e Work with existing private insurers e Use a back-door approach and just force private employers to hire more Saudis The government could set up a state insurance company The government could set up a single-state insurer that is either funded through direct contributions or through general taxation. The government would likely need to get external help from a party knowledgeable in insurance and risk, which could be an insurer, Saudi or otherwise. Daman, Abu Dhabi's health insurer is owned 80% by its government and 20% by German insurance company Munich Re. Existing private insurers may not have capacity if they were made responsible The government could decide to execute any financing scheme through existing private insurers, or give citizens the option of choosing either a government or private insurer. The existing private healthcare insurers in Saudi Arabia are unlikely to have the resources (both people and systems) in place to provide cover for an additional 20m people immediately and will need some time to prepare. Any large scale immediate expansion could put them at risk of substantial underwriting losses that they would presumably seek to have back-stopped by the government in the initial stages. Chart 57: Health insurers by share of claims (1H15) 28% 25% 4% T% 20% 16% mBupa Arabia =Tawuniya mMedguif mMalath mAxa © Other Source: BofA Merrill Lynch Global Research, CCHI OS Merrill Lynch GEMs Paper #26|30 June 2016 57 HOUSE_OVERSIGHT_016167