In Egypt, shanty areas are the worst in terms of healthcare. Hence many have pinned their hopes on the new health insurance bill, whose umbrella should cover the entire population. Although the bill should have seen light in the first half of 2009, it has yet to be discussed in Parliament and the reason for the delay is unknown. Yet the question that begs an answer is whether the bill—if passed—will perform as the effective solution to all the health problems of Egyptians, or will only serve to bring on injustices that could harm the interests of the poor.
Dream bill
At the end of 2008 the Health Minister Hatem al-Gabali said that the new health insurance bill lay at the top of his ministry’s agenda. He added that restoration processes were now underway to prepare clinics and hospitals in Suez governorate to deal with the new health insurance system, and said Suez would be the first to run the scheme and would be followed by other governorates.
The Ministry of Finance is expected to finish the studies that will function as the basis for the bill: a survey on the most widespread illnesses, average treatment costs, and suchlike. The Health Insurance Authority enthusiastically cooperated and put in a great effort to provide the Ministry of Finance with the database for its work.
As for his expectations of the new system, Dr Gabali believes it will be successful, but may take three to four years to work ideally.
Saïd Rateb, head of the Health Insurance Authority, said that health insurance clinics had recently been put through a number of modifications to upgrade the service until the issuance of a new public health insurance law. Moreover, doctors were being prompted to deal with patients in a humane manner and measures were being put in place to prevent doctors from manipulating health insurance regulations to fulfil their own interests.
Dr Rateb added that the clinics would work on Fridays to serve aged patients whose relatives sometimes have to take time off from work to accompany them to the clinic. A central emergency unit was founded to facilitate communications between clinics and hospitals in emergency cases.
Early diagnosis
Given that diabetes and hypertension are two of the most widely spread diseases among Egyptians, Essam Anwar, general manager of Cairo Health Insurance, told Watani: “We realise that negligence in treating such cases could have grave consequences and may even be fatal, and the treatment costs are very high. So we assigned the mission of early diagnosis to 11 clinics in Cairo to contain these illnesses at the beginning. The project began in July 2008, and it was found that 4.6 per cent of the patients admitted were liable to hypertension.
Brimful with hazards
Samir Diaa’i, head of the Cairo Doctors’ Syndicate and a member of the committee assigned with formulating the new bill, told Watani that: ‘health allocations in a given country should be consistent with the health conditions and needs of that country. States strive to raise health expenditure to improve people’s lives and productivity. As for Egypt, it is sad to admit that health allocations have diminished over the past three years.
“The Egyptian government, Dr Diaa’i said, is pursuing the advice of foreign experts who are not acquainted with the state of health in Egypt. Two years ago the Prime Minister issued a decision declaring the Health Insurance Authority a holding company, which implies transforming it into a private corporation. The Supreme Constitutional Court, however, issued a ruling annulling the premier’s decision on the grounds that health insurance should remain a State responsibility.”
Dr Diaa’i warns that the new bill is bound to herald in countless problems. “It shoulders patients with 30 per cent of the cost of treatment, with no ceiling. This is an overly high burden in light of the sky-rocketing costs. The phrase “with no ceiling” brims with hazards, since it leaves the door open to shouldering people with unaffordable expenses. Equally important is the stipulation that the new health insurance is obligatory for the entire population. Advanced and comprehensive healthcare systems offered by companies and employers will be annulled and everyone will have to be subject to the new system.”
Says who?
Although the bill includes an article stipulating that the needy will be exempted from the costs, Dr Diaa’i questions who will judge who is needy and to what degree. As for medication, the system implies the use of an obligatory list, which will place patients at the mercy of the drug manufacturers.”
Dr Diaa’i concluded that the solution to the appalling state of healthcare in Egypt was raising public expenditure on healthcare and introducing health officials biased towards the poor rather than embracing the mentality of the capitalist market.