A more effective health insurance scheme is sorely needed. The authorities concerned believe they have produced a better system as they prepare to present the final draft of the new health insurance law, reports Reem Leila Minister of Health and Population (MOHP) Hatem El-Gabali recently met with Prime Minister Ahmed Nazif to present the latest amendments to the new health insurance law. Despite government attempt to allay public concerns, the draft has raised several controversial issues. The bill, which has been presented to several political parties for debate, has undergone several changes. The final draft which aims to restructure the health insurance sector, will shortly be submitted to the People's Assembly (PA) for approval. El-Gabali has repeatedly said that this new universal social health scheme will be implemented by 2011. Insurance wise, the system will provide comprehensive coverage for people under the new umbrella which currently stands at only 42 per cent of the nation. According to the final draft, health services will reach every corner in Egypt and the health insurance net will extend to people in rural areas upon the completion or renewal of primary health units. Abdel-Rahman Shahin, the official MOHP spokesman, said the ministry has already started renovating more than 1,000 health units out of 4,000, to be finished during the next three years. Abdel-Moneim Ebeid, an anaesthesiologist at Cairo University and a member of the Specialised National Council, previously criticised the new system, saying low-income patients who cannot afford to pay fully for either health services or medicine will find themselves obliged to pay one-third of the cost of medicine, a third of the cost of an operation if needed, and one- third of medical tests. However, Shahin said the new draft will ensure equality and will provide excellent services to all people regardless of their place of residence or income. Shahin underlined the importance of setting up a "perfect financial system" in accordance with people's income. He said the draft stipulates that the Ministry of Social Solidarity will be responsible for paying monthly subscriptions on behalf of the 22 million people who are below the poverty line. The ministry will also financially support citizens who have started paying their subscription but stopped after they were unable to complete payments. MP Saleh El-Shemi, head of Shura Council's health committee, said the Ministry of Social Solidarity will help needy families and limited income people to encourage them to participate. "For three months, the ministry will continue paying for those unable to pay, to be renewed when necessary, after documents are provided proving that financial assistance is needed and that there is an inability to continue paying the monthly instalments. The non-paying public will continue enjoying health services, instead of halting the service entirely until people restart payment," stated El-Shemi. According to the final draft all unofficial sectors, including storekeepers and vendors, will be financially covered by the ministry to enable them to enjoy the benefits of the new health insurance system. Creating a system of primary healthcare is to be based on the country's responsibility for the health of citizens and not on the recovery of expenditures and transferring initial requirements of health into goods. In order to guarantee high quality service, Shahin said all health sector employees will be granted incentives, which was nearly impossible with the old health insurance law. But Ebeid has raised fears regarding the new health system, saying it will cover only what is called the basic benefit package. Surgeries such as open heart, and liver and kidney transplants are not included in the package. However, Shahin said people should stop worrying, saying the new draft will cover not only basic health requirements but also all kinds of operations. "All kinds of operations, medication and cancers will be covered by the new health system. Liver and kidney transplants will be covered by the National Liver Programme," Shahin added. The only remaining challenge is open heart surgery whose costs are formidably high. An MOHP spokesman will soon come up with a suitable solution. Separating services from finances by establishing a monitoring body within the new health insurance system to follow up on service levels and to guarantee the quality of service provided by the authorities, is not intended to pave the way to privatise the service. According to the Egyptian constitution, the government is responsible for providing healthcare for the people. It is a process which aims at providing services in a sound economic way. "The minister of health will be heading the monitoring body. Among his responsibilities is to evaluate the service specified to make sure it is in accordance with international standards," Shahin said. The new system will be applied as soon as the PA approves it. Application will take place in three phases, the first being at the three Canal cities for six months. An evaluation will be conducted at the end of the period. Delta cities will comprise the second phase, then Upper Egypt cities. "By the year 2011 the new health insurance system will be applied across Egypt," added Shahin.
