An equity-based financial framework for a sustainable healthcare system in Arab countries.

Background: Disparities persist in access, quality and outcomes across different socioeconomic strata. Addressing these disparities requires a comprehensive understanding of the underlying factors contributing to healthcare inequities. Even though healthcare equity has been discussed in the literature, no comprehensive frameworks have been developed considering the given country's distinctive demographic cultural and socioeconomic variables.

Objectives: This study proposed an equity-based financial framework to enhance the sustainability of the healthcare system in Saudi Arabia, the United Arab Emirates (UAE) and Qatar. Moreover, this research aimed to examine the key factors influencing equitable access to healthcare services.

Material and methods: A cross-sectional study design was employed, utilizing national health accounts, demographic surveys and health outcomes data from 3 Arab countries: Saudi Arabia, UAE and Qatar. The study included participants from 15 medical organizations, 500 policymakers and 10,000 patients. A stratified random sampling technique was employed to ensure a diverse and representative sample. The economic equity measurements included the principal component analysis (PCA) and Theil index. Financial sustainability was evaluated using techniques such as the cost-effectiveness analysis (CEA) and systems dynamics modeling techniques.

Results: This study identified a positive convergence in healthcare systems among Qatar, Saudi Arabia and the UAE. The Theil index value of 0.35 suggested a balanced distribution of healthcare resources across the 3 countries. Policy A had an incremental cost-effectiveness ratio (ICER) of $15,000 per quality-adjusted life year (QALY), making it more cost-effective compared to Policy B with an ICER of $20,000 per QALY and Policy C with an ICER of $25,000 per QALY. The Delphi technique achieved a consensus level of 90%, while Policy C emerged as the most preferred option in the multi-criteria decision analysis (MCDA), scoring a total of 85 points. Moreover, the PCA accounted for 60% of the variations related to healthcare equity in the specified countries.

Conclusions: The findings of this study provide valuable insights for policymakers, offering a new roadmap for economic evaluation studies aimed at enhancing healthcare equity and sustainability in Arab countries.