There is dire need for a more effective health insurance system capable of providing Egyptian citizens with high-quality treatment at their outlet of choice. Only 37 million Egyptians actually benefit from health care and health insurance. To this end, the Ministry of Health has completed the final draft of a health insurance bill and will send it to parliament for ratification. Minister of Health Ahmed Emad told the press the bill aims to provide health insurance to low-income citizens, making use of new medical insurance cards for families rather than individuals. “It will cover a new set of diseases and injuries through an authority which operates directly under the president's supervision,” Emad said. According to Emad, the ministry will launch a quality-control authority for hospitals to be included in the new system. Only hospitals with qualified doctors who receive good salaries and have high-quality infrastructure and equipment will be included in the insurance system. The new draft, to be presented to parliament, annuls any other insurance system and all Egyptians are to be insured. The latest version of the health insurance bill includes a wider range of ailments that were previously excluded under the umbrella of governmental health insurance, such as mental health illnesses, injuries caused by natural disasters, and preventative treatment. The authority set to monitor the new system has been delineated in the new version as a non-profit governmental entity. Public healthcare facilities will also remain under the government's jurisdiction and will not be privatised, according to the bill. The government will enhance their quality in accordance with the standards set out by the new insurance system. Health Ministry spokesman Khaled Megahed said the health minister's plan intends to tackle the overhaul of the healthcare sector and improve services at existing hospitals by building 135 new healthcare facilities and developing 5,314 units. According to Megahed, this will mark the first milestone in implementing the new health insurance system. “There are 2,558 healthcare units already renovated while the rest are still under construction,” said Megahed. Under the new system, Megahed said the government will cover what limited income brackets cannot in such financing, stressing the importance of reaching an insurance policy that provides advanced health service, adding that the new system will give citizens the chance to enjoy health care at the department they select, which would unleash competition among the private, government and military hospitals. The core of the new system, according to Megahed, is “managed care”, which he describes as being based on “modern management techniques and competition as a means towards quality and cost effectiveness”. The Health Insurance Authority (HIA) would have both direct and indirect resources to fund its programmes. Direct income comes from the premiums and co-payments paid by beneficiaries, as well as contributions from the state treasury. Indirect funds would come from taxes levied on particular industries and goods that are considered hazardous to health, such as cigarettes, alcohol, sugar and insecticides. The ministry will launch a quality-control authority for hospitals to be included in the new system. Only hospitals with qualified doctors who receive relatively good salaries and have high quality infrastructure equipment will be included in the insurance system. As for funds, the new bill amended the minimum amount for subscriptions from pensioners to only one per cent of an individual's monthly pension. The funding also requires at least three per cent of gross domestic product (GDP) to be spent on the healthcare sector, in addition to taxes generated from cigarettes, alcoholic beverages, cement factories, driving licenses and other resources. The new draft aims to cover the entire population with a basic package of priority health services, in addition to two packages for medical treatment and surgery abroad. The basic package would include examination, diagnosis and treatment, all free of charge. The primary difference, Megahed said, would be that healthcare services would be provided on the basis of need rather than the ability to pay. “All regions and citizens of all income brackets will have equal rights in the new health insurance system,” the minister said. He also promised that the new system would utilise top of the line healthcare facilities, supplies, drugs and medical staff. According to Megahed, separating the public healthcare system's administration from its sources of funding was the key to helping ensure that the service meets international standards. Another goal is giving citizens covered by the plan the freedom to choose which hospital to go to. “This will increase competition among the private, public and military hospitals,” he said. The new draft will annul Law 10/1967, which deals with medicine provided by the Health Insurance Organisation (HIO); Law 32/1975, which regulates the insurance system of state employees; and Law 99/1992, regarding health insurance of school students. The health insurance bill has been a source of controversy between the ministry and the Doctors Syndicate since its drafting in 2015. The bill was exchanged back and forth between both parties following concerns over some of the new draft's articles. Syndicate Secretary-General Mona Mina said in a press conference that the bill was amended several times and is now a much improved version but still has many flaws that need revision. Mina believes that a number of articles in the bill were not amended and raised concerns on behalf of the syndicate. The articles tackle the definition of people in need of insurance. “We believe this definition should be broadened to include not only pensioners but anyone who receives below the minimum wage,” said Mina. The bill currently mandates the provision of health insurance for this segment of the population to the Ministry of Social Solidarity. Moreover, the bill fails to tackle the rights of health insurance workers. “No tangible success in this service will be witnessed unless the rights of its providers are ensured,” Mina said. The syndicate has also reiterated its call to create an actuarial study for the system, an essential step towards ensuring its sustainability. The only actuarial study is outdated, according to the syndicate, as it dates back to 2007. The reason for the absence of more recent studies is said to be linked to the lack of expertise in actuarial studies and the health sector. Megahed said a holding company is to be established to bring all 40 health insurance hospitals, 600 clinics and around 5,000 health units under its umbrella as part of the government's plan to develop the health insurance sector. Egypt currently spends an estimated LE15.5 billion on medical care, roughly five per cent of GDP. The international average is 7.4 per cent of GDP. “The ministry's ultimate goal is an efficient, affordable and accessible medical care system that does not discriminate between people geographically, socially or otherwise,” Megahed said.
