Factors Influencing Support for National Health Insurance: Evidence from Qassim Region, Saudi Arabia

As part of Vision 2030, Saudi Arabia is transforming its healthcare system, shifting away from an unsustainable free-service model. To establish a more sustainable healthcare system, policymakers are considering introducing a National Health Insurance (NHI) program, which would require citizens to make regular financial contributions. This research explores Saudi citizens’ willingness to support and contribute financially to the proposed NHI program, as well as the key socio-economic, demographic, and health-related factors influencing their decision. This study employed a cross-sectional design, utilizing the Contingent Valuation (CV) method. Primary data were collected from 1194 respondents residing in the Qassim region of Saudi Arabia through an online survey between November 2024 and January 2025. Descriptive statistics, binomial, and multiple regression were applied to identify the factors associated with Willingness to Pay (WTP) for NHI. The study indicated that approximately half of the respondents (49.33%) support and are willing to pay for the NHI program ( p < 0.01). The mean monthly contribution is estimated at 158 SAR (42.13 US$) with a median amount of 100 SAR (26.6 US$). This amount constitutes about 1.8% of the current healthcare expenditure in 2023. Factors such as being male, having a medium-sized family, and having a family member with a chronic disease increase the likelihood of WTP for NHI. Additionally, the maximum amount of respondents are willing to pay is significantly associated with gender, the presence of chronic disease in the family, obstacles to accessing healthcare, satisfaction with current healthcare services, and existing health insurance status. This study offers valuable insights into Saudi citizens’ willingness to financially contribute to the NHI program. However, its successful implementation depends on addressing cultural acceptance, building public trust, and ensuring affordability for low-income groups. Effective rollout of the NHI requires the coordinated efforts of multiple stakeholders, including government agencies, healthcare providers, employers, health insurance organizations, civil society, and regulatory bodies.