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Preparing for phase two

Bassem Aly reports on developments in Egypt’s universal health insurance system

Bassem Aly , Tuesday 3 Dec 2019
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Egypt’s President Abdel-Fattah Al-Sisi last week announced the formal launch of a new universal health insurance system. The first phase of the system started in July 2018 in Port Said and should cover all of Egypt by 2032.

This came a few days after Al-Sisi gave the nod to initiate the experimental stage of the second phase in Luxor and South Sinai by March 2020.

The decision came during a meeting last week between Finance Minister Mohamed Maait, Health Minister Hala Zayed and Chairman of the Administrative Control Authority Sherif Seifeddin.

During the meeting, the officials told Al-Sisi about the steps taken to implement the first stage of the new system and the availability of financial resources. They also informed Al-Sisi about the preparations made for health facilities to handle the system.

In July 2018, Al-Sisi revealed the details of the system during the sixth National Youth Conference at Cairo University. Following his election to a second term in 2018, he said that health, as well as education reform, would come on top of his priorities.

In October, Executive Director of the newly formed General Authority for Health Insurance Ahmed Al-Sobki said that 6,000 surgeries had already been carried out as part of the new system. The scheme covered all medical services for beneficiaries, including medical examinations, imaging and medical tests, and major medical and surgical interventions if necessary.

Hania Sholkami, associate professor at the Social Research Centre at the American University in Cairo, told Al-Ahram Weekly that healthcare is “one of the rights that we [Egyptians] all need”.

Sholkami, a former special advisor to the Ministry of Social Solidarity, said the new system can serve as a useful alternative to the “chaos taking place in the market of medical services”. The old health system has been criticised by observers due to the low quality of services covered by insurance. Alternatively, Egyptians resort to private medical services which are very expensive.

In October, Maait said the new system involves providing comprehensive healthcare to put less pressure on Egyptian families.

He added that the General Authority for Health Insurance had decided on a package of medical services and price lists in coordination with all parties taking part in the process, including private companies.

“There will be actuarial studies every four years at most to review the financial sustainability of the system,” Maait stressed.

The arrangement covers a long list of medical services, including open-heart surgery, bone-marrow transplants, kidney and liver specialties, neurology and micro-surgery.

Other services are not included in the new system such as the periodic vaccination of children, national campaigns against diseases and epidemics and family planning programmes.   

The new system will be financed by a set of new taxes in addition to a marginal contribution by beneficiaries. According to features of the new system announced in June, public and private companies of any size will have to pay a 0.25 per cent tax on their revenues to help fund the system, and food and pharmaceutical companies will need to pay a tax of 0.5 per cent. Another means of funding will be fees for issuing and renewing drivers’ licences, toll fees on highways, and a tax of LE0.75 on cigarette packs and a 10 per cent tax on tobacco products.

Moreover, one per cent of the total income of employees will be deducted to finance the costs. People will pay a symbolic fee for medical services, such as 10 per cent of the price of radiography and 20 per cent of the price of medical tests.

In a phone interview with Amr Adib’s Al-Hekaya (The Story) talk show, Zayed said on Saturday that the Egyptian people will be divided into two categories: those who can and those who cannot afford healthcare services. Zayed pointed out that the cost of healthcare services per person on an annual basis is LE2,100, which is expected to reach LE6,230 by 2030.

Al-Sholkami brought to the fore multiple challenges, including the possibility that the well-to-do would be reluctant to pay for the new system as it might not be useful for them.

“For example, if someone is rich and gets sick, will he go to a public hospital,” she asked.

The aim, for Al-Sholkamy, is to convince those who have the financial capacities to fund the new system to “keep it going”.

Moreover, she stressed the importance of objectively defining who can and who cannot pay for healthcare. “Not everyone who lies in the middle between the rich and the poor can afford paying for healthcare.

“You can easily determine those who are very rich and those who are very poor in Egypt. But the grey area is much, much bigger than both of them. We have to efficiently and precisely determine it, to make sure that paying for the system can be done by only the people who can afford it,” Al-Sholkami explained.

The first phase of the plan starts in the coastal Port Said governorate and covers seven general hospitals, four medical centres and 24 healthcare units. The system will also be applied in Ismailia governorate as a pilot phase starting January 2020.

The new system’s second phase will start from 2021 to 2023 in Luxor, Matrouh, Red Sea, Qena and Aswan. The third phase, from 2024 to 2026, will be in Alexandria, Beheira, Damietta, Sohag and Kafr Al-Sheikh. The fourth, from 2026 to 2028, will be in the governorates of Beni Sweif, Assiut, Minya, New Valley and Fayoum. The fifth phase will start from 2029 to 2030 in Daqahliya, Sharqiya, Gharbiya and Menoufiya.

The last phase will be from 2031 to 2032, in Cairo, Giza and Qalioubiya.

*A version of this article appears in print in the 5 December, 2019 edition of Al-Ahram Weekly.

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