beneficiaries with unprecedented efficiency, ensuring accurate and transparent pricing, facilitating cost forecasting, and reducing unjustified price discrepancies for similar cases.
Alignment with the Kingdom's Vision 2030
This movement cannot be separated from the broader context of the Health Sector Transformation Program, one of the programs under the Kingdom's Vision 2030. The health system aims to enhance the efficiency of both public and private spending and achieve financial sustainability. Implementing diagnostic packages contributes to creating a competitive, quality-driven environment, motivating hospitals and medical centers to improve their operational performance and adopt global best practices to remain competitive. This, in turn, positively impacts the overall readiness of the health sector.
Controlling financial waste and improving data
One of the most important pillars of this system is eliminating financial waste resulting from unnecessary medical procedures or redundant tests that do not add therapeutic value for the patient. By focusing on the accuracy of medical coding according to the International Classification of Diseases (ICD), the system ensures the reliability of health data. This accurate data not only serves the financial aspect but also forms a solid foundation for decision-makers to develop future health plans based on real evidence, thus enhancing the efficiency of the entire system.
Improving the patient experience and treatment journey
Ultimately, this technological and administrative transformation directly benefits the patient. By controlling costs without compromising quality, resources are directed toward better patient care, reduced waiting times, and faster medical approvals. Through this strategy, the council aims to prepare the healthcare sector to implement diagnostic packages with high operational efficiency, while establishing clear frameworks for evaluating actual impact, to ensure beneficiaries receive a safe, accessible, and high-quality treatment journey.
