The Payer Must Hold the Provider Accountable
Separating the roles of regulator, funder, and care provider turns health spending into strategic purchasing , with each party answerable for its own results.
This post is a translation of the original Arabic article.
We expect hospitals to answer for the quality and cost of care. The organization purchasing that care should answer for its decisions as well.
A payer sets prices, contract terms, and the services it purchases. It also shapes approval requirements, claims reviews, and payment schedules. Each decision affects a provider's ability to operate.
Take a hypothetical home-care contract. The provider is responsible for qualified staff, timely visits, and delivery of the care plan. It needs a price that supports the required quality, clear rules for accepting claims, and a payment schedule it can plan around. Problems in that relationship can reach the patient as delayed or interrupted care.
The Saudi Model of Care describes the intended separation of regulatory, funding, and care-delivery roles. The value of that separation becomes visible when we can identify which party controls a problem and hold it responsible for resolving it.
A referral delay might begin with a shortage of appointments. It might arise from a lengthy approval process. The original contract might have purchased too little capacity. Combining these situations under one indicator makes it harder to choose the right response.
I would measure payer performance alongside provider performance: decision times, payment reliability, clarity of rejection reasons, and speed of dispute resolution. Providers should answer for access, quality, outcomes, and appropriate use of resources. This is a recommendation for how accountability should work across the relationship.
The patient also needs a named party to resolve interruptions while a dispute is being settled. Treatment needs continue during claims reviews and exchanges of correspondence.
A useful care contract assigns responsibility to the party able to control it and provides a fast route through disagreements. That gives hospital leaders a fair basis for accountability and brings purchasing decisions closer to their consequences for patients.
