A new health insurance law was approved by the cabinet last week. Its avowed aim is to allow greater numbers of people access to the kind of advanced quality healthcare systems lacking in most public hospitals. But while the government insists the new law will force a qualitative shift in the healthcare system others remain sceptical. “By separating the financier, the service provider and the regulator the new law will guarantee the quality of the service presented to the people,” says Mohamed Maait, deputy minister of finance. Under the draft health insurance law three bodies will administer the system: a healthcare authority, in charge of service outlets; a quality and accreditation authority, which licenses hospitals according to quality standards; and a health insurance authority which will administer health insurance. The law should come into force within six months, says Maait, and the hospitals enrolled in the new system will be developed once the quality and accreditation authority is established. “Actuarial studies have been undertaken to assess the flow of finances and the sustainability of the project across all governorates, factoring in the annual increase in the population,” Maait told Al-Ahram Weekly. Minister of Health Ahmed Radi has announced the new law will be rolled out gradually. The first stage of the roll out will include Suez, Ismailia, Port Said and North and South Sinai. The new health insurance system is a comprehensive framework for fixing deficiencies in the current healthcare system and not just a legal framework for insurance coverage for citizens, says a study by the Egyptian Initiative for Personal Rights (EIPR). EIPR, a leading NGO, sees the way all Egyptians — in the private, public or informal sectors — fall beneath its umbrellas the most positive aspect of the new law. Ensuring the participation of everyone achieves social justice in health and helps guarantee the sustainability of its financing, concludes the EIPR study. “Unlike the current system which treats the individual as a unit the new law treats the family as a single entity. This guarantees the treatment of those who need it most (women, children and the elderly) whatever the cost of the services they may need,” says EIPR. One of the main advantages of the law is that citizens will pay subscriptions or be exempted depending on their income. Mohamed Fouad, head of the Right to Medicine Centre, argues one of the new law's most radical features is that it provides health insurance to groups that have long been excluded, including women who work informally, street vendors and day labourers. But Fouad warns some articles need to be revised, especially those regulating the government's commitment to financing the project. According to the new law, people who fall under Health Insurance Law 79/1975 will have to pay one per cent of their income, 2.5 per cent for their spouses and 0.75 per cent for their children. The Ministry of Social Solidarity will pay the subscription fees for those in the Tadamon and Takaful programmes. “It would have been better if polluting industries such as those manufacturing cement and petrochemicals were taxed more to help finance healthcare as happens in much of the rest of the world,” says Fouad. Fouad also argues children should be excluded from payment of insurance fees. He also believes the new law fails to adequately address the treatment of those with chronic diseases. “Patients with chronic illnesses are required to pay 20 per cent of the price of medicine, five per cent for tests and 10 per cent for X-rays. It would have been better for them if they had to pay less.” Fouad also worries most government hospitals that will be enrolled in the new insurance system fall well below the required standards. “Prepping these hospitals will cost more than LE15 billion. Will enough funding be made available to raise the standards of 664 public and central sector hospitals, 81 university hospitals and 18 educational hospitals,” he asks. The poor conditions in public hospitals leaves the door open for private sector hospitals in which case, says Fouad, the new law will become a backdoor privatisation of the health insurance sector. EIPR, meanwhile, is seeking guarantees that any public-private sector partnership will not affect the availability or quality of services. “According to the latest income and spending study, Egyptians' private spending on healthcare amounts to 72 per cent of total spending on the health sector,” notes EIPR. While the current system is unable to cover those who, like seasonal and informal workers, lack insurance, high-income Egyptians are increasingly withdrawing from the system which affects its financing. The result, warns EIPR, echoing Fouad, is that lucrative healthcare provision is increasingly being eyed by the private sector.
