Saudi Cultural Missions Theses & Dissertations
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Item Restricted International Agreements Enforcements in Saudi Arabia: by Finding Defined Enforceable Mechanism(Saudi Digital Library, 2025-05-15) Nofal, Ibrahim; Bendistis, Brett EIntroduction 9 Chapter 1: Study Context - Modern International Concerns for Saudi Arabia. 21 1.1. Introduction 21 1.2. Saudi Arabia’s Vision 2030 22 1.3. International Concerns in the Context of Vision 2030 26 1.3. International Investment 32 1.4. International Concerns on Expropriation. 40 1.5. Application of Shari’ah Law in the Expropriation Context 43 1.6. International Dispute Resolutions 44 1.7. Gulf Cooperation Council (GCC) 47 1.8. Saudi Arabia and International Organizations 52 1.8.1. World Trade Organization (WTO) 52 1.8.2. United Nations (UN) 63 1.9. Conclusion 65 Chapter 2: King’s Regulation of International Affairs 69 2.1. Introduction 69 2.2. Monarchy and International Relations 70 2.2. King's Competences in The Field of Executive Authority (Administrative Field). 72 2.3. King's Competences in The Field of Regulatory Authority. 75 2.4. King's Competences in Extraordinary Circumstances. 79 2.5. State of Emergency (Exception). 80 2.6. The State of War. 82 2.8. Implications for Treaty-Making and Enforcement 84 2.7. Chapter Summary 85 Chapter 3: Crown Prince’s Authority 87 3.1. Introduction 87 3.2. Authority of the Crown Prince 88 3.3. Reference of Regulations When it Comes to Inheritance of The Kingdom. 89 3.4. Procedures of Appointing Crown Prince. 90 3.5. Powers of the Crown Prince. 92 3.6. Implications of the Crown Prince’s Powers on the Treaty-Making Process 94 3.7. Chapter Summary 95 Chapter 4: A Brief Overview of The Saudi Legal System 99 4.1. Introduction 99 4.2. The Basic Law of Governance 100 4.3. Saudi Government Authorities (Executive, Legislative, and Judicial). 102 4.3.1. The Executive Branch 102 4.3.2. The Legislative (Regulatory) Branch 104 4.3.3. The Judicial Branch 110 4.4. Regulatory Tools used at Royal Discretion in Kingdom of Saudi Arabia 117 4.4. Distinguishing Characteristics of Treaties 121 4.4.1. Definition of Treaties 122 Closed Treaties 124 Semi-Open Treaties 126 Open Treaties 129 4.5. Creation of Treaties 131 4.5.1. Negotiation 131 4.5.2. Signature 135 4.5.3. Approval 138 4.5.4. Ratification 141 4.5.5. Reservations, Declarations, Understandings, and Provisos 143 4.5.6. Entry into Force and Treaty Publication 145 4.6. Enforcement of Treaties 148 4.7. Interpretation of Treaties 154 Evolutionary Interpretation 157 Emerging Consensus 158 Margin of Appreciation 160 4.8. Ratification 162 4.8.1. Actors in the Making and Ratification of International Agreements 162 4.8.1.1. The Executive Branch 163 4.8.1.2. The Judicial Branch 165 4.8.1.3. The States 166 4.8.2. Laws Governing the Making of International Agreements 166 4.8.3. United States Constitution 167 4.8.3.1. Treaties 167 4.8.3.2. Executive Agreements 167 4.8.4. Federal statutes 172 4.8.4.1. Treaties 172 4.8.4.2. State laws and regulations 174 Chapter Summary 177 Chapter 5: The Saudi Arabia Treaty-Making Process and Mechanisms for Internal Enforcement 179 5.1. Introduction 179 5.2. Treaties in the Context of Shari’ah Law and its Importance in Saudi Arabia 180 5.3. Importance of Treaties in Saudi Arabia 182 5.4. Overview of the Treaty-Making Process in Saudi Arabia 183 5.4.1. Negotiation and Drafting 184 5.4.2. Review by Relevant Authorities 185 5.4.3. Approval by the Government 186 5.4.4. Ratification by the King 186 5.4.5. Publication and Implementation 187 5.5. Historical Context of Saudi Arabia Treaty-Making 188 5.6. The Constitutional Framework for the Saudi Arabia Treaty Process 191 5.6.1. The Saudi Basic Law of Governance (1992) 192 5.6.2. Royal Decrees 192 5.6.3. The Council of Ministers 193 5.6.4. Ministry of Foreign Affairs (MOFA) 193 5.6.5. Shari’ah Law 194 5.6.6. The National Assembly (Shura Council) 194 5.6.7. Implementation of Treaties 194 5.7. The King’s Role in Treaty Approval, Ratification, and Implementation 195 5.8. Saudi Public Interest under Shari’ah and its Implications on Treaty Ratification Process 197 5.8.1. Definition of Maslahah (Public Interest) in Shari’ah 198 5.8.2. Applications of Public Interest (Maslahah) 199 5.8.3. Maslahah in Treaty Decisions 199 5.8.3.1. Maslahah in Treaties Relating to Economic Cooperation 200 5.8.3.2. Human Rights Treaties and Shari’ah Principles 201 5.8.3.4. Environmental Treaties and Maslahah 202 5.8.3.5. National Security Treaties and Maslahah 202 5.8.3.6. Rejection of Treaties Based on Maslahah 203 5.8.4. Governance Institutions and their Role in ensuring that Maslahah in Treaty-Making Process in Saudi Arabia 203 5.8.4.1. Board of Senior Scholars (Hay'at Kibar al-Ulama) 204 5.8.4. 2. Shura Council (Majlis al-Shura) 205 5.8.4.3. Council of Ministers 207 5.8.4.4. Supreme Judicial council 208 5.8.4.5. Ministry of Justice 210 5.8.4.6. Islamic Banking and Finance Institutions 211 5.8.4.7. King Salman Humanitarian Aid and Relief Center 212 5.8.4.8. Public Prosecution 212 5.8.4.9. Specialized Committees and Councils 214 5.8.5. Case Studies on Treaties that have been Affected by Maslahah 216 5.9. Implementation of Treaties Within Saudi Arabia Domestic Laws 220 5.9.1. The Need for Implementing Legislation 220 5.9.2. The Impact of Treaties on Domestic Law 224 5.10. Mechanisms for Enforcing Treaties Internally in Saudi Arabia 230 5.10.1. Royal Decrees 230 5.10.2. The Council of Ministers 230 5.10.3. Ministries and Government Agencies 231 5.10.4. The Shura Council (Consultative Council) 231 5.10.5. Judiciary and Legal Framework 232 5.10.6. Regulations and Administrative Orders 232 5.10.7. International Organizations and Committees 232 5.11. Effectiveness of Saudi Arabia Treaty Enforcement Mechanisms 233 5.11.1. Successes in Implementation and Compliance 233 5.12. Challenges and Limitations of Enforcing Treaties 237 5.12.1. Compliance with Shari’ah Law 237 5.12.2. Sovereignty and National Interests 238 5.12.4. Conflict with Domestic Laws 240 5.12.5. Public Opinion and Cultural Sensitivities 242 5.13. Ongoing Debates and Political Dynamics in Saudi Arabia’s Treaty Process 244 5.13.1. Shari’ah Law vs. International Norms 244 5.13.2. The Role of Religious Authorities 245 5.13.3. Economic Globalization and Sovereignty 245 5.13.4. The Impact of Regional Politics 246 5.13.5. Saudi Arabia's Relationship with the United States and Other Western Powers 247 5.14. Chapter Summary 247 Chapter 6: The United States Treaty-Making Process and Mechanisms for Internal Enforcement in Comparison to Saudi Arabia 251 6.1. Introduction 251 6.2. Overview of the Treaty-Making Process in the U.S. 252 6.3. Historical Context of U.S. Treaty-Making 254 6.3.1. Constitutional Foundations 255 6.3.2. Key Historical Treaties and Their Impact 256 Treaty of Paris (1783) 256 Louisiana Purchase Treaty (1803) 258 North Atlantic Treaty (1949) 259 Treaty of Versailles (1919) 260 General Agreement on Tariffs and Trade (GATT) (1947) 260 United Nations Convention on the Law of the Sea (UNCLOS) (1982) 261 6.4. The Constitutional Framework for the U.S. Treaty Process 262 6.4.1. Article (2), Section (2) of the U.S. Constitution 262 6.4.2. The Roles of the President, Senate, and House of Representatives 263 The President 263 The Senate 263 The House of Representatives 264 6.4.3. Negotiation and Drafting of Treaties in the U.S. 266 6.4.4. U.S. Senate Approval Process 267 6.4.5. Historical Examples of Successful and Failed Ratifications 268 The Paris Agreement 268 Comprehensive Nuclear-Test-Ban Treaty (CTBT) 268 New START Treaty (2010) 269 6.5. Implementation of Treaties Within U.S. Domestic Laws 270 6.5.1. The Need for Implementing Legislation 270 6.5.2. The Impact of Treaties on Domestic Law 272 6.6. Mechanisms for Enforcing Treaties Internally in the U.S. 274 6.6.1. Federal and State Compliance 274 6.6.2. Role of Federal Agencies 275 6.6.3. Judicial Enforcement of Treaties 275 6.7. Effectiveness of U.S. Treaty Enforcement Mechanisms 277 6.7.1. Successes in Implementation and Compliance 277 6.7.2. Challenges and Limitations of Enforcing Treaties 277 6.7.3 Ongoing Debates and Political Dynamics 280 6.8. Comparison of Saudi Arabia Treaty Process with the U.S. Approach 282 6.9. Applicability of U.S. Treaty-Making and Enforcement Mechanisms to Saudi Arabia 284 6.9.1. Potential Adaptations and Challenges 284 6.9.2. Cultural and Political Considerations 285 6.10. Chapter Summary 287 Chapter 7: Treaty-Making and Enforcement in France: A Comparative Analysis with Saudi Arabia 288 7.1. Introduction 288 7.2. The Treaty-Making Process in France 289 7.2.1. Constitutional Framework 289 7.2.2. Types of Treaties 290 7.2.3. Procedure for Ratification 291 7.2.4. Role of the Executive and Legislative Branches 291 7.3. Internal Enforcement Mechanisms in France 292 7.3.1. Incorporation into Domestic Law 292 7.3.2. Judicial Mechanisms 292 7.3.3. Role of Government Agencies 292 7.4. Effectiveness of France’s Treaty Enforcement Mechanisms 293 7.4.1. Case Studies on International Treaties 293 The Treaty of Maastricht of 1992 293 The European Constitution of 2005 293 7.4.2. Challenges and Limitations 294 7.5. Comparative Analysis: Applicability of France’s Treaty Process to Saudi Arabia 294 7.5.1. Political Environment Considerations 295 7.5.2. Cultural and Legal Considerations 295 7.6. Potential Recommendations for Adaptations and Reforms 296 1. Enhancing Public Participation in Treaty-Making 296 2. Strengthening Legislative Oversight and Parliamentary Involvement 297 3. Aligning Treaty Processes with International Best Practices 298 4. Addressing Compliance and Enforcement Challenges 299 7.7. Chapter Summary 300 Chapter 8: Treaty-Making and Enforcement in United Arab Emirates (UAE): A Comparative Analysis with Saudi Arabia 302 8.1. Introduction 302 8.2. The Treaty-Making Process in the UAE 303 8.2.1. Constitutional and Legislative Framework 303 8.2.2. Steps Involved in Formulating Treaties 310 8.2.3. Role of the Executive and Legislative Branches 310 8.3. Internal Enforcement Mechanisms in the UAE 311 8.3.1. Incorporation into Domestic Law 313 8.3.2. Judicial Mechanisms 315 8.3.3. Role of Government Agencies and Compliance Bodies 316 8.4. Effectiveness of the UAE’s Treaty Enforcement Mechanisms 19 8.4.1. Case Studies on International Treaties 316 8.4.2. Challenges and Limitations 317 8.5. Comparative Analysis: Applicability of UAE’s Treaty Process to Saudi Arabia 318 8.5.1. Overview of Saudi Arabia’s Legal Framework for Treaties Error! Bookmark not defined. 8.5.2. Comparison with UAE Treaty Process Error! Bookmark not defined. 8.6. Potential Recommendations for Adaptations and Reforms Error! Bookmark not defined. 8.7. Chapter Summary Error! Bookmark not defined. Chapter 9: Conclusion and Recommendations 319 9.1. Overview 321 9.2. Recommendations for Improving Saudi Treaty-Making Process 322 9.2.1. Legislative Oversight and Public Accountability (Lesson from the USA): 322 9.2.2. Judicial Review for Constitutional Consistency (Lesson from France): 324 9.2.3. Modernization and Flexibility (Lesson from UAE): 326 9.2.4. Balancing Domestic and International Obligations (Lessons from All): 328 9.3. Chapter Summary 331 References 33233 0Item Restricted IMPACT OF BANK-SPECIFIC AND MACROECONOMIC FACTORS ON THE FINANCIAL STABILITY OF BANKS IN GULF COOPERATION COUNCIL COUNTRIES VIA CORPORATE GOVERNANCE(Universiti Putra Malaysia, 2025-05) ALSULMI, FATIMA; Rosli, MahmoodThis study examined the bank’s financial stability based on internal factors (bank specific factors) and external factors (macroeconomic factors). Furthermore, this study examined the moderating role of corporate governance (board size, board meeting frequency, and CEO duality) between bank-specific and macroeconomic factors. The bank’s financial stability was measured by the z-score as an accounting measurement and Distance to Default as a market measurement. The analysis focused on a sample of listed banks in the Gulf Cooperation Council (GCC) region from 2014 to 2022 using STATA software. The results were based on the dynamic panel estimator of the two-step system Generalised Method of Moments (GMM). The findings suggested that credit risk had a significant effect, liquidity risk had no significant effect on the bank’s financial stability, and operational risk negatively affected it. Income diversification and capital adequacy positively impacted the bank’s financial stability. Regarding macroeconomic factors, oil prices contributed positively to banks’ financial stability. Gross Domestic Product (GDP) and interest rates negatively influenced the bank’s financial stability, while inflation had a mixed effect: positive on bank z-score but negative on bank Distance to Default. The COVID-19 pandemic showed a significant negative effect on the bank z-score and a positive effect on bank Distance to Default. The moderating effect findings highlighted that board size and meeting frequency mostly had a negative moderating effect between bank-specific factors and the bank’s financial stability. Meanwhile, CEO duality showed both negative and positive moderating effects. The analysis of the moderating role between macroeconomic factors and the bank’s financial stability showed that board size and meetings had a moderating role. In contrast, CEO duality only moderated the relationship between macroeconomic factors and bank Distance to Default. These findings suggest important implications for bank governance and stability in the GCC region.7 0Item Restricted TOWARD A SUSTAINABLE (GREEN) FINANCE IN THE GCC: A COMPARATIVE ANALYSIS OF THE ROLE OF THE ESG AND FINANCIAL SECTORS IN SAUDI ARABIA, QATAR, AND UAE(Brunel University London, 2024-09) Alangri, Norah; Andreadakis, SteliosThis dissertation explores the context of sustainable (green) finance in the Gulf Cooperation Council (GCC) by examining the role of ESG and financial sectors in three GCC countries, including Saudi Arabia, Qatar, and the UAE. Given the rise of the significance of the ESG and financial sectors, the dissertation selected those three countries for their high capital in their financial sectors, including central banks, capital market authorities, Sovereign Wealth Funds (SWF), and some of their green banks. While the dissertation presented the transformation from Corporate Social Responsibility (CSR) to Environmental, Social and Governance (ESG) in the first chapter, it then focused on sustainable finance and economic diversification to lay the background for the findings. In the third and last chapter, the dissertation details the ESG and financial sectors in Saudi Arabia, Qatar and the UAE. The findings indicate the growing significance of the ESG, especially in encouragement by central banks and requirements in capital market authorities, and its adoption in SWFs and some banking institutions focused on green strategy. The ESG and sustainable finances appeared to be tools in investments; however, while Saudi Arabia, Qatar, and the UAE have similar orientations in this regard, they are independent in this financial policy with some intention to offer a collective approach.37 0Item Restricted Essays on Sustainable Growth and Development in GCC Countries(Howard University, 2024-06-28) Alamri, Aisha; Kato, MikaThis article analyzes the effects of natural resources and location determinants on foreign direct investment (FDI) in the Gulf Cooperation Countries (GCC) using panel data from 2000–2022. Using oil production, oil reserves, and oil production in relation to oil reserves as a means to measure natural resources, I determine fixed effect (FE) and random effect (RE) analyses based on the Hausman test. This study concluded that oil production, and oil production relative to oil reserves discouraged FDI in GCC countries. Furthermore, the study concludes that there is a positive relationship between oil prices, infrastructure, and FDI, while human capital has no influence on FDI.42 0Item Restricted Developing Smart Cities in Saudi Arabia. promoting innovation and evaluating smart initiatives. The case study of Jeddah city, Saudi Arabia.(University of Aberdeen, 2024-06-24) Almaghrbi, Rayan; Philip, Lorna; Beecroft, MarkTo date, the main focus of Smart City development has been in North America and Western Europe. The development of Smart Cities in other geographies has received more limited attention. This study seeks to help address this imbalance by focusing on the development of Smart Cities in the context of Gulf Cooperation Council (GCC) countries, with a focus on Saudi Arabia and the city of Jeddah in particular. By focusing upon a single city case study, the research explores how related Smart City technologies are being used, seeks to understand the implications these have for planning policies and municipal activities, and elicits information from the public about their views of Smart City developments. The study aims to contribute to the emerging literature on Smart City development, paying particular attention to the currently understudied area of how such approaches will be impacted by and have impacts upon current and emerging policy drivers in Saudi Arabia, such as Saudi Vision 2030. Primary data collection was undertaken in two distinct phases. Firstly, semi-structured interviews were conducted with a range of national and municipal-level stakeholders representing public and private sector interests. Secondly, a questionnaire survey, administered online, elicited attitudes and opinions about Smart Cities and their development in Saudi Arabia from a sample of the city of Jeddah’s resident population. The study revealed that Jeddah's smart practices show a real commitment to Smart Cities concept. Significant attention has been given to smart initiatives in relation to governance, environment, living, and economy, but smart mobility and community participation require more work. The study concluded with a list of recommendations designed to provide guidance for Jeddah's promotion towards becoming a Smart City. These recommendations can be extended to other Saudi and GCC cities.23 0Item Restricted Beyond Bonds: Unlocking Sukuk's Potential in Hedge Fund Portfolios Amidst Market Volatility, an ARCH and GARCH Models Analysis(King's College London, 2023-09-14) Ajaj, Mohammed; Papailias, FotisThe global financial ecosystem, which is fraught with economic uncertainty and turbulent bear markets, drives hedge funds to seek for alternative investment opportunities that promise stability and substantial returns. In this context, the potential of Sukuk, an Islamic alternative to conventional Bonds, is examined in comparison to Bonds, particularly during bear markets. Despite abundant research on Sukuk and conventional Bonds, a quantitative comparison analysis, particularly one focusing on GCC Sukuk, remains relatively unexplored. This work fills this need by modelling the financial time series of these instruments using the Capital Asset Pricing Model (CAPM) and Autoregressive Conditional Heteroskedasticity (ARCH) and its generalized counterparts (GARCH & EGARCH). Preliminary findings indicate that Sukuk, due to their asset-backed nature, demonstrate exceptional resilience during economic downturns. Because of their low market sensitivity, Sukuk have the ability to diversify hedge fund portfolios, according to the CAPM model research. In addition, the GARCH and EGARCH models revealed a divergence in volatility patterns between Sukuk and Bonds between 2020 and 2023, emphasizing Sukuk's resilience to negative shocks. To summarize, while Sukuk looks to offer various advantages over conventional Bonds, particularly in bear markets, financial practitioners are recommended to take a balanced approach, always re-evaluating their investment strategies in the ever-changing finance landscape.10 0Item Restricted Foreign capital investment in the Kingdom of Saudi Arabia: How has legislation been formulated over the years to cater to foreign capital investment? How do Saudi and EU laws compare in terms of trade and capital investment?(Saudi Digital Library, 2023) Albeladi, Semood Hussain; Kenny, MelAs a developing nation, Saudi Arabia presents foreign investors with numerous business opportunities. Foreign Direct Investment (FDI) is an essential component of both the national and global economies. Saudi Arabia is desperate to open its market to an unlimited number of participants, who will undoubtedly contribute to the economy and business environment. In this research, the Saudi local market will be analyzed from various angles, and its characteristics are outlined. Throughout this work, numerous definitions, and explanations of FDI in Saudi Arabia will be provided. Key advantages, sectors, and characteristics of the Saudi Markets were outlined. It will also explain the development of legislation in the Kingdom of Saudi Arabia to be compatible with foreign investment. On the other hand, how Saudi laws and European Union laws compare in terms of trade and capital investment. The Ministry of Investment of Saudi Arabia, which is the legal authority responsible for facilitating these investments, is the starting point for investors seeking more information. This might demonstrate the potential and benefits of Saudi FDI opportunities. Consequently, there are several strong indications of outstanding opportunities to increase the business's profitability. Foreign direct investment (FDI) in Saudi Arabia still offers a vast opportunity to conduct a variety of businesses and invest in emerging industries.25 0Item Restricted Regulatory Framework of Investment Legal Regime in the Arab Gulf Region(Saudi Digital Library, 2023-09-01) Alhudaithy, Khaled Mohammed; Ortino, FedericoSignificantly relying on a singular finite source of energy as the primary source of income can be momentarily beneficial yet detrimental on the long run. This research aims to explore and compare how two neighboring with similar economies states have utilized their positions and shaped their regulatory framework for investments legal regime to curtail for foreign investors needs to ultimately diversify its economies.44 0Item Restricted You're Not Alone: the Intersection between Technology and Domestic Violence in the GCC(Saudi Digital Library, 2023-11-13) Alsugair, Lulu Hamed S; Parmanand, SharmilaThe purpose of this project is to explore how technology and domestic violence are framed in relation to each other and what the current contexts are in which they are found within the states of the Gulf Corporation Council (GCC). Situating my research in the case study of a domestic violence organisation in Bahrain, hereafter known as “Organisation X”. I want to analyse the potentials, risks, and implications that arise from integrating technology as a lifeline for domestic violence survivors. The research aims to highlight how the push to use technology, more specifically, mobile applications, addresses the issues of domestic violence in terms of the survivor’s decision to get help and access to services and support. Furthermore, it explores how technology transformed its role as a facilitator, threat, and lifeline for domestic violence survivors. Additionally, I deployed the use of semi-structured interviews with key staff members in Organisation X, which were analysed through critical discourse analysis, thematic analysis, and the approach of the critical friend to understand the culture that contributed to the transition from a physical mobile helpline to an app. The findings from the interviews in relation to the intersection between technology and domestic violence were that technology expands the scope and scale of services that can be accessed by survivors of domestic violence, however, the extent to which these services will retain the same efficiency, quality, and longevity as those provided by locally based service providers and the state infrastructure is yet to be determined.21 0Item Restricted Patients in KSA preference for emergency department visitation to general practitioner services and what advanced practice nurses could do to encourage patients to make the best choice(Saudi Digital Library, 2022-09-30) Alghatani, Fawziah; Roberts, Sara LisabethBackground: Emergency care services support the management of the emergent and non-urgent conditions. Advance Practice Nurses are an integral part of handling GP services and delivering care in Saudi Arabia. The GP services have reformed over time worldwide to anchor the delivery of quality and prompt care to citizens and visitors. Aim and Objectives: To conduct a systematic review that will explore emergency department visitations and general practitioner services in Saudi Arabia; To establish the preference for emergency department visitation to the general practitioner services among patients in the Kingdom of Saudi Arabia; To delineate what advanced practice nurses could do to inspire patients to choose between general practitioner and emergency department visitation. Methodology: A systematic review approach was used to answer the research question. A search was conducted on PubMed, ScienceDirect, MEDLINE, and Cochrane Library and PRISMA Flow Chart used to select 10 studies that met the eligibility criteria. A thorough quality assessment by using the ROBINS-I tool while data extraction done, and findings generated the key themes. Results: The key themes from the synthesis of the ten studies were preference for EDs, preference for primary or GP services, the key factors behind the preference for ED visits to GP Services, and role of APNs in the preference for GPs or EDs. The quality-of-care guarantees response to the urgent and non-urgent cases. On the other hand, the availability and accessibility of care in the EDs in Saudi explain their preference by the patients to the GPs. The organizational factors were of quick medical care, easy access, discounts, unavailability of the appointments in GPs shaped their demand. GPs offer continuous relationship, cost-effective, and treatment, which discourages ED care accessibility and visitation due to overcrowding and limited resources. Comparatively, personal factors of knowledge, attitudes, medical conditions, and age influence preference for EDs to GPs for urgent as well as non-urgent conditions. Conclusion and Recommendations: Patients prefer ED visitation to the GP services in KSA. APNs should champion the enhancement of services in the primary care units to reduce overutilization of ED. Future research could explore the primary factors besides quality of care or continuous relationship.6 0