July 5, 2019

In Port Said Governorate the first stage of the comprehensive health insurance system has been initiated as a pilot for two months starting from July 1 to September 1. The Ministry of Health has prepared seven hospitals and 20 health units, and there are roughly 17 health units and four hospitals under preparation.

A governmental perspective

According to the government, under the social solidarity system through which medical services are provided, the state will take care of those who do not have the means to pay. The system will cover whole families, not individuals. Official government opinion is that comprehensive insurance reduces personal spending on health services, which then limits poverty caused by illness. It is expected that this system will contribute towards the fair price of medical services and access.

The comprehensive health insurance system covers all medical services for everyone who meets its standards starting with a preliminary medical check, to scanning and medical analysis, to surgeries.

One way to benefit from these services is to be a subscriber to the system and pay all the fees. Those who don’t subscribe to the system won’t benefit from the comprehensive social health insurance until he pays all the delayed fees in one go or in installments, except in emergencies.

Concerning the objectives of the project, Minister of Finance Mohamed Maait stated that this system aims to reduce poverty and sickness rates, and focuses on providing full medical protection to all family members who are paying the fees. For families who do not have the means to pay the coverage, the state will pay. The President has said the project requires EGP 600 billion over 15 years.

The government has chosen Port Said specifically because it is small. The population is about 750,000 and health insurance covers about 60 per cent of people. There are low unemployment rates compared to other governorates of Egypt, which will reduce the numbers of who cannot afford the fees. 

It is anticipated that the law will be applied over six stages over 15 years between 2018 and 2032, which includes:

The first stage: The governorates of Port Said, Suez, South Sinai, North Sianai and Ismailia. 

The second stage: The governorates of Aswan, Luxor, Qena, Marsa Matruh and the Red Sea.

The third stage: The governorates of Alexandria, El-Beheira, Damietta, Sohag and Kafr El-Sheik.

The fourth stage: The governorates of Asyut, The New Valley, Faiyum, Minya and Beni Suef.

The fifth stage: The governorates of Daqahliyah, Sharqiyah, Gharbiyah and Menoufia.

The sixth stage: The governorates of Cairo, Giza and Al-Qalyubia.

Canceling free medical care

Free medical care at the state’s expense will be canceled gradually in conjunction with each applied stage of the comprehensive health insurance system, and it will be completely canceled once the insurance system is mainstreamed across the entire country. Its budget will then be transferred to the insurance.    

Subscription percentage per person 

Under the new law the percentage of salary deducted will range from one to three per cent for the employer, monthly. As well as that the head of the family pays the fees for the non-working spouse and the rest of the family members, while the state treasury pay for those who do not have the means to do so.

An obligatory law

This law is obligatory for all citizens who live in the Arab Republic of Egypt, and is optional for those who are working or living with their families abroad. 

The Medical Syndicate represented by its General Secretary Ehab El-Taher has concluded the negative aspects as follows: 

1. The law depends on contracting with hospitals, which will give greater opportunities to private hospitals at the expense of the public hospitals, which are already on the decline. 
2. Multinational corporations: The Medical Syndicate believes that there are several multinational corporations that have started purchasing private hospitals; it is a potential problem if the health system is controlled by them.
3. It will increase the financial burden for the citizens who will pay higher fees than they do currently. 
4. Doctors’ salaries: The syndicate also criticised the absence of any article that determines the size of doctors and medical workers’ salaries in the new law.
5. Custodial penalties: The new law stipulates that if a doctor prescribes medication that doesn’t correspond to the established criteria he could be imprisoned.
6. Fees: According to the new law every hospital has to pay EGP 1,000 per bed.

The Almawkef Almasry website mentioned that the fact that 60 per cent of Egyptian doctors are currently working in Saudi Arabia and thousands in the USA, Canada and Australia could be an obstacle to the system. 

The fact that there aren’t enough hospitals would also be an obstacle. About 65 per cent of public hospitals have applied to get the certification.  

The 2014 constitution stipulates that the state commit to the establishment of a comprehensive health care system for all Egyptians. The contribution of citizens to its subscriptions, or their exemption, is based on their income. 

Moreover, it says that every citizen is entitled to health care, and the state commits to allocating a percentage of government expenditure that is no less than 3 per cent of its GDP to health. This percentage will gradually increase to reach global rates. In addition, it says that denying any form of medical treatment to any human in an emergency or life-threatening situation is a crime.