A 98-year-old man with a serious heart condition had to have heart valve surgery in one of Port Said governorate’s hospitals last month. The cost of the operation was LE600,000 of which the elderly patient paid nothing, thanks to the newly introduced universal health insurance system.

The cost of the operation was covered by the General Authority for Healthcare (GAH): the only outlay that fell on the patient and his family were the meagre installments they pay to be part of the new system.

The universal health insurance scheme, enshrined in the universal health insurance law issued in 2017, began to be rolled out in Port Said in early 2018. The first phase of the new scheme will take four years to complete, cost an estimated $510 million, and include Ismailia, Suez, South Sinai, Luxor and Aswan. By 2030 the scheme should cover the whole of Egypt.

The new system provides an umbrella for all Egyptians, regardless of their means or location, says Haitham Azzaz, professor of internal medicine and nephrology at Ain Shams University’s Faculty of Medicine and head of the GAH.

The 2017 law is the most significant advance in healthcare provision for half a century, and a major step towards meeting the stipulation that “each citizen has the right to health and to access universal quality healthcare” contained in Article 18 of the 2014 Constitution.

Egypt’s growing population has long constituted a challenge to public services, particularly education and healthcare. The population reached 100 million in 2019. According to the UN Population Fund, it is expected to grow to 128 million in 2030 and 150 million in 2050.

The increase in population in the past 20 years was coupled with deteriorating healthcare services. In Egypt non-communicable diseases are responsible for 82 per cent of deaths, and 67 per cent of early deaths, annually. Cardiovascular diseases are the most common cause of death, and Egypt has the highest rate of obesity among the 20 most populous countries in the world. Over 70 per cent of Egyptian adults (above the age of 18) are overweight, six per cent suffer from diabetes and 26 per cent have hypertension, according to the 100 Million Health national campaign.

“The new scheme is based on equality of distribution, and access to services. Gone are the times when patients would have to be transferred from one governorate to another to access healthcare services,” says Azzaz.

There is no cap on spending on treatment. Some patients with heart conditions and neurological disorders need medication that can cost LE40,000 a month. The medicines will be provided free within the universal healthcare system.

Though the private sector started offering healthcare services in the mid-1970s it did little to boost healthcare provision overall: profit-driven provision was limited to large cities with residents who were able to afford the services on offer, excluding the poor and marginalised.

Statistics show the public sector has remained the leading healthcare provider in Egypt. In 2018 there were 808 public hospitals with 98,500 beds and 1,157 private sector hospitals offering just 35,000 beds. In the same year the state footed an LE8.4 billion bill for the treatment of 2.6 million patients.

The new universal health insurance system will offer services to more than 100 million Egyptians, including groups such as employees in the agricultural sector and residents of Bedouin and border areas, that have traditionally had little access to state-supported healthcare services.

“The new system has attracted internationally famous Egyptian doctors,” notes Azzaz. “The system is targeted and fast-paced, much like the healthcare systems offered in advanced countries. The scheme offers lucrative returns for doctors, who work in an environment that offers the best available support.”

The universal health insurance law separates finance from services. The General Authority for Universal Health Insurance is responsible for paying for the healthcare services offered to patients, investing any remaining sums, and contracting healthcare service providers from the private and public sectors, while the General Authority for Health Accreditation and Regulation monitors the quality of healthcare services provided. An independent body, it reports directly to the president.

The GAH is tasked with providing healthcare services and treatment. It will own and operate healthcare facilities in every governorate where the project is implemented though, under the new law, GAH facilities will only be contracted to provide universal health insurance services if they gain the approval of the General Authority for Health Accreditation and Regulation.

Minister of Finance Mohamed Maait says the programme will have three main sources of funding: allocations from the general budget; subscriptions into the programme and taxes levies on goods such as tobacco, fizzy drinks and others that negatively affect people’s health.

In 2018 spending on the healthcare sector consumed 1.4 per cent of GDP, 60 per cent of which was shouldered by patients and directed towards labs, clinics, private hospitals, or deducted from their salaries in the form of health insurance payment. The burden is spread disproportionately: average Egyptian families spend 21 per cent of their income on healthcare while families with higher income pay 13.5 per cent.

The new scheme is digitised, connecting doctors and pharmacies to a database of available medicines and their alternatives to ensure appropriate treatment is available at all times. The database identifies patients by their ID number and allows doctor and patient to share test results with other parties as needed.

The digital scheme faced a number of challenges when it was launched in Port Said, Luxor and Ismailia. Many families said they wanted female patients to be treated by women doctors, requests that were noted in the system. Other patients from tribal communities didn’t have the official documents - birth and marriage certificates and even IDs – needed to enroll in the programme and determine whether they are eligible to participate, meaning alternatives had to be found.

To overcome the problem of men who have more than one wife living in a different area, wives are allowed to register at the nearest healthcare facility, to them though they remain attached to their husband’s file. They are coded differently, however, to ensure privacy.

Differential coding is also applied to large tribal families in which three or more generations of the same family live in one house, while employees who reside in one governorate but have a steady job in another are exceptionally registered in the scheme in the governorate where they work though their files remain in the governorate where their families reside.

*A version of this article appears in print in the 24 December, 2020 edition of Al-Ahram Weekly