| Summary: | In 2005, Saudi Arabia implemented the Cooperative Health Insurance System (CHIS) for the purpose of shifting the financial burden of running health care services from the Ministry of Health (MOH) to the private sector. The aim of this study was to investigate, for the year 2007, beneficiaries' satisfaction with the CHIS in Riyadh, the capital city of Saudi Arabia, since no study had, as yet, been conducted. The current study uses a sequential explanatory design, a mixed methods approach, consisting of both quantitative and qualitative data analysis. The Canadian Common Measurement Tool (CMT) was used. In addition to service delivery, access and availability of facilities, communication and the cost dimensions, two new dimensions were added to the original instrument, namely, the employer role and the insurance company role. The results obtained showed the instrument was reliable and valid to be used to measure satisfaction with the CHIS. Using a five point Likert scale, 462 participants completed the questionnaires. Following analysis, 21 interviews contextualised by participant observation were conducted to assist in interpreting the findings of the primarily quantitative study. NVivo was employed for qualitative data analysis. Study findings revealed that 59% of respondents were moderately satisfied with the CHIS and that it has improved access to the health care system. However, beneficiaries were not satisfied with waiting times to receive the service under the CHIS. The comprehensiveness of covered health services was also a major concern. Beneficiaries were highly satisfied with their employer's role and moderately satisfied with the role of the insurance company in their coverage with health insurance. The most frequent problem reported by respondents was that some services were refused. The cost of health insurance and non-covered health care services was a common misconception. In addition, beneficiaries' awareness towards health insurance is still limited. The finding revealed that satisfaction with the insurance company role, service delivery, type of coverage and inclusion of family members were most important in explaining beneficiaries' satisfaction. Finally, the study provides insight into service improvement priorities which could inform future planning initiatives for health insurance development. The practical implications of the findings for health care providers, insurance companies and health care policymakers were highlighted, as were recommendations for improving the implementation of the CHIS in Riyadh city and suggestions for future research.
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