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Many countries now struggle to provide cost-effective, quality healthcare services to their citizens. Saudi Arabia has experienced high costs along with concerns about quality of care in its public facilities. To address these issues the country is currently restructuring their healthcare system to privatize public hospitals and introduce insurance coverage for both foreign workers and citizens. The changes provide an interesting and insightful case for the challenges in radically changing a country's healthcare system. The situation also demonstrates a unique case in the Middle East for greater reliance of the private sector to address rapidly escalating healthcare costs and deteriorating quality. The complexity of changing a healthcare system is discusses with the many challenges associated with the change.