COOPERATIVE HEALTH INSURANCE. a shared. Employment adjustment Pumps 500 million into insurance companies say specialists

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1 COOPERATIVE HEALTH INSURANCE JANUARY 2014 Volume 6 issue number 4 a shared responsibility Development of the insurance industry Abdulaziz Al Turki: Chairman of the Saudi Diabetes & Endocrine Association Employment adjustment Pumps 500 million into insurance companies say specialists january

2 inside VOLUME 6 ISSUE WELCOme Editor-in-Chief: Dr. Abdullah Bin Ibrahim Al-Sharif Secretary General of the Council of Cooperative Health Insurance Asst.Editor In Chief Mohammed S. Al Hussain Asst. Gen.Secretary of Admin & Finance of the Council of Cooperative Health Insurance Consulting Committee: Dr. Mansour Bin Nasser Al-Hawasi Deputy Health Minister of Health Affairs Council Member Dr. Rached Bin Sulayman Al Rashed Al Homied General Executive Manager of King Faisal Specialist Hospital & Research Centre in Riyadh Council Member Mr.Ahmad Bin Saleh Al Homaidan Under Secretary of Ministry of Labor For Labor Affairs Council Member The General Secretariat of the Council of Cooperative Health Insurance PO Box Riyadh Phone: Fax: General Manager: Saudi Arabia / Partner Abdullah bin Abdul Rahman Al-Aqeel Consultant Project Development: Mansour bin Abdullah Hussein Damer Women s Department Manager / Partner Jihan Abdullah Mohammed Bagadir Distribution PO Box Riyadh 11372, Phone: The reproduction or reprinting of any part of this magazine must have the express permission of the publisher, who reserves the right to initiate legal action against any violation. We have a say The development of the health insurance industry is important in ensuring the stability of this vital economic sector in the light of the problems faced by some companies. This complex task is the shared responsibility of all parties. We at the Health Insurance Council are very much concerned about the success of insurance companies. However, achieving success requires the cooperation of all parties concerned, from the service providers and recipients of health insurance, to the insurance companies. For this reason, the cover story of this issue discusses how to reinforce this nationally important industry. In a related subject, the hot topic of this issue is the change to employment conditions enforced by the state, which will improve revenues for insurance companies. Sponsors must provide health insurance to workers in the Kingdom who do not have it, and to their family members. As is customary in each issue, we take a look at an insurance company and the services it provides. This time it is the turn of Amana Insurance Company. In the Social Responsibility section, we discuss the activities of the Saudi Association for Organ Donation, Ithar. This is an important subject and we wish to foster the culture of organ donation in the community. The Community Health section looks at another equally important subject, diabetes, focusing on its risks and its prevalence among different age groups in the community. For this reason, the Interview section hosts Professor Abdul Aziz Al-Turki, chairman of the Saudi Society for Endocrinology and Diabetes. No one can talk about a disease better than someone who suffers from it and has succeeded in controlling it. Our guest has made many contributions as a chairman and founding member of many associations that deal with health. In this issue we also elaborate further with an article by a doctor who specializes in diabetes. The magazine includes various other subjects. In the section World of Technology, we review the development of artificial limbs and in the Lifestyle section, we highlight Google s smart glasses. These can be used to give motorists information such as maps. They link people with the world, working like a laptop computer in front of the eye. We shed some light on India s experience with insurance systems. Then we take you on a tourist trip to the beach of Uqair, which is undergoing large-scale improvement through projects supervised by the Saudi Commission of Tourism and Antiquities. Uqair will become one of the largest tourist beach resorts on the Arabian Gulf. In other parts of the magazine, there are news stories about insurance, questions and answers, words of wisdom, poems and jokes. We finish the trip with Our Say and hope to meet you again. january

3 100 UÉ````N Oó````Y inside VOLUME 6 ISSUE contents Riyadh Office Cercon Building no.6, PO BOX , Riyadh Kingdom of Saudi Arabia T: +966 (11) Beirut Office Saifi Village Dabbas Bldg 1st floor P.O. Box Beirut, Lebanon T: Dubai Office PO Box Dubai, UAE T: +971 (04) Alef International 08 News Al-Rabiah adopts new regulations for health insurance... impact mid Spotlight Amana Cooperative Insurance was founded in 2010 as a public joint stock company with a paid capital of SR320 million to conduct general insurance business and health insurance 18 Hot Topic Employment Adjustment pumps 500 million into insurance companies 22 Social Responsibility Ithar Charity to encourage organ donation... Human conscience to save our fellow brothers 26 Cover Story Development of the insurance industry a shared responsibility 30 Interview Chairman of the Saudi Diabetes & Endocrine Association Abdulaziz Al Turki: 34 Finance and Investment Saudi insurance between investment attractiveness and capital disparity 38 Tech World Intelligent Prosthetics A Real Alternative for a Normal Life, 42 Reports and Analysis Mixed results for first nine months of Ten companies acquired a market share of 76 percent of gross written premiums for the sector during Q Around the World Health Insurance in India Sophisticated health care at the lowest cost compared to counterparts around the world 50 Lifestyle Google Glass.. When California Patrol stopped her, the American lady did not expect to be issued with a ticket for wearing glasses! 54 Travel and Tourism Al-Uqair Beach... where waves hug the shore and whisper secrets to the sand january Alef_advert.indd 42 10/15/11 4:55 PM

4 News News Al-Rabiah adopts new regulations for health insurance... impact mid-2014 Program for electronic insurance transactions Nine large companies competing to win SHIB project Council receives new members at the fifth session The General Secretariat of the Council of Cooperative Health Insurance welcomed the new members of its fifth session, appointed by Council of Ministers. These members are: Prof Dr Rashid Hamid and General Dr Saeed Al-Asmari, both representatives of state medical services; Khaled Al Salim, from the Chambers of Commerce; Saleh Al Sabil, representing health insurance companies; and Ahmed Hemaidan, from the Labor Ministry. Secretary-general of Council Dr Abdullah Minister of health and chairman of the Council of Cooperative Health Insurance, Dr Abdullah bin Abdulaziz Al-Rabiah, adopted new regulations for the cooperative health insurance system during the 92nd meeting of the General Secretariat of the Council, which was sitting in a new session. There was extensive debate on the regulations review, and secretary-general of the Council of Cooperative Health Insurance Dr Abdullah Al-Sharif commented: Council gave great importance to the participation of all concerned parties and specialists in the health insurance industry. All parties made detailed presentations on the proposed regulations, which were published on an internet portal for 60 days. Observations and suggestions were then collected, organized and analyzed. The new Al-Sharif wished the new council members success in their tasks. A presentation was then given on the cooperative health insurance system, its regulations, the vision and mission of Cooperative Health Insurance Council and its role in the provision and regulation of health care for all private sector workers and their families. Assistant secretary-general for Technical Affairs Dr Abdullah Al Hawasi gave a detailed explanation on the work and functions of the regulations are expected to be implemented during the first six months of Opening the meeting, Al-Rabiah welcomed the members of the Council in its fifth session, wishing them success in the performance of their tasks and in achieving the aim of enhancing the market for the cooperative health insurance industry. Secretary-general Al-Sharif presented a detailed report on the performance of the Cooperative Health Insurance Council s Secretariat and recent developments in the health insurance market. Al-Rabiah praised the members of the previous session, and expressed his deep gratitude and appreciation for their outstanding work, which contributed to advancing the cooperative health insurance industry, achieving among other accomplishments balanced growth. Technical Affairs various departments and divisions, and its functions. Data were also presented on numbers insured, insurance companies and health care providers from hospitals and medical centers. Assistant secretary-general for Administration and Finance Mohammad Al-Hussein provided a detailed review of the organizational structure of the Council of Cooperative Health Insurance. He explained the administrative and financial responsibilities of the Secretariat, and discussed the vision and development plans for the future. These included new and updated internal regulations aimed at raising the efficiency and effectiveness of administrative and financial work. Director of the program of Electronic Transactions Eng. Wael Al-Al Dahasi then discussed the management of information technology and presented information on completed and future e-projects. He also reviewed the mechanism of action of health insurance e-transactions. Nine companies specializing in local and global communications and information technology are bidding for a contract to implement and operate the Electronic Transactions Program Exchange for Health Insurance (SHIB). Bids have been received from: Tahakom Technology Company, Inc.; Telecommunication Union (Mobily), Inc.; MeduNet; Sejel Inc; e-communications International INC; Saudi Telecom Company (STC); Al Haseb Al Arabi Inc; Al Rajhi Group Holdings; and Al Elm Inc. Secretary-general of the Council of Cooperative Health Insurance, Dr Abdullah Al-Sharif said: The entry of major companies to this competition demonstrates the success of the Council s efforts in obtaining the best deals to meet the objectives of the project. Al-Sharif explained that the SHIB program is one of a number of large, important technical programs that will enhance the quality of health services for the insured and the organization of the health insurance industry, by supporting the development of standards, policies and electronic integration for the health insurance industry. It is important to establish connections between all parties in the insurance relationship and to establish an information infrastructure for decision-making. Once completed, SHIB will reflect positively on the future of the industry and the health insurance market The Secretariat of the Council has been concerned, since it commenced project planning, to implement the project with high efficiency. It has aimed to ensure use of the best available methodologies and techniques to develop the program, raise the quality of service for all parties in the insurance relationship and improve coordination and integration all parties to the insurance in all steps of the project. Al-Sharif said: The vision of the Council of Cooperative Health Insurance s program for SHIB has always been an integrated electronic exchange channel of insurance transactions which works efficiently and is highly effective for all parties in the health insurance industry. The Advisory Group for the SHIB project held a preparatory meeting to receive presentations. The meeting began with a speech from the secretary-general Al-Sharif, in which he asked the Advisory Group to base its decisions on specific technical standards and a thorough analysis of the strength of tendering companies as well as their experience in implementing similar projects. Director of the e-program at the Council of Cooperative Health Insurance Eng. Wael Al-Al Dahasi said: The advisory group charged with examining corporate presentations is composed of elite experts and specialists in several areas, including: the design of institutional structure, building infrastructure, health insurance, and e-health. Al-Al Dahasi reported that the contract is expected to be awarded within three months. The second phase of the development program will last a year and include the establishment of the infrastructure for the project, and designing and developing the structure and organization of technical and application systems. The third phase involves running the program according to schedule, and involving all health care providers and health insurance companies. 6 cooperative health insurance january

5 News News New guide on the use of the e-program for insurance documents The General Secretariat of the Council of Cooperative Health Insurance recently issued a guide for the use of the electronic program for health insurance documents, and this has been adopted as one of the operational tools to activate the e-portal. Secretary-general of the Council, Dr Abdullah Al-Sharif, said: The guide includes instructions and procedures that must be followed for providing health insurance. The guide is in line with the vision of Council of Cooperative Health Insurance for the e-transformation of insurance transactions. There is enthusiasm in the Council for investment in advanced technology to keep up with cultural and technical developments and to enhance the performance of the cooperative health insurance industry. Al-Sharif said: A strategic partnership with Al-Elm Information Security aims to provide an electronic connection service for health insurance documentation. Mandatory procedures for the issue or renewal of passports include information showing that health insurance is available for applicants. The health insurance data will be transmitted through the electronic link between the Council of Cooperative Health Insurance and Al-Elm Inc. Al Sharif reported that the electronic system for insurance policies is designed to ease and speed issue of health insurance documentation, as well as improve the electronic link between insurance companies and the Council of Cooperative Health Insurance. The electronic system will handle all electronic operations of documents, and provide information to speed decision-making. Statistical data will be available for study by the health insurance industry, and the system will ease the process of determining responsibilities in the event of violations of procedures, instructions and regulations. Director of the Information Technology Department, Eng Ahmed Al Damas, said: The e-portal project is the first step to electronic transition, and the portal has been designed according to the highest technical standards. The portal employs Microsoft SharePoint 2010 for content management; there is an English version of the site which conforms with the content of the Arabic version. The portal is compatible with all browsers (IE, Firefox, Safari, Chrome), and with the standards of the e-government (Yasser) regarding e-portals. It is also fully compliant with the regulations of the Council. The portal is set out and organized by the categories of work of the Council: insurance companies, service providers, employers, and staff and members of the Council. Comprehensive services are provided to these groups that interact automatically via interrelated and integrated systems, and the system is characterized by safety and ease and speed of delivery. Workers in the private sector, the population segment targeted by the cooperative health insurance system, will be able to research employers providing health insurance for themselves and their families and to look for health service centers approved in all regions of the Kingdom. Service providers and insurance companies will be able to finalize all transactions electronically, and also to automate notice of renewal dates and other important information. Agreement between Council of Cooperative Health Insurance and King Abdullah Institute for Research The Council of Cooperative Health Insurance has signed an agreement with King Abdullah Institute for Research and Consulting Studies to implement an analysis of data from health insurance questionnaires. The agreement was signed by the assistant secretary-general for the Council s Financial and Administrative Affairs body, Mr Mohammed Al Hussein, and the director-designate of the King Abdullah Institute, Dr Mohamed Al Dghaishem. Hussein said: The agreement s period of implementation is six months, and it will contribute to the development programs of the Council to build plans to improve the performance of the cooperative health insurance industry. The agreement is to investigate questionnaires collected by the General Secretariat of the Social Affairs to provide health insurance for 3000 orphans The Ministry of Social Affairs has signed a medical insurance contract with BUPA Arabia, under which the company will provide comprehensive cover, including that for most diseases, for orphans registered with the ministry. The signing of the contract coincided with the Arab Orphan Day. According to deputy minister for social and family welfare, and the secretary-general of the orphans charity, Dr Abdullah Al-Yousef, who signed the agreement representing the Ministry: The signing of the contract is a continuation of the project to provide medical insurance, which began a year ago at the initiative of BUPA and which provides medical insurance to orphans in the Social Affairs Ministry. Council and the use of appropriate statistical programs for the analysis of these data. The report will identify how relationships between operations in the industry sector work, for example the improvement and standardization of medical clearance requests. It will also promote the training and employment of young Saudis in the field of health insurance and increase the number of services and features under the umbrella of the cooperative health insurance system. Hussein said: Strategic planning and development requires the availability of general data and statistical indicators as well as comprehensive, accurate and detailed information on the cooperative health insurance industry during specific and periodic phases. Tawuniya workshop on corporate risk management meeting report Over 140 delegates attended a workshop entitled Risk Management from Theory to Practice, held at Le Méridien Al Khobar hotel in Al Khobar, in January The aim of the workshop which was organized by Tawuniya, the Company for Cooperative Insurance, for key customers operating in energy, chemicals and other sectors was to raise awareness of risk management and its importance to major companies. The workshop addressed three main areas: explaining methods of improving risk management; demonstrating lessons learned from the management of claims; and describing situations that can derail risk management programs. General Manager of Key Accounts Abdulaziz Al-Bouq reported that the workshop s main objective was to highlight the importance of insurance. In particular, risk management for both companies and individuals is now an urgent necessity to comply with the requirements of systems and legislators in various business sectors of the Kingdom. Al-Bouq emphasized that awareness of the nature of risks allows companies to manage them in a scientific manner. This helps control or even avoid negative effects and contributes to maximizing the effectiveness of insurance programs. Al-Bouq added that the workshop was one of a series of seminars and workshops being organized by Tawuniya in 2014 to help educate, and support relationships with, the company s customers. 8 cooperative health insurance january

6 News News International Award for Solidarity Takaful Resignation of Sanad s CEO Aljazira Takaful to practice insurance business Solidarity Saudi Takaful was recently awarded a BIZZ Award for 2013 by the World Federation of Companies. The company also obtained a certificate of outstanding performance for business-peer successes achieved since the launch of its new identity in the previous year. BIZZ Awards are international and held on Agreement between Al-Malath and ALJL Al-Malath Insurance Company has agreed with Abdul Latif Jameel United Leasing (ALJL) to provide insurance coverage annually for vehicles, owned by the two companies, to be loaned to third parties. The agreement is for three years. The initial value for the first year of the contract is reported as SR164 million. This is expected to have a positive financial impact on the company s results in the financial year annual basis; companies in more than 80 countries compete for them. Solidarity Saudi Takaful is the third largest insurance company in the Kingdom in terms of capital, offering all Sharia-compliant insurance services, including medical insurance and vehicle insurance, home and travel insurance, insurance against medical errors, engineering and marine insurance and more. Al-Malath, which was founded in 2007, provides services including aviation insurance, energy insurance, engineering insurance, fire and property insurance. The company also provides services in the cooperative health insurance sector for groups and individuals. Sanad Insurance and Reinsurance Cooperative Company (Sanad) has announced that its chief executive officer, Mr. Philip William Head, resigned December The resignation has been approved by the board of directors and Head will leave at the end of February The resignation is for personal reasons and due to special circumstances. Sanad wishes Mr Head success in his future dealings, and will announce the new CEO in the near future. Sanad, which was founded in 2007, is engaged in cooperative insurance operations as well as re-insurance. The company s main activities lie in the field of insurance and money investment, as well as in acquiring and moving fixed cash money or selling, replacing and leasing assets. Arabia Insurance elects its Board of Directors New chairman of SABB Takaful Board of Directors SABB Takaful has obtained the approval of the Saudi Arabian Monetary Agency to nominate Mr Yousif Ahmad Al Bourasheed as member of the Board of Directors (non-executive/independent) and chairman of the Executive Committee, as chairman of the Board of Directors for the current session of the Council, which began in April 2013, and to complete the term of his predecessor, Sheikh Fouad Abdul Wahab Bahrawi God bless his soul. Al Bourasheed has 29 years of experience in the banking and insurance business, during which he has held many leadership positions in the Saudi British Bank (from 1985 until 2004), most recently as general manager of the internal audit department. He is also a member of a number of committees in joint-stock companies. He was re-elected to the Board of Directors of the company and was also re-appointed chairman of the Executive Committee in the current session. Salama Cooperative Contracts with Iadat Al Tawasol Salama Cooperative Insurance Company has signed a contract with Iadat Al Tawasol Company for Cooperative Insurance Agency. The term of the contract is two years, and it will be automatically renewed for a similar period unless one or both of the parties decides otherwise. The Iadat Al Tawasol Company for Cooperative Insurance Agency will sell cooperative medical insurance producers and compulsory automobile insurance (third party) for the benefit of Salama Insurance. Iadat Al Tawasol Company for Cooperative Insurance Agency is licensed by the Saudi Arabian Monetary Agency, and is engaged in insurance agency through its branches and points of sale in several areas in the Kingdom. It is expected to achieve sales for Salama of SR70 million riyals per year, to show in financial statements at the end of Arabia Insurance Cooperative Company announced the results of its AGM, held on the December 19, 2013, in the hall of Sheikh Abdul Aziz Almogren at the Chamber of Commerce and Industry in Riyadh. Results of the vote on the Assembly s agenda were as follows: Approval of the election of the Board of Directors for the third session period of three years beginning January 2014, with the following elected: Abdulaziz Al-Omair, Abdulaziz Al-Qahtani, Fayez Faraj, Mohammed Arar, Khaldoun Abu Hassan, Ghassan Akil, Muhammad Khabaz, Munir Muasher, Osman Bedier and Naji Fayad. The percentage of the vote on the resolution was 100 percent. The company, which was founded in December 31, 2007, engages in activities of insurance and reinsurance in all branches of insurance, and complies with Cooperative Insurance Companies Control. The company, which was founded in July 2013, will commence insurance activities in protection and savings, and will comply with the control system of Cooperative Insurance Companies and its implementing regulations. It is a Saudi General Joint Stock Company approved by a decision of the Council of Ministers No. 137 and the Royal Decree No. (M/23). Members of the Board of Directors are: president Abdul Majid Sultan, Ziad Aba Al-Khail, Abdullatif bin Ghaith, Saad Mshawwah and Saqr Nadarshah as chief executive. 10 cooperative health insurance january

7 News Article SAICO withdraws request to raise capital The Saudi Arabian Cooperative Insurance Company (SAICO) is withdrawing its request to raise capital to complete required procedures. The company says that this decision should be read in conjunction with an earlier announcement posted on the Tadawul website regarding a recommendation to increase the company s capital. SAICO s activity in insurance dates back Saudi Reinsurance open to nominations for Board Saudi Reinsurance Company is inviting nominations from shareholders for membership of the Board of Directors for its third session, which begins early in Rajab, lasting three years. The nomination will be in accordance with the conditions set out by the Ministry of Commerce 3245/9362/222, dated 06/18/1412 AH, and the Ministry of Trade and Industry No. 3800/205/322, dated 12/26/1420 AH. It will comply with the corporate system and the Company system, the control system of Cooperative Insurance Companies and its implementing regulations, and the list of corporate governance and the listing rules and regulations issued by the Capital Market Authority. to Members of the Board of Directors are: Prince Ahmad Khaled Al Saud as chairman, George Shaheen Medawar, Abdul Mohsen Bakhit Mohammed Saeed, Abdullah Mohammed Al Khneifer, Abdulaziz Ali Abu Al Saud, and Hassan Abdullah Durar Al Somali as general manager of the company. The Saudi Reinsurance Company said: Shareholders who own a number of shares of not less than the value for 10 thousand riyals (equivalent to a thousand shares), and who do not occupy a public function, and wish to nominate themselves for membership of the Board of Directors, can apply for nomination to the Committee on Nominations and Rewards at the company and in accordance with the following conditions: the nominee shall request the nomination including his autobiography and qualifications and experience in the field of insurance and reinsurance and membership on the boards of other companies. A candidate who has previously served as a board member of Saudi Reinsurance Company is required to enclose the nomination request with a statement from the company s management for the last session he took membership of the Council, including: the number of board meetings that took place during each year of the session, and the number of meetings he attended by originality, and the proportion of attendance at total meetings. The candidate should also include the standing committees in which he was a member and the number of meetings held by each of those committees during each year of the session, and the number of meetings attended and the ratio of attending to the sum of the meetings, with a summary of the financial results achieved by the company during each year of the session. The candidate must also submit a statement of the shareholding companies in which he is still a member, and companies or institutions that he participates in management or ownership and exercise work similar to the company s business, taking into account that it is not permissible for a candidate to be a member of the board of another insurance company and should not hold membership of the Board of Directors for more than five publicly listed companies of shares in the financial market at the same time. The nomination for someone who was a member of the Board of Directors of a liquidated company or who was isolated in another company will not be accepted unless there is prior written approval from the Saudi Arabian Monetary Agency. Dr. Mohammed Issawi nephrologist Diabetes and renal failure Kidney diseases are long-term complications that can result from diabetes. One-third of patients with diabetes are likely to suffer from them. How can diabetes affect the kidneys, how can you protect them against diabetic renal impairment, what are the kidneys? What are the symptoms of kidney disease? And how can they be treated? Kidneys are important organs that work to filter the blood, and get rid of all the waste products and extra fluid through the production of urine. They also secrete a variety of hormones and vitamin D to control the absorption of calcium in the bones and regulate the amount of fluids and salts in the body, thus helping to adjust blood pressure. Each kidney contains about a million of tiny blood vessels kidney diseases result from the damage or the dysfunction of these vessels causing blood vessels to leak and making the kidneys work less effectively. Kidney disease can be very serious and should be diagnosed as early as possible as it can happen to anyone. Although it can happen to anyone it is more common in people suffering from diabetes and high blood pressure, when it is known as diabetic kidney disease. But why should kidney disease be more likely in diabetics? If diabetes is not controlled, high glucose levels in the blood will damage the vessels in the kidneys causing leakage, while high blood pressure prevents the kidneys filtering waste products effectively. Diabetic kidney disease develops very gradually and is more common in individuals who have suffered from diabetes for more than 20 years. However, with today s more effective diagnosis, treatment and control cases, fewer people suffer from it nowadays. The risks of kidney disease can be reduced by: controlled blood pressure and controlled glucose and lipids (cholesterol) levels in the blood- -agree on healthy personal goals with the diabetic health care team -follow a healthy eating plan (reduced fat, salt and sugar, with plenty of fruits and vegetables) regular physical activity- - take your medicines according to the prescription, and if you do not find them useful tell your doctor as soon as possible - if you are watching your glucose level at home, check it regularly and act accordingly. If levels are higher than normal, try to find out why. -quit smoking as nicotine damages the inner walls of blood vessels and causes fat to adhere to blood vessels For the early detection of diabetic kidney disease, patients should have as a minimum, a yearly check which includes analysis of protein in the urine. Your doctor should also conduct a blood test to assess the effectiveness of the kidneys. In the early stages of the disease patients do not suffer from any symptoms, so an annual test is extremely importance. There are many ways to treat kidney disease, so you should discuss any potential course of treatment with your doctor. Your doctor may, for example, propose: - a reduction of fluid, salt and certain foods, in which case you should seek detailed advice from an accredited dietitian. - diuretic (water) to help the kidneys get rid of extra fluid If kidneys are damaged and cannot filter and clean the blood naturally dialysis may be necessary. There are different types of dialysis treatment, which should be discussed with your doctor to decide on the most appropriate. However, if dialysis treatments are not successful, a kidney transplant can be necessary for patients with renal failure. A decision on a kidney transplant depends on the extent to which other organs of the body are affected by diabetes, especially the heart and other blood vessels. 12 cooperative health insurance january

8 Spotlight Spotlight Amana... A Wide Range of Insurance Solutions Amana Cooperative Insurance was founded in 2010 as a public joint stock company with a paid capital of SR320 million to conduct general insurance business and health insurance. In the first quarter of 2010, the company withdrew 40 percent of its capital for public subscription. Commenting on the foundations upon which Amana was established, Professor Abdul Ilah Al Rasheed, Amana Marketing Manager said: Amana in Arabic means honesty and keeping covenant, which represents one of the solid foundations that Amana Cooperative Insurance Company relies on in planning its business strategy. The company adopted this definition as a principle of its culture for developing business in order to accomplish sustainable results for its shareholders, as well as to meet their needs and achieve security and protection for them. Amana provides all types of insurance products to its corporate customers, while products offered to members include health insurance and vehicle insurance. The Business Development Department in the company, in collaboration with marketing, sales and technical management, conducts research and technical statistical analysis for markets and customer requirements to develop products and businesses. This step enables the company to provide the best services and offers that suit the customer s needs and insurance requirements. Discussing sales and marketing policy, Al Rasheed explained that Amana: Developed major marketing and sales strategies designed to put the company in an excellent level in the Saudi insurance market relying on a qualified staff, a high degree of expertise working through its branches in the central, eastern and western regions, as well as sales channels deployed in the cities of the Kingdom; to support its customers in getting the best products and insurance services. The company s customer service methodology depends on harnessing its potential and expertise in a way that attains the trust of the client to join it. We stand on all inquiries and needs with extreme seriousness and interest in order to provide an exceptional service that the client seeks and we are honored to provide. For the sake of achieving this, the company allocated a number for a customer service call center ( ) through a specialized team from which we seek to provide the best solutions and instructions, to achieve the highest satisfaction to our customers. Responding to claims With regard to responding Al Rasheed said: The company s role in dealing with customer claims does not stop at providing appropriate compensation as soon as possible, but is based on principles to ensure continuity of the client s activity. It strives to spare them from being exposed to any monetary damages that may affect the growth of his daily businesses. In this aspect, we seek to establish trust between the client and us; to achieve their utmost satisfaction He added: For this purpose, and to ensure the pace of the procedures; the company has established a main specialized center for claims in the Central Region, in addition to other claims departments in the eastern and western regions. As to the receipt of all claims, it occurs through outlets in all parts of the Kingdom. We take advantage of the evolution of information technology linking all branches securely with a data center enabling staff to operate electronically. Products... for companies and individuals Amana provides a wide range of insurance solutions designed to meet the needs private and corporate customers. The portfolio includes a range of products covering: health, vehicle, property, fire, shipping, engineering and other specialized insurances that cover all industry and service sectors. Health insurance Al Rasheed added: There are several health insurance programs according to customer needs, which offer the best health care provided in all hospitals and health centers Abdul Ilah Al Rasheed: There are several health insurance programs at Amana according to the needs of customers, in all hospitals and health centers that are accredited to the company and registered in the Cooperative Health Insurance Council in the Kingdom 14 cooperative health insurance january

9 Spotlight Spotlight during maintenance. The policies also cover all forms of damage and unexpected malfunctions of equipment, boilers and steam machinery, loss of profit as a result of interruption of work, additional expenses including staff salaries and extra expenses related to work, or expenses incurred by avoiding loss or decline of business revenue. Additionally, all forms of damage to stored goods from cooling malfunctions may also be covered by such policies. For maximum benefit customers may choose comprehensive construction, plant and equipment, electronic equipment, equipment breakdown, steam boilers and machinery, loss as a result of equipment breakdown/burst of boilers and steam machinery, and damage to stored goods insurance. Marine cargo insurance Amana also provides special insurance programs to cover the transportation and shipping of goods including any damage that may affect goods during their transport. Customers can insure goods on an annual, open or an individual shipment basis. Policies are categorized as marine cargo, land cargo or air cargo insurance. Work environment Amana is keen to attract and motivate qualified employees as a basis for success. We have a healthy and effective working environment where each employee is provided with all they need to develop their performance and increase their knowledge and skill. Human Resources works on implementing the necessary strategies to achieve the company s goals including identifying competencies for each job, achieving Saudization rates, and providing training programs, concluded Al Rasheed. Human Resource is working on the implementation of strategies to achieve the objectives of the company to choose the appropriate competencies for each job and achieve high rates of employment of Saudis accredited to Amana, and recorded in the Council of Cooperative Health Insurance. They are also accompanied with an integrated round the clock follow-up by specialists in the safe implementation of all conditions and obligations of the insurance policies in a way that benefits customers. Moreover, the team develops all currently available programs, in addition to innovating health care programs to suit all categories. Our policies cover emergency, hospital treatment, examinations, medicines and, outpatient clinic expenses, as well as offering flexible benefits to suit the needs of client. Motor insurance Al Rasheed said: We offer special programs to insure vehicles. This includes bearing all financial obligations and costs related to traffic accidents, fire and theft (whether the situation requires repairing or full compensation), in addition to medical costs resulting from accidents. Our services allow customers to choose between repairing his vehicle in automobile agencies or in a car workshop approved by us, or expanding the geographical coverage and other benefits that make things flexible for the customer to choose the suitable coverage. This type of insurance includes third-party liability for vehicles and damages to the third party, and comprehensive insurance which covers all damages of the insured and all parties involved in accidents. Property insurance Our property protection includes insuring buildings and all contents with policies against theft, work stoppage, civil disobedience, riots, vehicular collision, and natural disasters. Our different policies are fire, comprehensive, theft, loss of profits, against the risk of subsequent losses, and business interruption insurance. Engineering insurance The construction, processing and equipment of projects and their implementation are a major concern of the company, said Al Rasheed. Through specialized engineering insurance policies, the company bears all financial damage to facilities and equipment used during construction, in addition to substitute- equipment The company s response to the claims of customers does not stop at providing appropriate compensation as soon as possible, but is the basis to ensure continuity of client activity Miscellaneous accident insurance Amana s most important product is the miscellaneous accident insurance policy, which covers costs and liabilities arising from various incidents. Amana also offers a range of policies to cover labor costs during the stoppage of work, loss of profits and movable property resulting from dishonesty, and damage of facilities and broken or damaged storefronts, medical expenses, all bodily injuries, and many others. Polices include: personal accident insurance as a result of an accident, civil liability insurance, product liability insurance, work accident insurance in line with the legal system of workers compensation, insurance against breach of trust, insurance for funds, insurance for shops windows, neon signs and interfaces. 16 cooperative health insurance january

10 HOT TOPIC HOT TOPIC Employment adjustment pumps 500 million into insurance companies The deadline for corrections by expats who violated the residence and work system, which was guided by the Custodian of the Two Holy Mosques King Abdullah bin Abdulaziz may God protect him, reflected positively on the health insurance market, since it succeeded in pumping large financial returns into the insurance companies, estimated at SR 500 million, according to specialists. The Labor Department revealed that about 2.4 million workers corrected their situation within the time limit, and hundreds of thousands of offenders were deported. But how was the health insurance market positively affected by this labor adjustment? And how did the insurance companies prepare for the corrections? Experts will discuss these topics in the following segments. Mitigation of Government Services Workers in insurance companies agree that the huge revenue, which boosted the market, was only the correct application of the system. All workers in the private sector must obtain health insurance, in accordance with Article II of the Regulations of the Cooperative Health Insurance System. These link the renewal of residency with health insurance. Estimates show that there are 6.1 million foreign workers residing in the Kingdom who have insurance cards, out of a total of 8 million beneficiaries of health insurance. The rest, 2.18 million people, are Saudi nationals working in the private sector. There are questions about whether the correction period of labor violations added to these numbers. Dr Abdul Wahab bin Abdullah Al-Khamis, an expert in insurance issues and health policy, predicted that the deadline for correcting the conditions of employment will reduce the demand for state health services. He pointed out that: If there is a large number of people who do not have health insurance, then there will be an indirect increase in the number of people who receive health care through government hospitals, especially those not qualified for such treatment. For example, emergency departments in some government hospitals receive critically ill patients from traffic accidents. Some of these cases are expatriates who do not have correct residency. They are treated humanely and receive the health care they need. Scientific study Dr Abdulwahab Al-Khamis explained: After 2008, all workers in the private sector were supposed to have health insurance regardless of the size of the companies in which they work, especially after the Cooperative Health Insurance System linked the renewal of residency to the provision of health insurance. It is also worth mentioning that the casually employed is one of the main groups that do not have health insurance, according to a study conducted in Riyadh. Dr Al-Khamis mentioned his study in an article about employment and health insurance. His research included all companies operating in the private sector, regardless of size and economic activity, and excluded workers in non-profit or state companies or those working in the private health sector, such as hospitals, health centers, pharmacies and opticians. The objective of the study was to determine the proportion of workers in the private sector without health insurance and to identify the reasons. The study found that 21.2 percent of those who do not have health insurance were working for non- sponsors. Other important reasons not having health insurance were: non-renewal of residency (20.6 percent), labor with a security document as a formality or paperwork only for the renewal of residency (27.4 percent), health insurance was very limited and it expired without being renewed (16 percent) and other reasons (4 percent). On Thursday he predicted that the corrections would include 32 percent of those who do not have health insurance. Al-Khamis: The deadline for correcting the conditions of employment will reduce the demand for state health services 18 cooperative health insurance january

11 HOT TOPIC HOT TOPIC Mohaimeed: The main benefit of this campaign is that these corrective actions will reduce cases of fraud, such as personal fraud Reducing Fraud Yasser Mohaimeed, a specialist in the insurance sector, estimated the number of workers who do not have health insurance through their work with non-sponsors at 39 percent of those employed in the Kingdom. He said that: When a worker does not possess health insurance, this means that the whole family lacks insurance. He explained that: The main benefit of this campaign is that these corrective actions will reduce cases of fraud, such as personal fraud, because all employees are now committed to the regulations and carry insurance cards that guarantee the necessary treatment. As for whether the insurance companies are able to absorb such huge numbers of violators of the residency and work regulations, Mohaimeed confirmed that: The companies are able to absorb these numbers. The network of hospitals and clinics is able to accommodate them too. He added that the money from the adjustment was from those employed by non-sponsors and those who did not have health insurance for themselves and their families. He also expected that health insurance for domestic workers (men and women) would be soon approved, pointing out that the insurance companies are ready to receive the large numbers of people involved, and would be able to provide medical cover for them within their programs and products. Service Development Regarding competition during the corrective period, insurance specialist Yasser Mohaimeed called for updates to the insurance companies products, and the networks of hospitals and clinics contracting with them. He argued that: Competition for the revenue from correcting the employment violations will intensify and the companies that will remain in the insurance market are those able to compete with affordable prices and good services. The exceptions would be companies whose prices do not match the service provided or which did not invest in their reputation and brand. He stated that competition was not on price only, but also on quality. He suggested that the insurance companies should consolidate their brands to suit their products. Employers and service bureaus ignorance of the insurance market may lead them to buy an insurance policy from a company that is not suitable for their workforce or has a poor network of therapeutic centers. He criticized insurance companies with a large network of hospitals and treatment centers, which refrained from advertising adequately and did not disclose the size of their networks and the quality of their products. Their efforts were in vain. Mohaimeed forecast that: In the first year that the deadline for adjusting the conditions of employment applies, employees will build their understanding of health insurance. When they first use an insurance card, workers will discover the quality of the insurance product. If the quality is not at the required level, then the health insurance policy would not be renewed. Workers will share their experiences of the insurance companies with their friends, employers with their counterparts, and managers in the private sector with their counterparts as well. Insurance companies with the strongest and the best products will continue, while those with poor products and a poor network will not last. Vulnerable insurance companies will incur losses if they do not work on their credibility, especially in the first year. Offices near Passport Departments Insurance companies have recently been opening branches near the headquarters of the departments where employees can amend their employment details. This could be seen in a visit to the Directorate General of Passports in Riyadh. The aim of these new offices is to take advantage of the corrected employment conditions by issuing private health insurance cover to the workers and their families. This was confirmed by Mr Saad Khabbaz, director general of Arabia Insurance Cooperative Company, who said in a press statement that: Insurance companies have been stepping up their presence near the offices of the departments of immigration and labor. They want to provide medical insurance by taking advantage of the desire of foreign workers to rectify their status. He added that: Insurance companies opening new offices close to government departments where people can submit medical insurance documents, has been a standard procedure for some time. However, recently, especially since the announcement of the deadline for correcting labor violations, insurance companies have opened more branches close to passport and employment offices. There has been competition between the companies. Workers in insurance companies offices in Al-Marbaa, which is near the Passport Department, said they receive about 100 requests a day per office to issue health insurance documents for workers, in addition to the insurance policies that are processed daily for companies. Field Visit A field visit carried out by the Cooperative Health Insurance magazine to the offices of insurance companies adjacent to the building of the Directorate of Passports in the capital was very revealing. At first glance, the offices looked small with two to three workers at the most, located in adjacent buildings. There are long queues of hundreds of people in front, including employees, sponsors and consultants who work in service offices, seeking to renew residency and transport certificates after receiving an insurance card. The employees in these offices said that they sell hundreds of insurance cards daily to individuals and businesses. Their work peaks in the early morning and then gradually decreases during the day. Ahmed Zenawi, an employee at a branch of an insurance company, said that: Many become unemployed and people over the age of 55, choose not to correct their situation. Instead they return to their country. The price for an insurance card, more than SR 4,000 per person, is too high for them and their employers. He added that this high price for these types of people was because they would need more medicines compared to others, in addition they would need more medical tests and see doctors more often. This increases the operating expenses of the insurance companies, who might face losses especially if the person needs surgery. People have two options: either to violate the regulations and risk deportation, or to get an insurance policy and renew their residency through employment with a legal sponsor who will pay this amount. He added: From early morning, the office becomes crowded with a large number of sponsors and employees. This prompts the insurance company to increase the number of staff in its offices, who can check more new policies and gain the largest number of potential customers. He continued: Some customers leave the office when they see it is too crowded. They go to a less crowded office, where they can complete the business quickly. This was more common in the days before the end of the deadline for corrections, he said, adding that: There is still a heavy demand for the services of insurance companies, even after the expiry of the deadline. Mr Sleiman, one of the workers in an insurance office, said that: Most of the workers who receive insurance cards are ignorant of the terms and conditions. They only get an insurance card as a routine procedure to correct their situation and renew their residency. Then they are surprised when they have to use the card in a network hospital that does not suit them, or they do not know the diseases and medications covered by the insurance policy. He also called on workers Insurance companies have been stepping up their presence near the offices of the departments of immigration and labor to identify the type of insurance card and the insurance product before buying the insurance policy, to get the maximum benefit, and to ensure the continuity of the company that appropriately provide their services. Sleiman predicted that the large numbers of people in employment would lead to a reduction in the price of insurance policies, since the companies would reduce their prices to make their products more attractive. He explained that the price war that is recently taking place in the market may pose a risk to companies and cause losses that could threaten their stability. The First Test Insurance specialist, Yasser Mohaimeed, said that this correction of the employment situation was only the first test for insurance companies. They had to figure out how to absorb the large number of new customers. He also stressed that insurance companies should take advantage of this test by developing their capacity, networks and internal systems, and increasing their capital. It was anticipated that soon this test would be followed by a new product in the insurance market: health insurance for domestic workers. Later there would be insurance for other citizens. The companies need to prepare for these changes to get the greatest possible benefits at all levels. 20 cooperative health insurance january

12 Social Responsibility Social Responsibility message to reach people at both intellectual and emotional levels, spurring individuals to work toward the goal of increased organ donation. Today most people would agree that donating an organ to someone who is urgently in need is one of the most honorable contributions a person can make. However, until recently, organ donation was considered unacceptable according to religious and social principles. Overcoming this resistance required a new culture of organ donations, which has been accomplished through a variety of means, such as public awareness campaigns and educational seminars. Saudi Ithar Charity was among the organizations seeking to encourage people to embrace organ donation as an act of charity. Founded in 2010, Ithar Charity works to encourage organ donation through education and social efforts. Name and Vision Ithar Charity s goal is to encourage donors and patients to accept organ donation through religious and media campaigns and community training workshops. The organization is also focused on giving donors the opportunity to set the conditions of their donation and helping the patient to cope with the process of receiving an organ donation. Ithar seeks to accomplish this Ithar Charity to encourage organ donation... Human conscience to save our fellow brothers The Prophet, peace be upon him, said: And whoever saves one, it is as if he had saved mankind entirely (Al Ma idah 32): and : The example of the faithful in their mutual empathy, mercy, and sympathy, is like the [single] body, when one organ complains [from injury] the rest of the organs empathize through sleeplessness and fever. This verse and Hadith highlight the great importance of collaboration and cooperation among believers, caring for each other and contributing humanitarian support to their needy brothers in every time and place. by strengthening the social dimension of the donation process. Ithar s work begins with its name. The organizers of Ithar Charity chose a name that reflects the great significance of the donor s choice to serve another by giving what is most precious to them: a part of their own body. With this idea in mind, the founder s chose the name Ithar, an Arabic word for altruism, to reflect the high altruism represented by organ donation. Ithar Charity was officially established in June 2010 as a result of a decision by the Minister of Social Affairs, No 67,781 dated 29/06/1431 AH; the organization was registered in the register of charities (no 577) that same day. The foundation of the charity s work is its drive to encourage organ donation, develop community awareness, and nurture a culture of organ donation using the latest communication and information tools and strategies. A focus on the fundamentals is an important part of this effort; a key element in the drive to sensitize the community to the charity s vision is the ability to explain the vision clearly and engagingly to potential donors, patients, and volunteers. This ambitious mission will allow the charity s Activities According to Dr Hanan Al-Ghamdi, Vice President of Ithar s Board of Directors, the charity s work is organized around three themes: Patient and donor support Providing emotional support and education for patients with organ failure and their families and honoring donors and recipients at periodic meetings as well as at an annual meeting in the holy month of Ramadan. Public awareness Organizing awareness campaigns to spread the culture of organ donation and encourage a greater number of donors to meet the permanent need. Medical teams Organizing lectures, seminars, and workshops to educate and train medical staff; fostering exchange experiences with advanced countries to bring new knowledge into the medical system; and ensuring the availability of continuing medical education in organ donation and transplantation. The charity s scope covers the eastern region, but, the Chairman of the Board said: We do not stop here. The charity has signed several memorandums of understanding with specialized overseas medical centers (Detroit Medical Center), and also with a team of organ transplant specialists in Spain, which is considered the best in the world in the number of organ donors per year, in addition to holding memorandums of understanding with the relevant authorities in the Kingdom of Saudi Arabia. The most important element of Ithar s awareness campaign is the Cultural Committee, which works to spread religious awareness and urges imams to discuss the religious permissibility of organ The organizers of Ithar Charity chose a name that reflects the great significance of the donor s choice to serve another by giving what is most precious to them a part of their own body 22 cooperative health insurance january

13 Social Responsibility Social Responsibility donation. The committee also seeks to spread awareness through print, broadcast, and online media campaigns, as well as through community awareness campaigns in schools and universities. Short films about the association s objectives and the importance of organ donation supplement the effort. The committee also engages in a wide variety of other efforts to raise awareness, from contracting with local and satellite television outlets to film movies in hospitals in the eastern region to disseminating statistics and press reports. The organization reaches a wide variety of audiences by publishing interviews with specialist doctors and people affected by organ donations, conducting briefings on organ donation and community attitudes toward it with key members of the community, and celebrating World Kidney Day through traditional and online media, as well as social networks. Finally, the charity continues to develop its website and is working toward the publication of a journal concerned with the issues of organ donation. These efforts appear to be yielding some success. Dr Al-Ghamdi said that public awareness of organ donation in the Kingdom is progressing remarkably. Thanks to Ithar s work, many more people now know how and why to donate organs. Achievements and Obstacles Ithar Charity has faced a number of obstacles to its goal to increase organ donation. According to the administration, the main obstacle to increasing organ transplantation is a lack of the required organs. There are currently about 14,000 patients on waiting lists in the UK; the only route back to a normal life for these patients is an organ donation from a suitable donor (alive or dead). In spite of this challenge, the charity has made pioneering achievements in the region. Dr. Hanan Al-Ghamdi said that public awareness of organ donation in the Kingdom is progressing remarkably There are now professional transplant centers in the Kingdom that meet global standards, such as the organ transplant center at the King Fahad Specialist Hospital in Dammam. Ithar has also succeeded in getting the Al-Shafaa Al-hasana Committee to approve donations from people who are brain dead. Approximately 3,000 people from all parts of the Kingdom signed documents consenting to donate their organs after death. In the past several months, nine people have been saved by donations from brain-dead patients whose families were convinced to donate their loved ones organs by the Committee. The charity s efforts have also had a noticeable effect on public awareness, reflected in the number of applicants agreeing to organ donation and an increased seriousness in handling the e-card (available at donate.eithar.net). One driver of this increased awareness is Ithar s distribution of more than 60 different printed reports on organ failure and organ transplants throughout the eastern region, in malls and major health centers as well as during the annual charity run last year. Objectives and Results At its founding, Ithar established a set of short-, medium-, and long-term goals. These included administrative necessities, such as establishing a headquarters for the organization, opening bank accounts to receive donations and subscriptions, and attracting members and volunteers. The functional goals reflect the charity s focus on awareness and education. Ithar sought early on to organize a variety of events, including training seminars; visits to patients with organ transplants or awaiting organ donations; awareness workshops for families of patients; periodic visits to schools, universities, and other institutions; and meetings and scientific conferences for medical staff. Finally, reflecting the full range of its services, Ithar set goals to activate the role of social specialists in following up with patients with organ transplants and attract elite doctors and international experts in organ transplantation to help medical personnel access international standards. The organization is also working to establish mechanisms to provide assistance to needy patients. Ithar is also eager to attract volunteers to build links of communication between citizens and organ transplant patients. These efforts will lead to more widespread programs that will benefit the community as a whole. For instance, the organization seeks to create a database to be used in future studies and to raise the level of the Saudi health system by fostering communication with scientific and medical research institutes within and outside the Kingdom, coordinating with the Ministry of Health to create scholarships that will support the Saudization of the organ transplantation domain, and establishing offices of coordination within hospitals and health centers to assist patients. Finally, in order to ensure Saudi organ transplant patients receive the best possible care, Ithar is coordinating support for the construction of a state-of-the-art organ transplant center in the Eastern Region. This center will include an integrated hospital with clinics and laboratories equipped with modern medical technologies, as well as an entertainment room for patients. A Story of Love and Life Organ donation is an act of love, as illustrated by the story of the former Qadisiyah footballer Abdulaziz Al-Salem, who retired from soccer after donating a kidney to his wife, who suffered a sudden kidney failure while giving birth. According to Dr Al-Ghamdi: He confirmed that he has no regrets about his decision. On the contrary, he considers it the most heroic act of his life, because the doctors told him to choose between his wife and baby, but he donated his kidney to save the lives of them both. Despite the fact that being a professional football player was his childhood dream,... he had no choice but to donate his kidney to save his wife and daughter, depending on God Almighty to earn a livelihood. She added: Every time he sees his colleagues inside the stadium, Al-Salem remembers his beautiful past with football. He is a player from the generation of Yasser Al Qahtani, Ahmed Ruwaie, and Bandar Al-Khalidi, and he had hoped to continue his career with them. But he is pleased with his share, wishing them all the best, and stressing that if he has a son, he will encourage him to the world of football in order to achieve what he couldn t. As for his wife ( Nawf Ali), she is well protected in the eyes of her husband, and a good wife who Former Qadsia player Saudi Abdulaziz Al-Salem s kidney donation to his wife is a humanitarian story that illustrates the true love and altruism involved in organ donation deserved the donated kidney. Salem did not tell her about the fact that the organ was his until months after the surgery. It was a rough time for the family because he was in the hospital under the scalpel and she was giving birth to a child. Abdullah Fahad Al-Hazza, the Qadisiyah president, said that Al-Salem still exists among them in the team, describing him as one of the Knights of Qadisiyah, pointing that what he did is not unusual for a brave Saudi man. Al-Hazza announced that Al-Salem would join one of the club s training sections as an administrator or an administrative assistant. 24 cooperative health insurance january

14 Cover story Cover story Development of the insurance industry a shared responsibility The Saudi Arabian insurance industry has progressed in leaps and bounds since its inception in the early 1950s. Perhaps the biggest leap was the introduction of the Cooperative Insurance Companies Control Law in 2003, and this has encouraged the growth of the sector and companies working within it, while increasing awareness of the importance of insurance. The law has also forced all parties in the sector to define their responsibilities and to perform them optimally. The insurance sector is an influential factor in the industry and trade of the Kingdom of Saudi Arabia. It is a significant agent for economic development in the Kingdom. Reflecting this importance, the industry has evolved considerably in recent years. The number of companies operating in the sector has reached 33, and there are another 166 companies providing services that support insurance. Total written premiums reached SR21 billion in 2012, compared with SR5.8 billion in 2007 a growth rate of about 30 per cent per year. The size of the sector necessitates an effective partnership between all concerned parties: authorities, licensed insurance companies, third-party service providers and corporate and individual beneficiaries of insurance services. The aim of such a partnership is the ongoing and substantial development of the sector both internally and to keep pace with progress in other countries. The sector also requires confidence to be placed in its roles as a foundation of risk management procedures, a safety net for the economy and a preserver of the safety of all those who support and benefit from it. Organization and implementation The Kingdom attaches great importance to the insurance sector. As one of the newest, most active and most dynamic economic sectors, it requires constant review and development of its mechanisms, particularly in the simplification of its procedures. The Kingdom has been heavily involved in devising systems to manage the work of insurance companies. It was responsible for detailed and general frameworks of protocol, it identified parties eligible to pursue work in the sector and it introduced measures to assess the performance of operating companies. The Council of Cooperative Health Insurance has done much to develop the health insurance sector, and therefore has also been largely responsible for the success of insurance in the Kingdom. Health insurance in the Kingdom of Saudi Arabia is under the aegis of the Council and its legal and regulatory framework regulations. These systems are now responsible for almost 8.5 million individuals through 28 insurance companies. Such legislation and regulations form the basis for the advancement of the health insurance industry in Saudi Arabia. The active participation of key partners in the health insurance industry and the presence of human personnel with expertise in insurance and insurance systems have also aided this development. The Health Insurance Council supervises the health insurance system, drafts executive regulations and organizes the logistical implementation of these rules. It is also responsible overseeing cooperative insurance companies and the adoption of health facilities that provide cooperative 26 cooperative health insurance january

15 Cover story Cover story health insurance services. The Council meets periodically with the aim of developing and improving the regulatory and legislative frameworks governing the health insurance market. Regulatory role for SAMA The Saudi Arabian Monetary Agency (SAMA) oversees, supervises and regulates Saudi insurance activity. According to its governor, Dr Fahad Abdullah Al-Mubarak, SAMA aims to regulate the insurance industry in accordance with high standards and practices, to introduce more efficiency into the sector and to help insurance companies provide high-quality service and protection to individual and group policyholders. SAMA is also undertaking a comprehensive study of the insurance sector in the Kingdom. In this study, it is taking account the experience of the sector in previous years, investigating the challenges faced in the present day and planning for those to be expected in the future. Al-Mubarak said: In the early stages of the study, we obtained reports and presentations from all relevant parties in the insurance industry. Insurance companies, brokers and insurance agents, clients from individuals and companies, and government agencies have helped provide a clear perspective on the challenges for the sector. According to Al-Mubarak, the overall aim is to achieve further development, stability and growth for the coming years. Plans are in development for the insurance sector to contribute more to local economies, to promote awareness of insurance services, to strengthen the mechanisms for sharing information and to improve procedures for the settlement of claims. Al-Mubarak said: There must be commitment to a shared Al Saleh: Awareness of the importance of insurance is necessary for society. Insurance provides integrated protection for wealth and for the large projects that are one of the main pillars of the national economy responsibility from all parties; the rapid development of the insurance market makes it imperative for companies to exploit the energy of human and technical resources and to be prepared for forthcoming challenges through the development of policies, mechanisms of action and human resources to ensure the growth and development of companies. Community awareness of insurance Awareness of insurance is an essential pillar in the consolidation of solidarity (Takaful) and an important factor in promoting the industry. It is necessary to disseminate information about insurance through all levels of society. Mr Al Bahi Mohammed Al Saleh, relations manager of medical service providers Sanad Cooperative Insurance and Reinsurance, said: Awareness of the importance of insurance is necessary for society. Insurance provides integrated protection for wealth and for the large projects that are one of the main pillars of the national economy. Awareness also contributes to the mobilizing of domestic savings and investment to contribute to the development process, as reflected in increased rates of growth in the national economy and in the creation of jobs and new business opportunities. Awareness of insurance also helps in identifying the needs, and types of insurance required, for each individual sector within the community. Al Saleh suggests that it is impossible to measure awareness of the importance of insurance to society. However, we do know that this awareness is influenced by several factors, including economic, social, political and religious considerations. For example, insurance in advanced industrial countries is perceived as necessary and essential. However, developing countries consider it a luxury. Individual awareness effectively supports the success of insurance and thus the success of the economy as a whole. The existence of a sound and sophisticated insurance market is an essential component of any successful economy, Al Saleh thinks. Unfortunately, the sector is not immune to fraud. However, as it has expanded, the evolution of law and regulation have significantly increased the profile of the industry and also reduced the incidence of misbehavior. For Al Saleh, the prosperity of the insurance industry directly contributes to the Kingdom s capacity to deal with global economic changes. It also helps to diversify sources of income for the economy. Insurance in the economy Dr Jihad Saeed Al Yousuf, director of health insurance at Sanad Cooperative Insurance and Reinsurance, also stresses the economic importance of the insurance sector. He said: Optimal investment of the proceeds of insurance companies, resulting from profits and underwriting premiums, helps provide adequate reserves to pay claims; this allows companies to be more self-reliant. This directly affects the prosperity of the industry and, in turn, the Kingdom. According to Al Yousuf: Those involved in the process of insurance seek diligently to promote the industry, and it is important to emphasize the role of SAMA, the Council of Cooperative Health Insurance and other stakeholders, such as the King, His government and other higher authorities in the Kingdom. Al Yousuf added: Technically, there are several elements that help ensure the success of the insurance industry. These include, but are not limited to, choosing an efficient re-insurer with a good global reputation; the equitable distribution of risk between companies, and the level of training for, and the development of competencies in, the technical personnel at companies, particularly those working in the departments of initial public offering (IPO) and claims. Also important are factors such as access to global statistics and the experience of international companies; the roles played by brokers and insurance agents; the standardization of prices commensurate with the insured risk (to avoid unfair competition); and availability of certified actuaries to determine and analyze types of risk and estimate prices. Al Yousuf said The insurance industry is one of the more modern sectors of origin in the Kingdom. It is moving relatively slowly, but constantly, and evolving for the better. Insurance companies and observers are actively working to evaluate the progress of this sector to make it a leader at the level of other sectors. As for the constraints faced by insurance companies, Al Yousef said: There are many gaps for insurance companies to cover for example, the absence of actuaries (it is rare to find trained actuaries within companies technical staff). Prices can be ill-conceived and competitive, which may lead to a reduction in the value of the insurance premium that is, to one that does not represent the real danger for the insured. Other difficulties include a lack of technical skills, poor training and a lack of insurance brokers and agents. It is clear that the development of the Saudi Arabian insurance industry requires the concerted support of all parties to continue the rapid growth of recent years and to establish the presence of this vital sector within the national economy. Al Yousuf: Optimal investment of the proceeds of insurance companies, resulting from profits and underwriting premiums, helps provide adequate reserves to pay claims; this allows companies to be more selfreliant. This directly affects the prosperity of the industry and, in turn, the Kingdom 28 cooperative health insurance january

16 Interview Interview Chairman of the Saudi Diabetes & Endocrine Association Abdulaziz Al Turki: I have been suffering from diabetes for 40 years this is what motivates me to focus on this disease. Fourteen percent of Saudis live with diabetes and, according to Health Minister Dr Abdullah bin Abdulaziz Al-Rabih, the Kingdom is among the top 10 countries in the world exhibiting increasing prevalence of this disease. To shed more light on this epidemic and efforts to combat it, this issue hosts Mr Abdul Aziz bin Ali bin Abdul Rahman Al Turki, President and CEO of the Saudi Diabetes and Endocrine Association (SDEA). Al Turki holds an honorary doctorate in humanities from the Lebanese American University, as well as bachelor s and master s degrees in business from George Washington University in the USA. In addition to his chairmanship of the SDEA, he presides over both the Council of the Association of Cancer in the Eastern Region, and the Board of Directors of (Ithar) Association for organ donation; he also is an active member of the Society of Friends of Patients, the Charitable Society for the Care of Orphans, and other charitable organizations. In our interview, Al Turki revealed the personal reason for his interest in diabetic patients, and reflected on three decades of building the SDEA s diabetes programs to benefit diabetes patients and the Assembly health professionals doctors, nursing staff, and nutrition specialists who treat them. *Tell us first about the Saudi Diabetes and Endocrine Association. When was it founded, and what are its objectives? What have you achieved so far, and what organizations do you work with? The SDEA was founded in 1985, and was originally named the Diabetes Club. Its most important objective is to raise awareness of diabetes and its complications, as well as the fight against obesity. Thank God, we have achieved many of our goals and expanded our mission to include larger segments of Saudi society and institutions. We work with many interested parties, including the Ministry of Health, the University of Dammam, King Fahd University of Petroleum and Minerals, Saudi Aramco, and the Royal Commission, as well as health organizations, the media, civic associations, industrial enterprises, the Ministry of Education, and others. What types of activities does SDEA implement and plan? How are they funded? The association organizes specialized training for health workers of all kinds -- doctors, nurses, nutrition and education specialists -- as well as educating patients with both type I and type II diabetes, particularly children. We also focus on programs to combat obesity and osteoporosis, and promote overall family health, for example healthy shopping, healthy cooking and sports for all. Funding comes from various sources: businesses, personal contributions from members of the Board of Directors, and support from the Ministry of Social Affairs. The association has had a long-time policy of keeping expenses low, which has helped it stay in continuous operation for so long, A lot of the staff are volunteers of both genders, which also helps to foster a culture of voluntarism among health professionals. To what extent does the association interact with the community? Do you have direct contact with people with diabetes? The association has excellent relationships with both the professional community and the community of patients themselves. We respond to many requests from medical, social, industrial, and educational institutions, and many individuals participate in the association s various clubs and committees, including the Women s Committee, Education Committee, Social Committee, Media Committee, and Scientific Committee. We communicate constantly with diabetic patients, both children and adults. In fact, there are special pages of the Association s website for patients, including the (Sweet Smiles Club) page for children with type I diabetes. There are also regular meetings for people with diabetes in the association s headquarters and Scitech in Jubail, and other centers in the Eastern Province. Are there other branches of the SDEA? Where are they located? The headquarters of the association is in Al-Khobar. At present, there are no other branches, although we plan to open branches in the Eastern Region. In the meantime, we collaborate with the various diabetes associations in different parts of the Kingdom that share common goals for fighting diabetes. What prompted your attention to diabetes? Is there a personal story behind your devotion to this subject? Professionally, I have a keen interest in improving the lives of diabetic patients of all ages, by helping them to live safely with the disease without any complications. I am also motivated by the importance of combating the disease in the first place and reducing the risk of infection once it is established, as well as raising community awareness of diabetes. There is another important factor, a more personal one: I have had type I diabetes myself for 40 years. I am thankful to God that medical advances and attention have enabled me to live with diabetes and that I have had no complications. My experience as a diabetic has been a primary motivation for my work in preventing and treating this disease. Speaking as a diabetic yourself, can you tell us why diabetics often lack the willpower to maintain dietary behaviors that prevent the disease from worsening? Diabetes requires both constant medical care and the adoption of healthy life behavior. Adhering to proper food and exercise regimens, avoiding smoking, and getting regular medical examinations all require great determination and continuous planning on the part of the diabetic. Diabetics need psycho-social support and moral support, and this support must be sustained on both a personal and an institutional level. As for the food, unfortunately there are a lot of fatty and unhealthy foods in our culture that do not benefit the patient, usually sweets delicious, but harmful. This is why it is so important to continually educate people with diabetes and their families, so that they understand the critical importance of adopting healthy behaviors and healthy lifestyles so they can live with the disease without problems or complications. On the occasion of World Diabetes Day, the Minister of Health mentioned that the National Committee to Combat Diabetes is going to follow up the implementation of the Gulf plan to combat this disease. Is there a role for your Association in this committee? Are the Commission and your association in agreement about fighting diabetes? There is no conflict at all between the ministry s efforts and the efforts of the association. In fact, the two organizations are cooperating and integrating various initiatives aimed at patients with diabetes, the community at large, and medical professionals. God willing, this collaboration will be the start of a comprehensive effort to stop the spread of diabetes and its complications, and limit the serious health, social, economic and psychological effects of the disease. What are the types of diabetes, and what are the differences among them? There are three main types of diabetes that differ in their etiology and sometimes their treatment methods. Type I depends on insulin, while Type II is often associated with obesity, so its treatment depends mainly on the appropriate food and exercise, although sometimes it is treated with We call for a national register of diabetes.if we want to fight diabetes, we must fight and reduce the spread of obesity sugar reduction pills or insulin. The third type is gestational diabetes, which appears during pregnancy and requires intensive monitoring and the patient s commitment to eating the proper diet. In some cases, type III requires insulin and follow-up after the birth, as well. How has the SDEA benefited from its relationship with some unions and international institutions concerned with the disease? The relationship between the association and the international institutions devoted to diabetes goes back more than 25 years, because the association is the sole official representative of the Kingdom at the International Diabetes Federation, as well as in American, European and other diabetes associations. This collaboration is strategic in nature and continually evolving. The benefits are tremendous. Our international colleagues provide us with research and clinical guidance, while we provide them with guidance on the Mediterranean Diet and the fasting month of Ramadan and the pilgrimage for Muslims all over the world. You can see the results of this cooperation in the activities of the International Diabetes Federation, which comprises representative organizations from over 180 countries. 30 cooperative health insurance january

17 Interview Interview Why do you think people are not taking diabetes seriously enough, despite the many warnings about its dangers? How do you think we should deal with this this negative reaction as a culture? Facing diabetes requires a recognition of its dangers and a concerted effort to combat it, not just by patients and their families, but by the community in general; by all government and private agencies, not just the Ministry of Health. Here at the Saudi Diabetes and Endocrine Association, we are alarmed by the accelerating spread of this disease and its complications over the course of more than 25 years, and we will continue to work with all these interest groups to circumscribe it. How many people in the Kingdom have diabetes? What is the percentage of the population that has diabetes? Does that statistic include all residents, or only Saudis? The number is big, and the statistics are scary and growing. In the adult population (20 to 70 years old), the prevalence is about a quarter of the population (25 percent), although some researchers believe it is as high as 30 percent. In children, the prevalence is even higher, affecting 30 in every 100 children, one of the highest prevalence rates in the region. The prevalence of diabetes in the Kingdom s total population is one of the highest in the world. We believe that Saudis as well as non-saudi residents exhibit this high prevalence due to genetic factors,, dietary behaviors, lack of exercise, and the nation s comfortable economic situation, which further contributes to frequent intake of foods with high calories. During the First Regional Conference for diabetes associations in the GCC countries, you called for the establishment of a Gulf Federation of diabetes. What happened to this initiative? What are the goals of this Federation? Yes, we did call for this step, and the association is currently following up with our colleagues in the various Gulf diabetes associations in this regard. The goal of this type of organization is to contain the spread of diabetes by sharing action plans and ideas. All the Gulf countries suffer from high levels of obesity and sugar intake, requiring comprehensive plans and coordination if we want to effect real change. We might collaborate on activities like developing health curricula for students, addressing diabetes and obesity in the workforce, and enacting laws and health standards that apply to food at hotels, airlines, major restaurants, food and medicine committees, food processing, and specifications of imported food. Saudi Health Minister Dr. Abdullah Al-Rabiah said: Saudi Arabia is among the first ten countries in the world in the prevalence of diabetes, which is nearly 14 percent of all ages. Does this alarm you as an association concerned with the fight against this disease? We share Ministers Al-Rabiah s opinion that the Kingdom has one of the highest prevalence rates of diabetes in the world; I would add not diabetes alone, but also obesity. Both conditions have serious repercussions for Saudi society, now and in the future. I would like to stress again the importance of community integration with government and private institutions of all types in the fight against diabetes and obesity, and the need to enact related laws and regulations as soon as possible. The association, the Ministry and the State share these priorities, but the responsibility falls on everyone. In the fight against the causes and complications of the disease, everyone is responsible: not only the Ministry of Health and the Saudi Diabetes and Endocrine Association, but also individuals, community groups, families, institutions and associations and ministries, at all levels. This is the only way we can be successful. The Ministry of Health has launched a decimal national campaign to control diabetes ( ). Have you seen any impact of this campaign in the past year? We are already seeing how this campaign is increasing people s awareness about diabetes, and we thank the Ministry of Health and urge it to continue these positive efforts. But as I said earlier, the ministry cannot alone encircle and control the prevalence of diabetes. All the ministries, government agencies and private institutions have a great responsibility. At SDEA, we are calling for a comprehensive national plan to combat obesity, because it is a major cause of diabetes: if we want to fight diabetes, we have to fight obesity and reduce its spread. We must work together to support the adoption of healthy lifestyles, such as balanced, low-fat diets, and exercise, weight control and glucose levels for all people and for all ages. This is the solution to this nation-wide problem. The GCC countries are within the 10 highest countries in the incidence of diabetes and obesity in the world. The reasons are hereditary and lifestyle-related Is there a national register of diabetes in the Kingdom? What does this record include, and what is its importance? There are multiple efforts to set up a national register of diabetes in the Kingdom, but this work needs more effort and perseverance, and requires the exchange of information between all health authorities in the Kingdom. For its part, the association called for the establishment of this record several years ago, due to its importance in both controlling the spread of the disease and developing plans for treating patients and preventing diabetes and its complications. The record also helps in health and economic planning to combat diabetes and reduce risk factors. The record contains personal information, results and dates of medical examinations and future health planning. This record holds strategic importance in the fight against the spread of diabetes; this is the reason behind the association s great interest in it. The ministries of health in other GCC countries spend a great deal of their budgets on coping with diabetes. What are the comparable numbers or percentages for Saudi Arabia? Do these figures include the expenditures of insurance companies on the insured? Yes, spending is substantial: we expect that the Ministry of Health spends a large percentage of its budget on diabetes, as do private health institutions, the armed forces, the National Guard, and private insurance companies. Diabetes has such a large impact on the Health Ministry s budget because of the large number of health problems and complications of the disease. It totals billions of riyals annually, and that doesn t take into account indirect expenses from loss of work, accidents and social and psychological costs. The responsibility falls on everyone in the fight against the causes and complications of the disease, not only the Ministry of Health and the Saudi Diabetes & Endocrine Association Guest Card Name: Abdulaziz Ali Abdulrahman Al TurkiTurkish Marital Status: Married with five children Qualifications: Bachelor of Business Administration, George Washington University, United States, Master of Global Business Management, George Washington University, United States, Honorary Doctorate in Humanities, the Lebanese American University in Beirut, Lebanon, Current positions: Chairman of the Board of Directors, Gulf Union Cooperative Insurance Company. Chairman, Rawabi Holding Group. Chairman of the Board of Directors, Bank Energy Capital Group. Member of the Board of Trustees, Lebanese American University, Beirut. Social activities: Chairman of the Board of Directors, Saudi Diabetes and Endocrinology Association, since Founder and Chairman,the Annual Charity Run, since Chairman of the Board of Directors, Saudi Cancer Society in the Eastern Province, since Chairman of the Board of Directors of the Saudi charity to promote organ donation (Ithar) in the Eastern Province, since Member of the Foundation Board, Charitable Society for the Care of Orphans (Binaa). Member, Friends of Patients. Member, Friends of the Saudi Red Crescent. Member of the Cooperative Office to sensitize communities in Dammam. Founding member and board member, the Association of Hosn Al Jiwar association in Bahrain. 32 cooperative health insurance january

18 Finance and Investment Finance and Investment Saudi insurance between investment attractiveness and capital disparity The decision to invest in a particular economic sector depends not on any single factor but on several that together determine the sector s level of attractiveness compared with others. The insurance sector is just like others in this regard. On one hand it is relatively new and promising, attracting the interest of many investors. On the other hand, some companies may find profitability challenging after establishment phases that exhausted much of their limited capital. In this issue of Cooperative Health Insurance, we ask a range of questions about investment in the insurance sector. Subjects tackled in this survey include reasons for optimism and the current state of play of investment in this sector, the controls to be taken into account when considering investment, the concerns that should be addressed, and the reasons why some insurance companies have not yet raised sufficient capital to fund expansion. A promising sector? Investing in the Saudi Arabian insurance sector has several advantages. Financial analyst Talal Al-Sayyah, says: Investment in the Saudi insurance sector is ranked third in importance after petrochemical and banking. This, he suggests is due to the magnitude of the premiums written (the revenue of insurance companies), which reached approximately SR20 billion for insurance companies operating in the Kingdom by the end of September Al-Sayyah adds: If we were to compare investment in the insurance sector with that in other countries, the timing of return on investment activity of insurance companies would be important, since companies in some countries distribute profit yields annually, others are distributed every half-year and still others each quarter. The proportion of profit dividends in some companies reaches 7.9 per cent, which is equivalent to that distributed by large petrochemical companies listed on the Saudi stock market. For Turki Fadak, director of research and advisory at Al Bilad Arabia Company, Al Khobar, the insurance industry is one of the most important sectors at the macroeconomic level, because it contributes indirectly to reducing the overall risk to the business environment. To potential investors, Fadak says that the relative attraction depends on the investment objectives and the expected returns and risk levels that can be tolerated, which will vary between investors. However, in the longer run, the Saudi insurance sector is promising; it is expected to grow over the next five years, especially because the Kingdom is one of the largest Takaful insurance markets in the Middle East. Professor Ikrami Abdullah, financial analyst in the economic reports unit at Al Eqtisadiah adds: The insurance industry in Saudi Arabia is characterized as a promising sector in the light of rapid population growth. The population reached 29.2 million people at the end of Other promising factors Abdullah sees include good returns and the fact that several insurance companies belong to banks, significantly boosting their chances of survival. Insurance sector: state of play Turki Fadak from Al Bilad Arabia Company says that the Kingdom contains 35 companies. These differ in competitive advantages from each other in terms of specialization in certain sectors or in providing general insurance services. Shareholders equity in insurance companies totals around SR10.5 billion. The volume of the insurance market reached 22 billion at the end of 2012 and subsequently, in the following nine months, SR19.3 billion an increase of 23 per cent compared with the same period in Three companies control 50 per cent of the market size, and there is strong competition between these companies. According to Ikrai Abdullah, from Al Eqtisadiah, investment in the insurance sector falls into two distinct camps. The first is major companies with well-known revenues and guaranteed return. The other is modern, low-capital companies, where the risks are high. Talal Sayyah says: There are few investors in the insurance industry who are investors in the real sense. The majority, or at least a large proportion, are considered speculators. Controls and challenges Investment in the insurance sector is governed by a set of rules reflecting the general climate of Saudi investment as well as controls specifically associated with conditions in the sector. Turki Fadak says: It is important at the outset that the 34 cooperative health insurance january

19 Finance and Investment Finance and Investment Turki Fadak: It is important at the outset that the investor determines his investment objectives, including the expected returns and potential risks, then selects companies according to financial criteria investor determines his investment objectives, including the expected returns and potential risks, then selects companies according to financial criteria, including the rate of growth in written premiums, management efficiency and degree of market competition within which the company operates. Ikrami Abdullah has clear advice. The most important controls on insurance investment are to choose companies that made profits and good returns in previous years, or are expected to make a profit in coming years, as well as companies operating in specialized insurance sectors. Talal Sayyah says: In the majority of insurance companies in the Kingdom there are insufficient controls, and therefore companies do not ensure preservation of investors money. For Sayyah, while speculation controls most of the shares in insurance companies, investment is likely to be discouraged. The answer, to his mind, lies in a rational and open investment policy. This might be summarized as follows: first, stay away from speculation it is imperative to employ funds in accordance with pure investment tools. If a company wishes to increase profitability, it must diversify its investment channels to achieve liquidity and profitability, investing some of its savings in the short term, some in the medium term and some in the long-term. In addition good levels of liquid funds should be Talal Sayyah: There are few investors in the insurance industry who are considered investors in the true sense deposited in banks to forestall any future risks. Even taking these controls into account, competition between companies creates challenges that every potential investor in the sector should consider. Turki Fadak says: The most important challenges are setting controls for competition in a manner that does not affect small businesses when competing with big companies. This requires the establishment of an independent body to oversee the insurance sector, which will reflect positively on the sector as a whole. For Ikrami Abdullah the challenges are: Weakness of the insurance culture in society as a result of the novelty of the sector; a focus on only two activities health insurance and vehicle insurance and the lack of qualified personnel to work in the sector. Talal Sayyah says that the main issues are the inadequacy of legal and regulatory controls on the sector, the lack of adequate monitoring of the performance of the sector s companies, and the non-acceptance of insurance by sections of the population. Sayyah suggests that initiatives are needed to encourage: demand for insurance products; the development of products that respond to the needs of the community; the activation of appropriate trade policies; the creation of better distribution channels for the sector; and the updating of guarantees to clarify the rights and duties of the insurers and the insured. Varying capital levels Whenever companies capital decreases, the investment risk increases. For some, there are concerns about the feasibility of investment in the insurance sector. These concerns are exacerbated by the presence of several low-capital companies. According to Turki Fadak, there are 21 companies in the sector who have a total capital of SR 200 million or less, while 14 companies have over SR200 million. Some companies are undercapitalized and struggle to build attractive portfolios. Strong competition from larger, established players exacerbate these effects. Efficient management and prudent policies have important roles to play in growing small businesses and increasing their competitiveness. Fadak adds Not all small businesses (SR200 million or under) are at the same level of performance. I would be concerned by companies that do not show growth in line with that of the sector as a whole; and I would expect these companies to be in a difficult situation in the future. This will eventually require them to reconsider their strategies or to merge with companies to achieve competitive advantage in the marketplace. Ikrami Abdullah disagrees. Low capital may be disturbing, but it is not the sole determinant of investment in companies. A company may have low capital but still achieve good performance in the market and attract customers; then it can increase capital to expand its activities. However, without a doubt, low capital limits companies ability to expand activities and increase their products and their spread through different regions of the Kingdom. Why some smaller companies do not look to raise capital to cope with the expansion of their activities may be for two reasons, according to Abdullah. The first is that companies do not expand operations adequately and therefore do not need to raise capital. The other is that these companies may still be new to the market and may find it difficult to attract capital. Talal Sayyah shares Fadak s concern about the vulnerability of capital, especially among new companies. It is imperative for insurance companies to raise the ceiling of their capital in order to manage challenges and difficulties and to avoid erosion of capital after two or three years of inception. All insurance companies, even those with low capital, are included in the stock market once established. After this, speculators control companies shares and capital. This situation might be avoided by the Saudi Arabian Monetary Agency (SAMA) supervising the work of licensed insurance companies, by raising the minimum capital threshold for companies, or by instigating non-inclusion in the stock market until after two or three years of work or until companies achieve a regular back-up of not less than 25 per cent of their capital. Adventure or safety? The optimal investment in the insurance sector requires the foundations of security, profitability and liquidity. Otherwise, the investment will be a misadventure with unwanted consequences. So says Talal Sayyah, and this is why he would like to see further controls over the insurance sector to rein in the speculation that burdens its investors. He would also like to see the conditions for the establishment of an insurance company re-examined, perhaps with an increase in the minimum capital threshold, a measure which he feels would head off the likelihood of speculation controlling capital or shares. Turki Fadak says: An investment is not an adventure if it is based on a specific investment criteria; because projections indicate growth in the Takaful insurance market of more than 10 per cent annually over the next three years. For Ikrami Abdullah, the proportion of adventure in investment in the insurance sector is determined by the nature of the company, the products it offers and the section of the population being targeted. We know that 25 companies from a total of 33, discounting the largest two Aljazira Takaful Ta awuni and Arabia Insurance, have accumulated losses. This confirms that investment in the insurance sector carries risk at a time when other strong companies have proven ability in the market and these are the companies that attract investment. Ikrami Abdullah: The greatest challenges to investment in the insurance sector are the weakness of the insurance culture, the lack of qualified personnel and a focus on health and vehicle 36 cooperative health insurance january

20 Tech World Tech World Statistics issued by the World Health Organization show that worldwide 390 out of every one million people will lose a limb, some of whom will not have a prosthesis. In Saudi Arabia alone, 3,347 people lose their limbs each year, an average of nine a day. This reveals the need for the science of prosthetics. In the fifth century BCE a prisoner amputated his leg to escape his prison chains and replaced it with a prosthetic. Afterwards, when people saw him walking they were surprised when they realized he was using a wooden limb. The need for artificial limbs was highlighted in 1529 CE, when warriors who were disabled in fighting were fitted with artificial limbs designed by a surgeon. Problem and Solution The real problem for traditional prosthetics is the lack of functionality. Moreover, they are ugly items that do not match the body of the person, either in color, size or shape. Traditional prostheses have a physical role, and the human side has been neglected, and perhaps this is what distinguishes the intelligent prosthetics that scientists and researchers are developing. After years of experience in designing prosthetics, scientists have developed better, more complex prostheses. Some can sense what is being touched. They can make hand-like movements, such as picking something up, typing, hitting and holding a cup. Prosthetics with Sensation In February 2013, the British newspaper The Independent unveiled what it described as a sensory revolution, the first artificial hand that can sense and feel. It is the first of its kind. Using one, hundreds of thousands people around the world who have lost limbs would be able to feel what their prosthesis touched. It will be fitted during surgery in the presence of senior scientists, who specialize in this field. The surgery will be carried out on a young man in his 20s, who lives in the Italian capital, Rome. He lost the lower part of an arm in an accident. The hand is called the Cyber Hand and belongs to a generation of artificial limbs with sensory perception. The hand will be directly connected to the nervous system of the patient through electrodes embedded in two nerves of the hand: the median nerve and the ulnar nerve. The man s brain will receive sensory signals from the sensory areas of his hand. There will be a quick effective bi-directional flow of information between the nervous system and the artificial hand, which is considered the most prominent development in the world of prosthetics. There is a glimmer of hope that the man will be able to control the movement of his new hand, receive touch signals from the hand s skin and feel heat. The new hand will send signals to the brain to warn about the danger of some liquids and surfaces, exactly like a natural hand. One of the advantages of implanting an artificial smart hand is that this helps to reduce the medical costs for operations, and it does not need any reinstallation Intelligent Prosthetics A Real Alternative for a Normal Life One of the most difficult things that a human might suffer is the loss of a limb. Nowadays, this loss is less difficult to deal with. Successive technological developments have enabled many people who have lost limbs to cope with the situation and continue their life normally, to the extent that they can fend for themselves. They can even feel that the prosthetic is a real limb, especially if it is an intelligent prosthetic. 38 cooperative health insurance january

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