The battle over restructuring Egypt's health insurance system takes a new turn. Hala Sakr peers round the corner The Court of Administrative Justice's ruling last week to suspend prime ministerial decree 637 of March 2007, which established the Holding Company for Healthcare, and suspending the transfer of the assets of the Health Insurance Organisation (HIO), including hospitals, clinics and related companies, to the holding company, marked a new turn in the debate over the government's proposed health insurance law. The case was filed by the Egyptian Initiative for Personal Rights, a leading NGO working in the health field and a member of the Egyptian National Right to Health Committee, the Hisham Mubarak Legal Centre, and the Egyptian National Right to Health Committee. The latter was formed by 20 organisations following prime ministerial decree 637 with the aim of defending universal and equitable access to healthcare services. The ruling described the decree as being in contravention of Article 17 of the Egyptian constitution which reads: "the state shall guarantee social and health insurance services". The ruling further emphasised that health insurance was a basic right enshrined in national and international human rights instruments. The case was contested on two points. First, the prime minister did not have the jurisdiction to issue a decree which would change the structure of the HIO. "This can only be done through parliament or the president. Second, the hospitals and clinics of the HIO are not the government's property to dispose of as it sees fit because they belong to the beneficiaries who have been paying their premiums for years," Soha Abdelaty, deputy director of the Egyptian Initiative for Personal Rights, told Al-Ahram Weekly. Commenting on the ruling, Said Rateb, head of the HIO, told the media that it was not the end of the case. "We [the government] will use all legitimate means to appeal against it and illustrating our viewpoint is in the interest of all citizens." Though the government has the right to appeal against the ruling in the Supreme Administrative Court within 60 days, its opponents have lauded the judgement as a "landmark decision". Abdelaty sees the ruling as "the first setback for the government's plans to restructure health insurance in a way that would adversely affect the majority of people". "It is a clear recognition of the government's obligation to respect the right of the people to health and its responsibility for realising that right in practice." Both within and outside the medical profession many feared the decree was the first step towards the wholesale privatisation of the health sector though Rateb repeatedly argued that establishing the holding company was aimed only at upgrading services. Mohamed Hassan Khalil, consultant cardiologist at the Nasr City Health Insurance Hospital and a vocal opponent of the decree and the government's plans for health sector reform insists that, "the decree simply transformed a non- profit-based service into a profit-based one and the next step is the current draft [health insurance] law to be presented to parliament". Alaaeddin Ghanam, former director of policies and strategies of the Ministry of Health and currently director of the Health and Human Rights programme of the Egyptian Initiative for Personal Rights, is astonished at the course the government has adopted. "Simply put, they placed the horse before the cart. The decision to establish the holding company should have followed the health insurance law and not vice versa. That would have given them the legal umbrella they needed." Khalil believes that the ruling against the prime ministerial decree has removed the immediate legal cover the government required in order to accelerate the privatisation of health insurance and make it a reality even before the law went to parliament. "Now they can only abide by presidential decree 1209 for the year 1964 under which the HIO was founded as a non-profit entity". While no one disputes that the health system is in urgent need of radical overhaul, differences remain over the direction of reform. The government has attempted to reassure its opponents that the new law will enhance coverage for all and will separate financial, managerial and auditing tasks which hinder the provision of healthcare service at the point of entry. Opponents, on the other hand, argue that the proposed separation of funding and provision of services will only place these services at the mercy of market forces and incentives. The draft law is expected to be presented to the Peoples' Assembly at the start of the new parliamentary session in November. It has already been withdrawn on more than one occasion.
