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American Journal of  Medical 
Science and Innovation (AJMSI) 

The Impact of  Unified Medical Insurance System Implementation (Nphies) on Healthcare 
Service Quality: Applied Research Case Study in Arrawdha General Hospital 

Dammam, Saudi Arabia
Mohammed Ibrahim Alnajjar1*

Volume 3 Issue 1, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i1.2630
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: April 28, 2024
Accepted: May 31, 2024
Published: June 04, 2024

Ensuring high-quality healthcare services is crucial for the well-being of  individuals and the 
overall development of  societies. In Saudi Arabia, healthcare reform efforts under Vision 
2030 emphasize the importance of  enhancing healthcare service quality. One key aspect of  
these reforms is implementing the unified medical insurance system, NPHIES. This system 
aims to improve access to healthcare and enhance the quality of  services provided. However, 
there is a lack of  research examining the specific impact of  NPHIES on healthcare service 
quality, particularly in hospitals like Arrawdha General Hospital in Dammam. This study 
aims to investigate the impact of  NPHIES implementation on healthcare service quality 
at Arrawdha General Hospital in Dammam, Saudi Arabia. By examining the relationship 
between NPHIES and healthcare service quality, the study seeks to provide valuable insights 
that can inform healthcare policies and practices in the region. The study has adopted a 
quantitative approach, collecting data through a questionnaire administered to physicians 
and administrators at Arrawdha General Hospital. Statistical analysis (descriptive statistics, 
t-tests, ANOVA, and Pearson’s correlation coefficient) have been used to analyze the 
data. Statistical analysis showed no significant differences in NPHIES implementation or 
healthcare service quality based on demographics suggesting a consistent perception across 
different demographic groups. The study also identified a statistically significant positive 
effect of  NPHIES on healthcare service quality, emphasizing its role in improving healthcare 
services. Future research should examine the impact of  the Unified Medical Insurance 
System (NPHIES) implementation on elderly patient satisfaction and health outcomes in 
Saudi Arabia.

Keywords
Healthcare Service Quality, 
Medical Insurance System, 
NPHIES, Saudi Arabia, 
Unified Medical Insurance 
System, Vision 2030

1 Atlas American University, 8 The Green, Ste #15974 Dover DE, 19901, USA
* Corresponding author’s e-mail: alnajjar.mohd@yahoo.com

INTRODUCTION
Since the formation of  the Ministry of  Health (MOH) 
in 1950 and the establishment of  the initial public health 
department in Mecca in 1925, the Kingdom of  Saudi 
Arabia (KSA) has experienced incredible developments 
in healthcare services. At the moment, Saudi Arabia 
has 487 hospitals with 72,981 beds, which is about 2.2 
beds for every 1000 people (Al-Hanawi et al., 2019). The 
government has given the development of  healthcare 
services of  different levels top priority, and in 2018 an 
additional budget was set aside for social and health 
services. This dedication to high-quality healthcare is 
demonstrated by the KSA healthcare system’s position 
of  26th out of  191 countries by the World Health 
Organization (WHO), which puts it ahead of  developed 
countries like the Canada, United States, and Australia, 
as well as adjacent Arabian Gulf  countries. However, 
barriers still exist in delivering improved healthcare 
services to the KSA’s rapidly expanding population. The 
total fertility rate was 3.04 and the yearly population 
growth rate was 3.2% between 2004 and 2010 (Alrowes, 
2023). Saudi Arabia’s population is expected to grow to 
39.8 million by the year 2025, 54.7 million until 2050, and 
61.3 million by 2100, according to UN estimates. With 
the population predicted to expand from 1 million to 
2.5 million older adults by 2020, assisting the elderly has 

become more challenging due to longer life expectancies 
(Alkhamis et al., 2021; Alkhamis & Miraj, 2021).
The current healthcare system is under stress due to this 
demographic transition, underscoring the necessity for an 
adequate supply of  highly qualified healthcare workers. 
The implementation of  the new strategic scheme, Vision 
2030, has presented both problems and possibilities for 
the healthcare industry to meet its strategic imperatives 
with its path in the years ahead. Vision 2030 sets priority 
in all economic sectors and acts as a road map for Saudi 
Arabia’s economic growth (Rahman & Qattan, 2021; 
Singh et al., 2022). The National Transformation Program 
(NTP) 2020 was introduced as part of  Vision 2030, and it 
outlines each ministry’s strategic goals, key performance 
indicators (KPIs), and key performance targets (KPTs) 
(Farghaly Abdelaliem et al., 2023). Healthcare quality 
improvement has evolved as a crucial emphasis for 
modern healthcare systems across the world, motivated by 
a shared desire to improve patient results and satisfaction. 
This dedication stems from the recognition that high-
quality healthcare facilities not only enhance individual 
health but also significantly contribute to society’s well-
being and economic development. Countries throughout 
the world are emphasizing healthcare quality as a critical 
component of  their healthcare reform initiatives, 
acknowledging its enormous influence on public health 



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and healthcare system efficiency (Reibling et al., 2019).
Aligned with the worldwide motion, Saudi Arabia has 
initiated comprehensive healthcare improvements as 
a component of  its Vision 2030, with the primary 
objective of  enhancing healthcare accessibility and quality 
throughout the country (Al-luhaym & Alshagrawi, 2023). 
The goal of  these changes is to improve the general 
quality of  healthcare services that the nation’s people 
receive by implementing substantial improvements to the 
health insurance system. For healthcare organizations, 
providing high-quality services is crucial since it improves 
beneficiary satisfaction and advances the general well-
being of  society. It has been demonstrated that higher-
quality healthcare may lower the prevalence of  disease 
and increase access to care, which is especially beneficial 
for those with limited resources (Haque et al., 2020). 
Improving healthcare service quality is a universal goal, as 
evidenced by international agreements such as the United 
Nations Summit’s Sustainable Development Goals 
(SDGs) from 2015 (Pongpiachan & Hashmi, 2020). Both 
public and commercial healthcare facilities worldwide are 
working to improve service quality by tackling the different 
elements that impact it. Implementing systems like 
medical insurance has been highlighted as an important 
component of  assessing healthcare service quality (Zhou 
et al., 2020). Despite these considerable advances, research 
into the influence of  Nphies deployment on healthcare 
service efficiency in Saudi Arabia is still scarce. This 
study aims to close this gap by investigating the extent 
of  Nphies application at Arrawdha General Hospital in 
Dammam and its impact on healthcare service quality. By 
providing light on this essential feature, the study hopes 
to give significant insights for healthcare professionals 
and policymakers seeking to improve healthcare delivery 
and outcomes in Saudi Arabia. Saudi Arabia’s Vision 2030 
is a revolutionary strategy that emphasizes healthcare’s 
critical role in attaining greater social objectives. The 
vision’s focus on healthcare quality enhancement intends 
to promote the population’s overall health and well-being, 
hence promoting economic development and growth. 

LITERATURE REVIEW
Medical Insurance System
Individuals worldwide rely heavily on the medical 
insurance system to provide coverage for healthcare 
services and financial stability. It serves as a social safety 
net, reducing the financial strain of  medical costs and 
fostering general well-being. Social insurance and private 
insurance are the two main types of  medical insurance 
systems found around the world. Social insurance provides 
residents with universal coverage and is financed by 
necessary contributions from employers, employees, and 
occasionally the government. National health insurance 
schemes in countries including the United Kingdom and 
Canada are two examples. Contrarily, private insurance 
entails individuals or companies buying private health 
insurance policies from insurance providers; the specific 
plan and insurer selected will determine the coverage and 

cost (AlJohani & Bugis, 2024). One country with a strong 
private insurance industry is the United States (Elena 
Nebolsina, 2018).
Medical insurance systems enhance healthcare access, 
reduce financial barriers, and promote preventative care, 
leading to better health outcomes. However, they also 
pose challenges like moral hazard and adverse selection. 
Balancing coverage costs with insured demands is crucial 
for long-term financial stability, and disparate resource 
allocation can lead to healthcare access inequities. Saudi 
Arabia’s medical insurance system has experienced 
considerable improvements, ensuring financial stability 
and accessibility for inhabitants. The system consists of  
many groups, including the National Health Insurance 
Scheme, which covers all necessary medical treatments. 
The program provides financial security for older 
individuals facing age-related health issues (Al-Hanawi 
et al., 2018). The Selective Medical Insurance Program 
(SMIP) provides comprehensive medical coverage for 
foreigners and their family (Zhou, 2023). The system 
provides financial security, expanded healthcare access, 
and enhanced efficiency. Healthcare’s growing costs pose 
issues in terms of  coverage, quality, and sustainability. A 
coordinated and sustainable system requires continuous 
monitoring and modifications.

Healthcare Service Quality
The idea of  healthcare service quality is complex and 
includes a range of  factors and indicators. Its main goal 
is to satisfy patients’ requirements and expectations 
while keeping in mind accepted norms. The degree 
to which a medical facility’s healthcare services satisfy 
patients’ requirements and expectations in accordance 
with predetermined criteria is a common definition of  
healthcare quality (Fatima et al., 2018). It also describes 
how well healthcare systems and procedures meet or 
surpass patients’ needs and expectations while adhering 
to legal requirements. The capacity of  a patient to pay 
for healthcare services is referred to as accessibility, and 
the dependability of  healthcare services in providing care 
and treatment for a patient is referred to as dependability. 
These two factors are used to determine the quality of  
healthcare (Swain & Kar, 2018).
The characteristics of  healthcare services can be 
measured in terms of  tangibility, empathy, assurance, 
responsiveness, and reliability (Setiono & Hidayat, 2022). 
Meeting patients’ fair expectations for non-medical 
aspects of  therapy and delivering prompt service are 
all included in responsiveness. The ability to provide 
dedicated healthcare services accurately and consistently 
while guaranteeing accurate invoicing is what is meant by 
reliability. Assurance includes staff  members’ attitude of  
confidence and trust, professionalism, competency, and 
kindness. The external expression of  tangible resources, 
such as structures, equipment, people, and communication 
devices, is referred to as tangible. It entails having access 
to contemporary medical technology and equipment, 
attractive physical settings, and well-groomed personnel. 



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Empathy is showing patients that you care about them 
individually and with compassion by acknowledging their 
situations while you provide care and therapy (Agustina & 
Handayani, 2023; Bentum-Micah et al., 2020).
Several indicators are employed to assess the quality of  
healthcare services, such as avoidable hospital admissions, 
various medications and therapies imposed in primary 
care, signs of  acute treatment, and measures showing the 
efficacy of  mental health services. Patient experiences 
and contentment are also major predictors of  healthcare 
service quality (Ng & Luk, 2019). The implementation 
of  a unified medical insurance system has considerably 
increased access to healthcare while lowering patients’ 
out-of-pocket payments (Al-Hanawi et al., 2021). It has 
also helped to close the healthcare utilization gap between 
rural and urban regions, promoting regional equity.

Research Perspectives on the Impact of  Health 
Insurance Systems on Healthcare Service Quality
The influence of  health insurance systems on healthcare 
service quality has been investigated from a variety of  
viewpoints, both in Saudi Arabia and worldwide. Several 
research has examined the link between healthcare 
insurance systems along with the quality of  healthcare 
services, providing light on various elements and 
dimensions of  this complicated subject. One important 
factor that has been investigated is the effect of  health 
insurance on accessibility to care and healthcare usage 
(Erlangga et al., 2019). According to research, having 
health insurance enhances the probability that people 
would seek medical care, get frequent exams, and receive 
essential medical treatments. Increased use of  healthcare 
services may contribute to better medical results and 
higher overall quality of  treatment (Djahini-Afawoubo & 
Aguey, 2022).
Additionally, studies have investigated the connection 
between patient happiness and health insurance. 
According to some research, having health insurance 

improves patient satisfaction, especially when it comes 
to financial security and access to care (Manzoor et al., 
2019). Further research into the variables impacting 
patient happiness in healthcare settings is necessary, since 
past studies have indicated that there can be differences 
in patient satisfaction depending on insurance status 
(Meesala & Paul, 2018). Furthermore, there has been 
discussion on how health insurance may raise the standard 
of  medical care. Research has demonstrated that health 
insurance can result in improved access to treatment, a 
greater usage of  preventative services, and a higher level 
of  satisfaction with care(Mazurenko et al., 2018). On the 
other hand, issues including unfair benefit distribution 
and variations in healthcare quality and accessibility 
amongst various demographic groups have also been 
brought to light (Bagnoli, 2019).

Healthcare Sector in Saudi Arabia
Saudi Arabia’s healthcare industry is rapidly growing and 
changing as a result of  the government’s dedication to 
raising the quality and availability of  healthcare services. 
The Saudi government is making large investments in the 
healthcare system as part of  Vision 2030, with intentions 
to boost private sector involvement and privatize several 
healthcare institutions (Moshashai et al., 2020). The goal of  
this move toward privatization is to increase effectiveness 
and lessen the load on the government to deliver 
healthcare services. One of  the most important projects 
is the National Health Insurance (NHI) program, which 
tries to build a sustainable healthcare system by collecting 
monthly financial payments from members (Puteh et al., 
2022). This initiative has received tremendous support, 
with many people eager to pay for NHI, especially those 
who routinely utilize public healthcare and are pleased 
with the results. Furthermore, the government offers 
free medicines to all residents through government-run 
healthcare facilities and social and public health insurance 
programs. 

Figure 1: Healthcare system in Saudi Arabia (Puteh et al., 2020)



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Saudi Arabia’s healthcare system confronts issues such 
as growing expenses, fast population expansion, and a 
high frequency of  chronic diseases (Almalki et al., 2011). 
To address these issues, the government is working 
to modernize the healthcare system and establish 
innovative care models. The six systems of  care that are 
keeping well, planned procedures, women and children, 
urgent problems, chronic illnesses, and the end stage 
of  life are being combined to provide complete and 
efficient healthcare. Additionally, the Saudi government 
encourages the application of  technology to enhance 
healthcare services. Initiatives focusing on organizational 
development and technological effectiveness are being 
adopted to improve the healthcare system’s efficiency and 
attractiveness (Sajjad & Qureshi, 2020). The purpose is 
to apply various healthcare technologies to enhance the 
organization’s reputation, employees, healthcare system, 
and general healthcare quality. Overall, Saudi Arabia’s 
healthcare system is experiencing major transformation 
to satisfy the rising demand for healthcare services. The 
government is aiming to develop a sustainable healthcare 
system that offers all citizens with high-quality and easily 
accessible healthcare services through Vision 2030 and 
other reform measures.
Figure 1 shows Saudi Arabia’s healthcare sector, which 
offers services to non-Saudi citizens through employer-
based health insurance, private healthcare, emergency, 
outpatient, and inpatient services. Citizens have access 
to public hospitals, private services, and free public 
services, including primary, general, specialist, and tertiary 
hospitals (Puteh et al., 2020). 

MATERIALS AND METHODS
The study evaluates the impact of  NPHIES on healthcare 
service quality at Arrawdha General Hospital, Dammam, 
Saudi Arabia, using a quantitative approach and by 
randomly selecting 300 participants.

Data Collection
The study used a standardized questionnaire to gather data 
from physicians and administrators at Arrawdha General 
Hospital. The questionnaire included demographic 
and NPHIES implementation sections. A total of  300 
questionnaires were delivered, with a response rate of  
91.67%. Of  these, 275 questionnaires were obtained and 
assessed valid for processing. Data collection was carried 
out over a set period of  time to guarantee complete data 
acquisition.

Inclusion and Exclusion Criteria
The study included those individuals with the targeted 
profession such as physicians or administrators which are 
motivated to participate in the study and are present at the 
Arrawdha General Hospital. Those who did not provide 
their agreement to participate in the study or who had 
no affiliation with the hospital were excluded from study.

Data Analysis
The study utilized the SPSS program to analyze data 
on the influence of  the unified medical insurance 
system (NPHIES) on healthcare services at Arrawdha 
General Hospital. Statistical methods included Pearson’s 
correlation coefficient, Cronbach’s alpha, T-tests, 
ANOVA, and regression analysis. The study aimed 
to understand the perceived effects of  the system by 
comparing responses from administrators and physicians. 
Response degrees were represented using likert scale and 
verification degrees for each axis were determined using 
the following formula:

Table 1: Distributed and retrieved questionnaires 
suitable for statistical analysis
Distributed 
questionnaires

Retrieved 
and valid for 
statistical analysis 
questionnaires

Percentage

300 275 91.67%

Table 2: Distributed and retrieved questionnaires 
suitable for statistical analysis
Gender Frequencies Percentages 
Male 142 51.6% 
Female 133 48.4% 
Total 275 100% 

Demographics
The frequencies and percentages were calculated for the 
study sample, and they are represented in the demographic 
variables, which include:

Gender

The Table 2 shows that the highest percentage achieved 
by respondents based on gender was (51.6%) ascribed to 
(Male), which was followed by a lower percentage (48.4%) 
allocated to (Female).  

Job Position
The Table 3 shows that the largest percentage obtained by 
respondents as per job position was (72.0%) attributed to 
(Physician), followed by the lowest percentage of  (28.0%) 
attributed to (Administrator).

Table 3: Distribution of  respondents as per their job 
positions
Job position Frequencies Percentages 
Physician 198 72.0% 
Administrator 77 28.0% 
Total 275 100% 



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Year of  Experience
The table 4 shows that the largest percentage obtained 
by respondents according to years of  experience was 
(51.6%) attributed to (From 5 to less than 10 years), 
followed by (29.1%) attributed to (less than 5 years). 
While the lowest percentage was (19.3%) attributed to 
(10 years and above).

The study tool, a questionnaire, was designed to assess the 
impact of  a Unified Medical Insurance System (NPHIES) 
on healthcare service quality. It included dimensions 
like responsiveness, reliability, assurance, tangibility, and 
empathy. The tool’s validity and reliability were confirmed 
through a pilot sample of  30 individuals.

Table 4: Distribution of  respondents as per the years of  experience
Years of  experience Frequencies Percentages 
Less than 5 years 80 29.1% 
From 5 to less than 10 years 142 51.6% 
10 years and above 53 19.3% 
Total 275 100% 

Table 5: Correlation coefficients between the total score for each dimension and the total score for the first axis: The 
implementation of  a Unified Medical Insurance System (NPHIES)
No. Dimensions Correlation Coefficient 
1 The First Dimension: Insurance Services Implementation .991** 
2 The Second Dimension: Health Services Implementation .992** 

Table 6: Cronbach’s alpha reliability coefficient for the dimensions and the total score for the first axis
No. Dimensions Statements No. Cronbach's alpha coefficient 
1 The First Dimension: Insurance Services Implementation 10 .984 
2 The Second Dimension: Health Services Implementation 10 .977 
Total  20 .982 

First Axis: The Implementation of  Unified Medical 
Insurance System (NPHIES):
The Validity and Reliability of  the Tool
The study revealed the psychometric characteristics of  
the questionnaire, by verifying its validity and reliability, 
by applying it to a pilot sample apart from the original 
study sample and which consisted of  (30) individuals.

The above table makes it evident that each dimension’s 
correlation coefficient values and the questionnaire’s total 
score for the first axis had (high) values, ranging from 
(.991** - .992**), and that they were all highly significant 
at the significance value of  (0.01). This suggests that the 
first axis has an elevated level of  construct validity.

The Reliability of  the Tool: Cronbach Alpha
The Cronbach’s alpha reliability coefficient was calculated 
for the first axis dimensions of  implementing a unified 
medical insurance system (NPHIES) and the total score 
in the questionnaire.

Table 6 shows high reliability coefficients for the first axis 
dimensions (.977-.984), with a total reliability coefficient 
of  (.982), indicating the questionnaire’s validity, reliability, 
and results for its application.

Second Axis: Healthcare Service Quality
The Validity and Reliability of  the Tool
The internal consistency validity was assessed by calculating 

the Pearson correlation coefficient between each 
statement’s scores and the total score of  the dimension 
from the second axis: healthcare service quality.

Table 7: Pearson correlation coefficients between individual statement scores and the total score for the dimension 
in the second axis of  Healthcare Service Quality
Statement 
No. 

Correlation Coefficient Statement 
No. 

Correlation 
Coefficient 

Statement No. Correlation 
Coefficient 

The First Dimension: Responsiveness 
21 .986** 22 .979** 23 .964** 
24 .932** 25 .960**  
The Second Dimension: Reliability 



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Table 7 shows that the correlation coefficients of  
statements with the total score of  the second axis of  
healthcare service quality were all statistically significant 
at a level of  (0.01). These coefficients ranged in 
responsiveness, reliability, assurance, tangibility, and 
empathy, indicating high internal consistency in the 
questionnaire’s second axis dimensions. The construct 
validity of  the second axis dimension, Healthcare 

Service Quality, was confirmed by examining correlation 
coefficients between each dimension’s total score and the 
second axis’ total score.

The Reliability of  the Tool: Cronbach Alpha
The Cronbach’s alpha reliability coefficient was calculated 
for the second axis of  Healthcare Service Quality and the 
total score in the questionnaire, as shown in the table. The 

26 .878** 27 .903** 28 .881** 
29 .922** 30 .864**  
The Third Dimension: Assurance 
31 .917** 32 .977** 33 .940** 
34 .924** 35 .851**  
The Fourth Dimension: Tangibility 
36 .856** 37 .974** 38 .868** 
39 .896** 40 .970**  
The Fifth Dimension: Empathy 
41 .880** 42 .962** 43 .967** 
44 .940** 45 .919**  

Table 8: Cronbach’s alpha reliability coefficient for the dimensions and the  total score for the second axis: Healthcare 
Service Quality
No. Dimensions Statements No. Cronbach's alpha coefficient 
1 The First Dimension: Responsiveness 5 .968 
2 The Second Dimension: Reliability 5 .972 
3 The Third Dimension: Assurance 5 .977 
4 The Fourth Dimension: Tangibility 5 .978 
5 The Fifth Dimension: Empathy 5 .972 
Total score 25 .979 

table shows high reliability coefficients for healthcare service 
quality dimensions (.968-.978) and total reliability coefficient 
(.979), indicating the questionnaire’s validity and reliability in 
its results, indicating its reliability for application.

RESULTS
The First Axis: The Implementation of  Unified 
Medical Insurance System (NPHIES)
The table shows that the implementation of  a Unified 

Medical Insurance System (NPHIES) at Arrawdha 
General Hospital in Dammam has achieved a high 
response degree, with an overall mean of  (3.71) and a 
standard deviation of  (.629). This success is attributed 
to the accurate information provided by the National 
Health Information Center about health practitioners 
and facilities, which supports the development of  the 
Saudi health insurance industry.

Table 9: The arithmetic means and standard deviations of  the respondents’ responses “The First Axis: The 
implementation of  a Unified medical insurance system (NPHIES)”
No Dimensions of  the first axis Mean Standard deviation Response degree Rank 
1 The First Dimension: Insurance Services 

Implementation 
3.69 .821 High 2 

2 The Second Dimension: Health Services 
Implementation 

3.73 .670 High 1 

The Overall Mean 3.71 .629 Moderate 



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The Dimensions of  the First Axis
The First Dimension: Insurance Services 
Implementation
The first dimension of  insurance services implementation 
in Saudi Arabia is high, with a mean of  (3.69) and a 
standard deviation of  (.821). The system allows insurance 

parties to file and track complaints, verifies policy validity, 
and seeks to improve and develop the health insurance 
industry. The Unified Medical Insurance System 
(NPHIES) has been successful in implementing insurance 
services, allowing for flexibility, and strengthening health 
insurance in Saudi Arabia.

Table 10: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent's responses to the 
first dimension: Insurance Services Implementation
No Statement Response Degree

M
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1 There is a unified channel for 
insurance transactions between 
health service providers and 
insurance companies. 

F 43 19 41 47 125 3.70 1.485 5 High 
% 15.6 6.9 14.9 17.1 45.5 

2 The application of  the system 
standardizes the medical and technical 
symbols used in the insurance sector.

F 50 17 53 37 118 3.57 1.525 9 High 
% 18.2 6.2 19.3 13.5 42.9

No Statement Response Degree

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3 The system assists in sending and 
receiving notifications and extracting 
periodic reports related to insurance 
transactions.

F 42 21 39 26 147 3.78 1.522 4 High 
% 15.3 7.6 14.2 9.5 53.5 

4 The system measures the extent of  
the commitment of  service providers 
and  insurance companies to the  
Council of  Health Insurance policies. 

F 41 16 38 46 134 3.79 1.470 3 High 
% 14.9 5.8 13.8 16.7 48.7 

5 The service allows all insurance parties 
to file and  track complaints submitted 
to the Health Insurance Board. 

F 37 8 50 27 153 3.91 1.437 1 High 
% 13.5 2.9 18.2 9.8 55.6 

6 The system verifies the validity of  the 
insurance policy of  the beneficiary (the 
patient) to obtain the required service.

F 46 10 47 20 152 3.81 1.532 2 High 
% 16.7 3.6 17.1 7.3 55.3 

7 The system accelerates the 
beneficiary’s access to health services 
and improves users’ experience.

F 51 13 48 28 135 3.67 1.556 6 High 
% 18.5 4.7 17.5 10.2 49.1 

8 The system seeks to improve and 
develop the health insurance industry 
in the Kingdom.

F 61 20 44 21 129 3.50 1.635 10 High 
% 22.2 7.3 16.0 7.6 46.9 

9 The system seeks to improve and 
develop the health insurance industry 
in the Kingdom.

F 44 12 67 38 114 3.60 1.457 7 High 
% 16.0 4.4 24.4 13.8 41.5 

10 The system provides information 
on the state of  the Saudi health 
insurance industry more accurately 
to allow for its development.

F 46 12 72 30 115 3.57 1.477 8 High 
% 16.7 4.4 26.2 10.9 41.8 

The Overall mean 3.69 .821 High 



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The Second Dimension: Health Service 
Implementation
Table 11 reveals a high mean for the second dimension 
of  health services implementation, attributed to the 
effectiveness of  unified digital health services. The system 

enhances healthcare quality, reduces costs, and facilitates 
information flow among facilities. The unified insurance 
system accelerates verification and approval processes, 
facilitating patient data exchange and treatment. This 
system improves decision-making and patient outcomes.

Table 11: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
second dimension: Health Services Implementation
No Statement Response Degree

M
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11 The system provides a 
comprehensive view of  the patient's 
treatment history. 

F  76 17 20 2 160 3.56 1.79 0 7 High 
% 27.6 6.2 7.3 .7 58.2 

12 The application of  the system 
facilitates the exchange of  patient's 
health information 

F  45 7 31 3 189 4.03 1.54 3 2 High 
% 16.4 2.5 11.3 1.1 68.7 

13 The application of  the system helps 
to speed up the verification of  the 
treatment mechanism and approval 
requests. 

F 53 1 18 2 201 4.08 1.59 6 1 High 
% 19.3 .4 6.5 .7 73.1 

14 The system facilitates matching the 
patient's national identity number and 
obtaining basic national information 
from the main source. 

F 62 12 20 25 156 3.73 1.66 8 5 High 
% 22.5 4.4 7.3 9.1 56.7 

15 The system enhances patient safety 
by exchanging unified  prescriptions 
across the Kingdom

F 58 11 58 24 124 3.53 1.58 3 8 High 
% 21.1 4.0 21.1 8.7 45.1 

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16 The system facilitates the flow of  
relevant information among healthcare 
facilities for treatment and research 
purposes.

F 60 12 62 28 113 3.44 1.57 3 10 High 
% 21.8 4.4 22.5 10.2 41.1 

17 The system provides updated clinical 
data to healthcare providers 

F 58 12 55 30 120 3.52 1.57 6 9 High 
% 21.1 4.4 20.0 10.9 43.6 

18 The system helps exchange 
information needed to refer a patient 
for care from one facility to another. 

F 40 7 59 6 163 3.89 1.48 8 4 High 
% 14.5 2.5 21.5 2.2 59.3 

19 The system helps direct access 
to information about health 
practitioners and health facilities 
from the National Center for Health 
Information

F 71 16 27 4 157 3.58 1.75 0 6 High 
% 25.8 5.8 9.8 1.5 57.1 

20 The system enables the exchange of  
vaccination information for public 
health monitoring and management.

F 50 10 32 8 175 3.90 1.59 2 3 High 
% 18.2 3.6 11.6 2.9 63.6 

The Overall mean 3.73 .670 High 



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Second Axis: Healthcare Service Quality
From table 12, the study reveals that healthcare service 
quality at Arrawdha General Hospital in Dammam has a 
high response degree, with an overall mean of  3.80 and a 
standard deviation of  .644. The reliability, responsiveness, 
empathy, tangibility, and assurance dimensions all have 

high response degrees. This is attributed to the efficiency 
and effectiveness of  the healthcare service provided by 
the Unified Health Insurance System. The adequacy 
of  resources and services, such as medicines, doctors, 
supplies, and outpatient rooms, contribute to the high 
response degree.

Table 12: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
second axis: Healthcare Service Quality
No. Dimensions of  the second axis Mean Standard deviations Respon se degree  Ran k 
1 The First Dimension: Responsiveness 3.88 .877 High 2 
2 The Second Dimension: Reliability 4.03 .876 High 1 
3 The Third Dimension: Assurance 3.62 1.120 High 5 
4 The Fourth Dimension: Tangibility 3.72 1.056 High 4 
5 The Fifth Dimension: Empathy 3.73 .966 High 3 
The overall mean 3.80 .644 Hig h 

The Dimensions of  the Second Axis
Table 13 shows that the overall mean for responsiveness in 
the first dimension was (3.88), with a standard deviation of  
.877. The system’s effectiveness in responding to patient 
requirements and providing efficient communication 
between insurance companies and medical care providers 
was attributed to its high response degree.
The system’s success in sending notifications to users to 
keep them informed about the latest developments in 
their health status was attributed to its ability to follow 
up with patients regularly. The system’s role in enhancing 

communication between healthcare providers in both 
public and private institutions was also attributed to 
its ability to coordinate between healthcare providers, 
ensuring ease of  communication and enhancing the 
quality of  healthcare in all institutions. The unified 
health insurance system at Arrawdha General Hospital 
Dammam has achieved high response degrees in terms of  
responsiveness, communication, and coordinating between 
healthcare providers. The system’s ability to effectively 
address patient needs and improve communication 
between providers is a key factor in its success.

Table 13: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
first dimension: Responsiveness
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21 The system enhances the quick 
response to all complaints of  system 
users.

F 56 18 1 3 197 3.97 1.68 0 2 High 
% 20.4 6.5 .4 1.1 71.6 

22 The system provides efficient means 
of   communication to receive users’ 
requests and  effectively deal with 
them.

F 67 12 15 8 173 3.76 1.73 3 4 High 
% 24.4 4.4 5.5 2.9 62.9 

23 The system enhances the quality of  
communication  between insurance 
companies and medical service 
providers by ensuring the flow of  
information.

F 67 4 7 5 192 3.91 1.72 6 3 High 
24.4 1.5 2.5 1.8 69.8 

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24 The system periodically sends 
notifications to all users to make 
them acquainted with the latest 
developments.

F 44 11 16 12 192 4.08 1.53 6 1 High 
% 16.0 4.0 5.8 4.4 69.8 

25 The system enhances communication 
between healthcare providers in both 
public and private healthcare

F 76 14 5 9 171 3.67 1.79 9 5 High 
% 27.6 5.1 1.8 3.3 62.2 

The overall mean 3.88 .877 High 

The Second Dimension: Reliability
The table demonstrates a high response degree to the second 
dimension of  reliability, attributed to the NPHIES platform’s 
quality control and supervisory services, the efficiency 

Table 14: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
second dimension: Reliability
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26 All medical records and insurance 
files are kept within one unified 
system to enhance the reliability of  
the information. 

F 28 40 21 3 183 3.99 1.49 9 4 High 
% 10.2 14.5 7.6 1.1 66.5 

27 The medical staff  depends on the 
information provided by the portal for 
tracking the medical history of  patients. 

F 18 38 16 9 194 4.17 1.37 2 1 High 
% 6.5 13.8 5.8 3.3 70.5 

28 The system enhance transparency in 
all medical and insurance services.

F 32 31 20 4 188 4.04 1.50 4 3 High 
% 11.6 11.3 7.3 1.5 68.4 

29 The NPHIES platform 
offers a range of  quality control 
and supervisory services to raise the 
Health Insurance Council’s efficiency. 

F 26 30 22 10 187 4.10 1.43 0 2 High 
% 9.5 10.9 8.0 3.6 68.0 

30 The system reduces the cost and time 
of  providing healthcare services to 
improve healthcare decision-making.

F 44 33 18 7 173 3.84 1.61 2 5 High 
% 16.0 12.0 6.5 2.5 62.9 

Total 4.03 High

of  medical staff  in tracking patient medical history, and 
the system’s ability to reduce healthcare service costs and 
time, ultimately improving healthcare decision-making and 
increasing transparency in insurance and medical services.

The Third Dimension: Assurance
Table 15 reveals a high response degree for the third 
dimension of  assurance, attributed to the system’s 
competence, professionalism, and kindness. The system 
ensures rapid intervention, user satisfaction, and translates 

cooperative health insurance principles into practice. 
The speed of  response and the unified health insurance 
system translate health insurance principles into practice, 
ensuring quality care.

Table 15: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
third dimension: Assurance
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31 The system ensures users’ satisfaction 
with healthcare service delivery. 

F 62 12 20 25 156 3.73 1.66 8 2 High 
% 22.5 4.4 7.3 9.1 56.7 



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32 The system improves the process of  
data sharing and management

F 58 11 58 24 124 3.53 1.58 3 3 High 
% 21.1 4.0 21.1 8.7 45.1 

33 The system translates the principles 
of  cooperative health insurance into 
practice. 

F 60 12 62 28 113 3.44 1.57 3 5 High 
% 21.8 4.4 22.5 10.2 41.1 

34 The system shall not disclose the 
identity of  the persons whose personal 
data is mentioned on the platform. 

F 58 12 55 30 120 3.52 1.57 6 4 High 
% 21.1 4.4 20.0 10.9 43.6 

35 The system guarantees rapid 
intervention if  the patient does not 
receive his required service

F 44 8 44 23 156 3.87 1.50 8 1 High 
% 16.0 2.9 16.0 8.4 56.7 

The overall mean 3.62 1.120  High 

The Fourth Dimension: Tangibility
Table 16 The fourth dimension of  the system’s efficiency 
and quality was praised for its attractiveness, ease, and 
flexibility in handling data. High responses were given 

to interactive browsing, structured search processes, 
and no difficulty in registration, indicating the system’s 
attractiveness and ease of  use, encouraging patients to 
use it for health services.

Table 16: Frequencies, percentages, arithmetic means, and standard deviations of  the respondent’s responses to the 
fourth dimension: Tangibility
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36 The system platform is attractive. F 54 12 34 28 147 3.73 1.59 3 4 High 
% 19.6 4.4 12.4 10.2 53.5 

37 The search process on the website is 
structured and highly  organized

F 43 11 47 32 142 3.80 1.49 0 2 High 
% 15.6 4.0 17.1 11.6 51.6 

38 Browsing the system is done 
interactively.

F 33 16 51 22 153 3.89 1.43 2 1 High 
% 12.0 5.8 18.5 8.0 55.6 

39 There is smoothness and flexibility in 
dealing with system data.

F 42 13 54 28 138 3.75 1.48 6 3 High 
% 15.3 4.7 19.6 10.2 50.2 

40 There is no difficulty in the 
registration process.

F 62 8 67 28 110 3.42 1.57 0 5 High 
22.5 2.9 24.4 10.2 40.0 

The overall mean 3.72 1.05 6 High 

The Fifth Dimension: Empathy
The fifth dimension of  empathy in Table 17 has a high 
response degree, with a mean of  (3.73) and a standard 
deviation of  (.966). The system prioritizes stakeholder 

needs, works around the clock, and is highly responsive 
to problems. Its efficiency in providing specialized care, 
tracking user needs, and immediate response to stakeholder 
problems contribute to its high response degree. Third: 

Table 17: Frequencies, percentages, arithmetic averages, and standard deviations of  the respondent’s responses to 
the fifth dimension: Empathy
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41 The system is designed in such a way 
that satisfies all stakeholders’ needs.

F 41 16 38 46 134 3.79 1.47 0 3 High 
% 14.9 5.8 13.8 16.7 48.7 

42 The system sets the needs and 
expectations of  all stakeholders

F 37 8 50 27 153 3.91 1.43 7 1 High 
% 13.5 2.9 18.2 9.8 55.6 



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43 The system works around the clock 
to ensure the availability of  required 
medical and insurance information.

F 46 10 47 20 152 3.81 1.53 2 2 High 
% 16.7 3.6 17.1 7.3 55.3 

44 The system keeps all stakeholders 
informed of  the latest news and 
updates.

F 51 13 48 28 135 3.67 1.55 6 4 High 
% 18.5 4.7 17.5 10.2 49.1 

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45 The system is highly responsive in 
dealing with stakeholders’ problems.

F 61 20 44 21 129 3.50 1.63 5 5 High 
% 22.2 7.3 16.0 7.6 46.9 

The overall mean 3.73 .966 High 

Statistical Analysis of  Study Variables for Unified 
Medical Insurance System Implementation
The findings of  the research showed that, for both the 
insurance and health services implementation aspects 
along with the overall mean, there were no statistically 
significant variations in the mean scores of  the study 
samples according to gender, job position, or years of  
experience. These results imply that perspectives on the 

implementation of  the unified medical insurance system 
were unaffected by factors such as gender, job title, or 
years of  experience.
Individuals from a variety of  demographic backgrounds 
had comparable opinions about the system’s 
implementation, demonstrating a uniform understanding 
of  its significance and effect on Saudi Arabia’s healthcare 
system’s quality.

Table 18: Demographic Analysis using T-test and One-Way ANOVA
Variable Test Dimension Sig. Result
Gender T-test Insurance Services Implementation 0.519 Not significant (p > 0.05)

Health Services Implementation 0.6 Not significant (p > 0.05)
Overall Mean 0.484 Not significant (p > 0.05)

Job Position T-test Insurance Services Implementation 0.983 Not significant (p > 0.05)
Health Services Implementation 0.1 Not significant (p > 0.05)
Overall Mean 0.374 Not significant (p > 0.05)

Years of  
Experience

One-Way 
ANOVA

Insurance Services Implementation 0.696 Not significant (p > 0.05)

Health Services Implementation 0.949 Not significant (p > 0.05)
Overall Mean 0.785 Not significant (p > 0.05)

Fourth: Analysis of  Healthcare Service Quality Based 
on Gender, Job Position, and Years of  Experience
As per the tables above, the evaluation of  healthcare 
service quality according to years of  experience, job 
position, and gender did not show significant differences 
in most of  the dimensions.
Responsiveness, reliability, assurance, tangibility, 
empathy, and mean did not significantly change based 
on gender. Likewise, job position had no apparent 

impact on these dimensions, except for tangibility, where 
administrators gave it a higher rating than physicians, but 
not very significantly. Except for responsiveness, where 
differences were getting close to significance, years of  
experience likewise revealed no significant differences 
in other aspects. These results imply that, in the studied 
context, views of  the quality of  healthcare services are 
not significantly influenced by factors such as years of  
experience, gender, or work position.

Table 19: Analysis of  healthcare service quality based on gender using T-test
Dimensions Gender N Mean SD T DF Sig. 

(2tailed) 
Sig

The First Dimension: 
Responsiveness 

Male 142 3.79 .856 -1.705 273 .089 Not-
significant Female 133 3.97 .894 



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Dimensions Gender N Mean SD T DF Sig. 
(2tailed)

Sig

The Second Dimension: 
Reliability 

Male 142 4.02 .901 -.238 273 .812 Not-
significantFemale 133 4.04 .853 

The Third Dimension: 
Assurance 

Male 142 3.57 1.148 -.654 273 .514 Not-
significantFemale 133 3.66 1.092 

The Fourth Dimension: 
Tangibility 

Male 142 3.68 1.118 -.712 273 .477 Not-
significantFemale 133 3.77 .987 

The Fifth Dimension: 
Empathy 

Male 142 3.71 1.011 -.375 273 .708 Not-
significantFemale 133 3.76 .919 

The overall mean Male 142 3.76 .696 -1.095 273 .275 Not-
significantFemale 133 3.84 .582 

Table 20: Analysis of  healthcare service quality based on job position using T-test
Dimensions Job position N Mean SD T DF S i g . 

(2tailed) 
Sig 

The First Dimension: 
Responsiveness 

Physician 198 3.94 .850 1.759 273 .080 Not-
significant Administrator 77 3.73 .933 

The Second Dimension: 
Reliability 

Physician 198 4.06 .835 .987 273 .325 Not-
significant Administrator 77 3.95 .976 

The Third Dimension: 
Assurance 

Physician 198 3.66 1.128 1.121 273 .263 Not-
significant Administrator 77 3.50 1.099 

The Fourth Dimension: 
Tangibility 

Physician 198 3.65 1.077 -1.783 273 .076 Not-
significant Administrator 77 3.90 .984 

The Fifth Dimension: 
Empathy 

Physician 198 3.73 .968 -.235 273 .814 Not-
significant Administrator 77 3.76 .967 

The overall mean Physician 198 3.81 .662 .496 273 .620 Not-
significant Administrator 77 3.77 .597 

Table 21: Analysis of  healthcare service quality based on years of  experience using ANOVA
Dimensions Source of  variance Sum of  

Squares 
DF Mean Square (F) value Sig. 

The First Dimension:  
Responsiveness 

Between Groups 3.818 2 1.909 2.507 .083 
Within Groups 207.126 272 .761 
Total 210.943 274 -- 

The Second Dimension: 
Reliability

Between Groups .913 2 .456 .592 .554 
Within Groups 209.495 272 .770 
Total 210.407 274 -- 

The Third Dimension: 
Assurance 

Between Groups 4.145 2 2.073 1.660 .192 
Within Groups 339.611 272 1.249 
Total 343.756 274 -- 

The Fourth Dimension: 
Tangibility 

Between Groups 3.773 2 1.887 1.701 .185 
Within Groups 301.747 272 1.109 
Total 305.520 274 -- 

The Fifth Dimension:  
Empathy 

Between Groups 2.017 2 1.009 1.082 .340 
Within Groups 253.538 272 .932 
Total 255.555 274 -- 



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The overall mean Between Groups 1.291 2 .646 1.564 .211 
Within Groups 112.279 272 .413 
Total 113.570 274 -- 

Fifth: Impact of  the Unified Medical Insurance 
System (NPHIES) on Healthcare Service Quality in 
Arrawdha General Hospital, Dammam
To answer this question, a simple linear regression analysis 
was used, and the following table shows that:
The health insurance system has a significant positive 
effect on the healthcare service quality at Arrawdha 

General Hospital in Dammam, accounting for 54% 
of  the variation in service quality. This is due to the 
system’s ability to enhance communication between 
healthcare providers and patients, providing updated 
clinical data. This system also improves the effectiveness 
of  communication between healthcare providers and 
patients.

Table 22: The effect of  applying the health insurance system on the healthcare service quality in Arrawdha General 
Hospital in Dammam
Independent variable  B Beta R R2 T value Sig. T 
The implementation of  a Unified 
medical insurance system (NPHIES)  

.752 .735 .735a .540 17.912 .000 

Constant 1.008 
Adj R2 .539 
F. value  320.842 
Sig F .000b  

DISCUSSION
The study conducted at Arrawdha General Hospital in 
Dammam aimed to assess the implementation of  the 
unified medical insurance system (NPHIES) and its 
impact on healthcare service quality. The results showed 
that the implementation of  NPHIES had a high response 
degree, with an overall mean of  (3.71), a standard 
deviation of  (.629), and a high response degree. The 
overall mean for the first dimension of  Insurance Services 
Implementation was also high, with an arithmetic mean 
of  (3.69), a standard deviation of  (.821). The results can 
be supported by a study conducted by (Li et al., 2023), 
which found that the adoption of  a unified medical 
insurance system increases health insurance’s resilience 
to risk and significantly improves rural populations’ 
access to healthcare. This system contributes to closing 
the disparity in healthcare utilization between rural and 
urban areas and enhancing regional equity. Overall, the 
health insurance system plays a crucial role in improving 
healthcare service quality in Dammam.
The second dimension of  Healthcare Service Quality 
was also high, with an overall mean of  (3.80), a standard 
deviation of  (.644), and a high response degree. The 
overall mean for the first dimension of  Responsiveness 
was high, with an arithmetic mean of  (3.88), and a 
standard deviation of  (.877). The overall mean for the 
second dimension of  Reliability was high, with an 
arithmetic mean of  (4.03), and a standard deviation of  
(.876). The overall mean for the third dimension of  
Assurance was high, with an arithmetic mean of  (3.62), 
and a standard deviation of  (1.120). The overall mean 
for the fourth dimension of  Tangibility was high, with 
an arithmetic mean of  (3.72), and a standard deviation 

of  (1.056). The overall mean for the fifth dimension of  
Empathy was high, with an arithmetic mean of  (3.73), 
and a standard deviation of  (.966).
There were no statistically significant differences in 
the responses of  the study sample regarding the level 
of  implementing the unified medical insurance system 
(NPHIES) attributed to the variables (gender, job 
position, and years of  experience) in both dimensions. 
There were no statistically significant differences at the 
level of  significance of  (0.05) between the mean scores of  
the study sample regarding the first axis: implementation 
of  a Unified medical insurance system (NPHIES) 
attributed to the (gender) variable in either dimension

CONCLUSION
The study carried out at Dammam’s Arrawdha General 
Hospital offers important insights into how the 
Unified Medical Insurance System (NPHIES) is being 
implemented and how it affects the standard of  healthcare 
services. The results show that respondents had a 
favorable opinion of  NPHIES implementation, pointing 
to a development in the improvement of  the healthcare 
system. The perception of  healthcare service quality was 
generally favorable, with reliability receiving the highest 
rating across all evaluated dimensions. Based on years of  
experience, work position, or gender, statistical analysis 
did not show any significant differences in the quality of  
healthcare services provided by NPHIES or its execution, 
indicating a similar view across all demographic groups. 
Notably, the study found that NPHIES had a statistically 
significant beneficial influence on healthcare service 
quality, highlighting the system’s significance in enhancing 
healthcare services. The recommendations to keep 



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making investments in the health and social sectors, 
employ professionals, supply required medical devices, 
recruit competent doctors, and provide an appropriate 
number of  nursing assistants demonstrate the need for 
continuous development in healthcare delivery. 

RECOMMENDATIONS
The recommendations include the need for the Saudi 
government to continue investing in health and social 
sectors, enlisting the help of  specialists, providing all 
necessary medical devices and equipment, attracting 
experienced and competent doctors, and providing 
an adequate number of  nursing assistants for doctors. 
Future studies should focus on the impact of  health 
service quality on patients’ satisfaction at Arrawdha 
General Hospital in Dammam and the effect of  applying 
the unified health insurance system on the health of  
elderly patients.

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