The Next Step in Transparency: Refining the Insurance Complaints Index in Saudi Arabia

A Commendable Leap Toward Transparency

The Insurance Authority’s recent publication of the Complaints Index for Q1 2025 is an important and welcome step in promoting transparency and accountability in the Saudi insurance ecosystem. By openly sharing complaint rates per 10,000 insured individuals, the Authority demonstrates its commitment to protecting consumer rights, increasing trust in the sector, and creating a more competitive insurance market.

This move should be recognized and applauded. It sets a precedent in the region for public access to performance data — one that empowers policyholders to make informed decisions and encourages insurance companies to elevate their service standards.

The Current Metric: What’s Being Measured?

According to the report, complaint rates are calculated based on the number of complaints submitted to the Insurance Authority per 10,000 insured beneficiaries, primarily in health insurance. For example:

• Al Sagr Insurance reported 4 complaints per 10,000 insured
• Gulf General recorded 53 complaints per 10,000 insured
• Other major insurers like Tawuniya and MedGulf fall in the mid-range at 34 complaints

Where the Index Falls Short

While the current method is ideal for public communication, it does not reflect the complex realities of complaint handling or customer experience in a health insurance context. Several issues arise:

1. Not all complaints are equal — administrative errors and denial of life-saving care are treated the same.
2. Insurers with complex case loads (e.g. chronic disease coverage) are penalized equally as those with simpler portfolios.
3. Resolution effectiveness and speed are not measured — only the volume of complaints.
4. No feedback loop — we don’t know whether the complaint was resolved or if the patient was satisfied.

Recommendations to Improve the Index Scientifically

To ensure the Complaints Index becomes not just a public-facing tool, but also a powerful mechanism for sector improvement, I propose the following:

1. Introduce Complaint Severity Classification

Weight complaints based on impact — e.g., critical denial of care vs. delay in response.

2. Measure Resolution Time and Satisfaction

Track how quickly and effectively insurers resolve complaints, and whether beneficiaries are satisfied.

3. Adjust for Claim Volume and Complexity

Use complaint-to-claim ratios and normalize scores for insurers handling complex or high-risk populations.

4. Publish a Complaint-to-Claim Ratio

A more operationally relevant metric: how many claims result in complaints?

5. Apply Qualitative Complaint Analysis

Use AI or thematic analysis to examine complaint content and detect systemic issues (e.g., network gaps, fraud triggers).

This flowchart outlines a refined, scientific approach to evaluating insurance complaints. It moves beyond simple complaint counts by introducing severity scoring, resolution metrics, normalized ratios, and qualitative analysis — forming a continuous feedback loop that drives real service improvement and regulatory insight.

What’s at Stake

Improving this index goes beyond better optics or data cleanliness. It supports key national goals:

• Aligns with Vision 2030 in promoting value-based, patient-centered care
• Incentivizes insurer behavior to resolve, not just absorb, complaints
• Supports smarter regulation — identifying underperformance early and responding with policy
• Enhances public trust, especially as out-of-pocket costs and insurance penetration rise

Final Word: A Strategic Opportunity

Saudi Arabia’s Insurance Authority is building a more transparent, modern, and consumer-centric system. This Complaints Index is the first version of something powerful — but now is the time to go deeper, use more scientific tools, and ensure that the metric becomes not just a public indicator, but a performance driver.

We owe it to our beneficiaries, our policymakers, and the evolving insurance sector to measure what truly matters — not just how many complain, but how well we listen and respond.