Healthcare in Egypt

Last updated

Life expectancy at birth in Egypt Life expectancy in Egypt.svg
Life expectancy at birth in Egypt

The Egyptian healthcare system is pluralistic, comprising a variety of healthcare providers from the public as well as the private sector. The government ensures basic universal health coverage, although private services are also available for those with the ability to pay. Due to social and economic pressures, Egypt's healthcare system is subject to many challenges. However, several recent efforts have been directed towards enhancing the system.

Contents

Healthcare system

Healthcare in Egypt consists of both a public and a private sector. For several decades, the government has provided a subsidized healthcare system that is meant to ensure health care for those who cannot afford it. [1] The system relies on four distinct financial agents, including the government and the public sector as well as private organizations and out-of-pocket payments made by individuals and families. [2] Due to its pluralistic nature, healthcare providers from the various sectors compete. [3] Therefore, patients have the liberty of choosing their doctor on the basis of their financial abilities. [4]

Public healthcare

Public health coverage is offered through the Ministry of Health, which operates a series of medical facilities providing free health services. There are two main quasi-governmental insurers. [5] The Health Insurance Organization (HIO), is the largest public health-care payer, along with the Curative Care Organization (CCO). Their services are provided under the form of basic coverage. [6] The HIO covers 60% of the population, including employees, students, and widows through premiums deducted from employee salaries and employer payrolls. [7] The organization operates its own network of medical facilities and at times contracts with private healthcare providers. The Curative Care Organization (CCO) offers inpatient and outpatient care in specific governorate through contracts with other entities and individuals. [8] Many mosques and churches also operate their own subsidized or free clinics, especially in the large cities. [9]

The Universal Health Insurance project is a new mandatory health insurance system in Egypt, operating in accordance with Law No. 2 of 2018. It aims to replace the current health insurance system gradually through diffusing into the country's governments. Its umbrella covers all citizens participating in the system. Universal Health Insurance differs from the Health Insurance Organization in that the family will be considered the main unit of insurance coverage within the system. Another difference is that Universal Health Insurance is based on separating funding from service provision, and the Universal Health Insurance Authority may not provide treatment services or participate in providing them, but its role is to contract different health care providers (public or private) to provide services for the insured citizens. [10]

Private healthcare

There are also private insurance options and a network of private healthcare providers and medical facilities. The private sector includes for-profit clinics, hospitals, and pharmacies. [11] The private medical sector is deemed superior to the public services, in terms of quality. Statistics show that the private sector is the initial choice of a healthcare provider in Egypt, even among the lowest income groups. [12]

Healthcare Financing in Egypt

The healthcare system in Egypt, a lower-middle-income country with a population of approximately 102 million as of 2020, [13] involves multiple stakeholders including public and private healthcare providers and several financing agents. Despite improvements in health indicators over the last decades, such as an increase in life expectancy from 64.5 to 70.5 years, [14] challenges remain in healthcare financing.

Total Health Expenditure (THE)

The Total Health Expenditure (THE) in Egypt, as a percentage of the Gross Domestic Product (GDP), has been relatively stagnant, ranging between 3.0% to 7.0% over the past 12 years, with a median of 5.5%. However, in absolute numbers, THE has been increasing, indicating a growth in healthcare spending in the Egyptian economy. [15]

Governmental/Public Health Expenditure

Governmental Health Expenditure (GHE) accounts for approximately one-third of THE, varying from 24.8% to 50% of THE. It represents about 3.0% to 7.3% of the GDP and around 6.8% of the government budget. This expenditure has increased over the years, with recent figures showing an expenditure of about 73 billion EGP for the year 2019-2020. [15]

Pharmaceutical Expenditure

A significant portion of healthcare spending is allocated to pharmaceuticals, accounting for about 26.0% to 37.0% of THE. This reflects the substantial role of pharmaceuticals in the healthcare budget, constituting a major component of both governmental and out-of-pocket healthcare expenses. [15]

Primary Healthcare Financing Sources

Out-of-pocket (OOP) expenditure is the primary healthcare financing source in Egypt, representing more than 60% of THE. This high proportion of OOP expenses poses a significant financial risk to families, potentially leading to catastrophic health expenditures and poverty. Government spending, primarily through the Ministry of Finance, accounts for about 37% of THE, supporting various healthcare activities and organizations. [15]

Key Healthcare Entities

Future Outlook: Universal Health Insurance (UHI)

In response to the challenges posed by the high OOP expenses, the Egyptian government is moving towards implementing Universal Health Insurance (UHI) to provide comprehensive healthcare coverage to the entire population, aiming to reduce financial hardships related to healthcare expenses. This initiative is expected to significantly alter the landscape of healthcare financing in Egypt, with a phased implementation planned to be completed by 2032. The UHI is designed to increase public funding proportion, reduce financing fragmentation, and introduce new roles for private health insurance in the form of complementary and supplementary health insurance schemes. [15]

Challenges and shortcomings

Challenges

Egypt is now considered the second most highly populated country in the MENA region, with Cairo being among the world's most densely populated cities. [18] The Egyptian population is relatively young, with 37% being children under the age of 15. The high population density, as well as increasing fertility rates, have challenged the healthcare system. [19] High levels of pollution and overcrowding trigger health concerns. [20] Egypt is a lower-middle-income country with high levels of unemployment. Despite the government's efforts to further the economy, 32.5% of Egyptians live in extreme poverty. With an increasing population and changing socioeconomic environment, Egypt faces great challenges in adapting to such developments in terms of healthcare facilities. [21]

Shortcomings

Medical care offered by the public health insurance system is generally of poor quality. Although the system ensures basic universal coverage, it faces several shortcomings in terms of quality of service due to underfunding. Only 4.75% of the GDP in Egypt is dedicated to investments in healthcare services. [22] Almost half of the public healthcare facilities have shortages of medical equipment and personnel. [23] It is presumed that only 20% of the 660 government hospitals are committed to safety and infection control standards. [24] Only about 6% of Egyptians covered by the Health Insurance Organization utilize its services due to dissatisfaction with the level of services it funds. In 2007/2008, 60% of health expenditure in Egypt was paid out of pocket by people seeking treatment. [25] Excessive reliance on out-of-pocket financing of medical treatments creates inequalities of healthcare access. [26] In 2007, more than 1/5th of the population struggled with catastrophic healthcare-related payments. [27] Additionally, there is a gap in terms of availability of medical services between the capital Cairo, and other rural areas. [28]

Improvements

During the past decade, the Egyptian healthcare system has improved in several aspects despite its pitfalls. By 2006, 95% of the population had access to primary healthcare within 5 km, and 98% of citizens were offered vaccinations. [29] Egypt is working on an overhaul of its public healthcare system to improve its quality. [30] [31] [32] [33] On 11 January 2018, the Ministry of Health and Population launched the National Health Insurance project and increased its expenditure on healthcare services. [34] The project aimed at providing more regular checkups for citizens as well as improving the quality and efficiency of the system. The Universal Health Insurance Law also attempts to extend healthcare coverage to a wider portion of society, rather than on a case-by-case basis. [35]

While significant progress has been made in HTA implementation in Egypt, there is still a long way to go to achieve full and fruitful benefits. The proposed roadmap with specific actions aims to establish a successful HTA structure and related activities in the country. This includes a focus on innovative pharmaceuticals with significant budget impact, with future expansion to additional technologies within the scope of HTA. [36]

Health Technology Assessment (HTA) Implementation in Egypt

Egypt, as a lower-middle-income country with a population of approximately 102 million, is undergoing significant changes in its healthcare system. The introduction of Universal Health Insurance (UHI) and increased health spending are part of efforts to address systemic inequalities and inefficiencies in the healthcare system. The implementation of Health Technology Assessment (HTA) is seen as a crucial step in this transformation.

A study was conducted among Egyptian healthcare sector decision-makers to propose an implementation roadmap for HTA. This roadmap is based on the national healthcare system's current status and includes interviews with experts representing the Egyptian healthcare system's middle and top-tier management.

HTA implementation in Egypt recommendations for specific actions. HTA implementation in Egypt recommendations for specific actions..jpg
HTA implementation in Egypt recommendations for specific actions.

Capacity Building

Experts recommended enhancing HTA and health economics capacity through more postgraduate programs tailored to country-specific needs. These programs should encompass not only theoretical knowledge but also practical, hands-on training. The proposal includes a timeline for developing these capacities, emphasizing the need for multidisciplinary skills in HTA, especially in health economics. [36]

Funding

For the assessment and critical appraisal aspects of HTA, private funding through submission fees is viewed as the most feasible option for the next decade. However, some public funding will be necessary, especially where HTA is initiated by public or academic institutes. The approach recommends a balanced funding model for critical appraisals, combining public and private sources. [36]

Legislation and Scope

It's proposed that HTA should be mandatory by law for pricing and reimbursement, especially for high budget impact innovative technologies. The establishment of HTA units at various health authorities, with a long-term goal of merging these into a single central HTA unit, is also recommended. Initially, the focus should be on innovative pharmaceuticals, with a gradual expansion to cover all health technologies. [36]

Decision Criteria

The decision-making process should utilize cost-effectiveness and budget impact analyses, alongside other criteria like multi-criteria decision analysis (MCDA) for tenders, especially for off-patent pharmaceuticals. [36]

Quality and Transparency

Implementing guidelines and specific timelines for the HTA process is crucial. However, the full implementation of such guidelines is expected to take 3–5 years. [36]

Use of Local Data

The importance of using local data in HTA is acknowledged, but there are challenges related to data availability and legal frameworks for data sharing. Efforts to develop more patient registries and utilize local claims data are recommended, anticipating that the data will be ready for use within 3–5 years. [36]

International Collaboration

Experts support international collaboration for HTA, suggesting partnerships with global HTA bodies like the National Institute for Health and Care Excellence (UK) and others in Europe and Asia. This collaboration aims to facilitate hands-on training and experience sharing. [36]

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

<span class="mw-page-title-main">Publicly funded health care</span> Form of health care financing

Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.

<span class="mw-page-title-main">Health care in Saudi Arabia</span>

Health care in Saudi Arabia is a national health care system in which the government provides free universal healthcare coverage through a number of government agencies. There is also a growing role and increased participation from the private sector in the provision of health care services.

<span class="mw-page-title-main">Ministry of Health (Turkey)</span> Government ministry of the Republic of Turkey

The Ministry of Health is the ministry of the Government of Turkey responsible for proposing and executing the government policy on health, planning and providing healthcare and protecting consumers. Likewise, it is responsible for proposing and executing the government policy on social cohesion and inclusion, family, protection of minors, youth and of care for dependent or disabled persons. The Ministry is headquartered in the Bakanlıklar in Ankara.

<span class="mw-page-title-main">Health care in Argentina</span>

Argentina's health care system is composed of a universal health care system and a private system. The government maintains a system of public medical facilities that are universally accessible to everyone in the country, but formal sector workers are also obligated to participate in one of about 300 labor union-run health insurance schemes, which offer differing levels of coverage. Private medical facilities and health insurance also exist in the country. The Ministry of Health (MSAL), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.

<span class="mw-page-title-main">Healthcare in Germany</span>

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

<span class="mw-page-title-main">Healthcare in Ethiopia</span>

As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).

<span class="mw-page-title-main">Healthcare in Tanzania</span>

Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.

<span class="mw-page-title-main">Health care in Cyprus</span>

Health care in Cyprus accounted for 7% of its GDP in 2014. Between 2010 and 2014, health care spending increased from $1,705 per capita to $2,062 per capita. Cyprus has a multi-payer health care system that consists of a public and private sector. The public sector is funded by payroll, earnings taxes, and employer contributions. The public sector healthcare provides social insurance for the employed, self-employed, and for several types of civil servant.

<span class="mw-page-title-main">Healthcare in Serbia</span>

Healthcare in Serbia is delivered by means of a universal health care system.

<span class="mw-page-title-main">Healthcare in Austria</span>

The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately.

Examples of health care systems of the world, sorted by continent, are as follows.

Government-guaranteed health care for all citizens of a country, often called universal health care, is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at broadly extending access to health care and setting minimum standards. Most implement universal health care through legislation, regulation, and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis.

<span class="mw-page-title-main">Healthcare in the State of Palestine</span>

Healthcare in the State of Palestine refers to the governmental and private healthcare providers to which residents in the claimed territory have access. Since 1967, there have been improvements in the access to healthcare and the overall general health conditions for residents. Advances in training, increased access to state-of-the-art medical technology, and various governmental provisions have allowed per-capita funding to increase, and therefore the overall health of residents in the region to increase. Additionally, the enhanced access to and funding from international organizations like the World Health Organization, the United Nations, the Palestinian Ministry of Health, and the World Bank Education and Health Rehabilitation Project have contributed to the current state of affairs within the healthcare segment of the Palestinian territories.

<span class="mw-page-title-main">Healthcare in India</span>

India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It also ranks 77th on the list of countries by total health expenditure per capita.

References

  1. ↑ Rashad, A.,and Sharaf, M. (2015). "Who benefits from public healthcare subsidies in Egypt?", Journal of Social Sciences, 4:1162-1176. p1163.
  2. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p5.
  3. ↑ Regional Health Systems Observatory (2006). Health System Profile- Egypt. Egypt: World Health Organization, p10. Archived 2020-08-14 at the Wayback Machine
  4. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p5.
  5. ↑ Rashad, A. and Sharaf, M. (2015). "Who benefits from public healthcare subsidies in Egypt?", Journal of Social Sciences, 4:1162-1176. p.1166
  6. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p10.
  7. ↑ Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p1.
  8. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p6.
  9. ↑ Haley, D., and Bég, S. (2011). "The road to recovery: Egypt's healthcare reform", The International Journal of Health Planning and Management, 27(1).
  10. ↑ The Universal Health Insurance Project- National projects - presidency.eg (2022) Presidency.eg. (Accessed: February 26, 2023).
  11. ↑ Rashad, A., and Sharaf, M. (2015)."Catastrophic economic consequences of healthcare payments: Effects on poverty estimates in Egypt, Jordan, and Palestine", Journal of Economies, 3:216-234. p220.
  12. ↑ Rashad, A. and Sharaf, M. (2015). "Who benefits from public healthcare subsidies in Egypt?", Journal of Social Sciences, 4:1162-1176. p1167.
  13. ↑ "Egypt Population 2024 (Live)". worldpopulationreview.com. Retrieved 2024-01-04.
  14. ↑ Pande, A., Abdel-Hamid, A. M. H., & Elshalakani, A. (2015). A roadmap to achieve social justice in health care in Egypt (No. 96329, pp. 1-110). The World Bank.
  15. 1 2 3 4 5 6 7 Fasseeh, Ahmad; ElEzbawy, Baher; Adly, Wessam; ElShahawy, Rawda; George, Mohsen; Abaza, Sherif; ElShalakani, Amr; Kaló, Zoltán (2022-01-07). "Healthcare financing in Egypt: a systematic literature review". Journal of the Egyptian Public Health Association. 97 (1): 1. doi: 10.1186/s42506-021-00089-8 . ISSN   2090-262X. PMC   8741917 . PMID   34994859.
  16. ↑ Rashad, Ahmed Shoukry; Sharaf, Mesbah Fathy (December 2015). "Who Benefits from Public Healthcare Subsidies in Egypt?". Social Sciences. 4 (4): 1162–1176. doi: 10.3390/socsci4041162 . ISSN   2076-0760.
  17. ↑ Pande, Aaka; El Shalakani, Amr; Hamed, Alaa (2017-01-02). "How Can We Measure Progress on Social Justice in Health Care? The Case of Egypt". Health Systems & Reform. 3 (1): 14–25. doi:10.1080/23288604.2016.1272981. hdl: 10986/26009 . ISSN   2328-8604. PMID   31514713.
  18. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p2.
  19. ↑ Regional Health Systems Observatory (2006). Health System Profile- Egypt. Egypt: World Health Organization, p7.
  20. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p3.
  21. ↑ Regional Health Systems Observatory (2006). Health System Profile- Egypt. Egypt: World Health Organization, p8.
  22. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p. 9.
  23. ↑ Haley, D. and Bég, S. (2011). "The road to recovery: Egypt's healthcare reform", The International Journal of Health Planning and Management, 27(1).
  24. ↑ "Egypt's new health care law has medical community worried". Al Monitor. 16 November 2017. Retrieved 19 February 2018.
  25. ↑ Gericke, A., Britain, K., Elmahdawy, M., and Elsisi, G. (2018). "Health System in Egypt". In: Ginneken, E and Busse, R (eds.) Health care Systems and policies, Health Services Research. Springer Science+Business, p10.
  26. ↑ Rashad, A. and Sharaf, M. (2015). "Who benefits from public healthcare subsidies in Egypt?", Journal of Social Sciences, 4:1162-1176. p1163
  27. ↑ Rashad, A., and Sharaf, M. (2015)."Catastrophic economic consequences of healthcare payments: Effects on poverty estimates in Egypt, Jordan, and Palestine", Journal of Economies, 3:216-234. p225.
  28. ↑ Allianz Care. "Healthcare in Egypt". Egypt: Allianz Care
  29. ↑ Saleh, W. (2006). "Reforming Egypt's health system: is it that simple?", BMJ, October 19: 333.
  30. ↑ "Egypt debates health care reform". Al-monitor.com. 24 November 2014. Retrieved 19 October 2017.
  31. ↑ "Egypt's Health Care System - the Center for Global Health and Diplomacy". Archived from the original on 2015-12-23. Retrieved 2015-12-22.
  32. ↑ "Egypt moving toward integrated healthcare system". Pharmaphorum.com. Archived from the original on 3 August 2018. Retrieved 19 October 2017.
  33. ↑ "Introduction". Justlanded.com. Retrieved 19 October 2017.
  34. ↑ Mena.(2018). "Health ministry launches national health insurance project", Egypt Today, July 12
  35. ↑ Hassan, T. (2019). "The universal health insurance law 2/2018", Sharkawy & Sarhan, February 10.
  36. 1 2 3 4 5 6 7 8 Fasseeh, Ahmad Nader; Elezbawy, Baher; Gamal, Mary; Seyam, Ahmed; Abourawash, Asmaa; George, Mohsen; Anwar, Mohamed; Amin, Magdy; Khalifa, Ahmed Yehia; Elshalakani, Amr; Hatem, Ashraf; Abdelhamid, Sohir; Elsamouly, Hossam; Fasseeh, Nader; Adel, Randa (2022). "A roadmap toward implementing health technology assessment in Egypt". Frontiers in Public Health. 10. doi: 10.3389/fpubh.2022.896175 . ISSN   2296-2565. PMC   9792961 . PMID   36582366.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.