Universal Health Coverage ( UHC ) is a goal any country would be aiming to achieve, and this is the case with Egypt’s new Universal Health Insurance ( UHI ) Law that promulgated Law 2 of 2018. It’s Executive Regulations Decree 909 of 2018. and in order to hit the United Nations Sustainable Development Goals and specifically the third goal under “Good Health and Well-Being“.
Fulfilling the 2014 Egyptian Constitution Article 18 : “…The state commits to the establishment of a comprehensive health care system for all Egyptians covering all diseases. The contribution of citizens to its subscriptions or their exemption therefrom is based on their income rates…” The new Universal Health Insurance Law is an important instrument to make the Universal Health Coverage a reality in the country where the concept of health actually started, and invented medical treatments for a lot of diseases and had advanced knowledge of anatomy and surgery five thousand years ago.
How is Egypt developing healthcare?
Egypt is developing to reach full implementation by 2032, that will assist the state to reach a Universal Health Coverage and to cover all Egyptians with quality health services, while ensuring adequate level of financial protection.
Implementation of the Universal Health Insurance Law will be happening gradually in order to entail major institutional transformation and coordination between the old and new system. This implementation of the new Law will be divided into six phases to cover all Egypt’s 27 governorates as the following:
• Phase 1: 5 governorates ( Port Said, Suez, ismailia, North Sinai and South Sinai )
• Phase 2: 5 governorates ( Red sea, Marsa Matrouh, Qena, Luxor and Aswan )
• Phase 3: 5 governorates ( Alexandria, Al-Bihira, Damietta, Suhag and Kafr El-Sheikh )
• Phase 4: 5 governorates ( Beni-Suif, Assiout, Minya, Wadi Al-Gadeed, and Fayoum )
• Phase 5: 4 governorates ( Al-Dakhleya, Al-Sharqiya, Al-Gharbia and Al-Monofya )
• Phase 6: 3 governorates ( Qaliobia, Giza and Cairo )
Within 15 years (maximum amount of time) of the effective date of the Law, it will be implemented. Nonetheless, the Government will have to improve its Healthcare facilities during the new Law implementation period previously mentioned in order to raise their efficiency and quality.
New Universal Health Insurance Law 2 of 2018, established three operations bodies to cover all citizens, not only civil servants as it was before. The General Authority for Health Insurance ( GAHI ), the General Authority for Healthcare ( GAH ), and the General Authority for Healthcare Accreditation and Regulation ( GAHAR ), these bodies will limit the role of the Ministry of Health to the provision of ambulance services and preventive medicine after the new Universal Health Insurance implementation is completed.
What are the new law regulations and characteristics?
The Legislation of the new Universal Health Insurance Law 2 of 2018, can be divided into three main sections:
• The creation of three different bodies which will prop the system.
• Financial funding of these bodies.
• Sanctions and Violations.
The New Bodies.
Creation of three new bodies that will be aiming to fund, build and supervise the scheme of the new Universal Health Insurance Law.
The General Authority for Health Insurance ( GAHI ), will have its own legal personality, under the supervision of the Prime Minister. Headquartered in Egypt’s capital Cairo, with offices all around the country. This body’s main aim will be collecting the premiums from citizens, investing the money collected safely, and funding the other two bodies through finance returns.
The General Authority for Healthcare ( GAH ), established to bring a tangible change to Healthcare in Egypt, providing the Healthcare in the state with three levels through health units, hospitals, and hospitals specialized in heart diseases and tumors.The health units will provide eight services: family health, dentistry, gynecology, obstetrics, pharmacy, pediatrics, laboratory, emergency and radiology. Although, the responsibility of building new hospitals treating various diseases, and establishing bodies in order to manage the existing Healthcare providers to offer the necessary medicines and medical tools.
The General Authority for Accreditation and Regulation, is the body responsible for supervising and setting the standards for the quality of the health units and hospitals, accrediting the establishments that will adhere to the standards by carrying out routine inspections of these establishments. Nonetheless, cooperation and coordination with similar international bodies will be one of this body’s responsibilities.
Employees insured under the Labor Law 79 of 1975, will be contributing to the new Law by paying a 1% of their salary. However, the new Universal Health Insurance Law will depend on personal circumstances unlike the old system where it was more generalized.
Under the Law 108 of 1976, insured business owners, members of liberal professions such as lawyers and journalists, and Egyptians working abroad will be paying an extra 4 percent to reach 5% of their growth insured salary or the income stated in their tax return. Moreover, Companies and establishments are required to pay 2.5% of their gross yearly revenue, and such contribution amount is non-deductible from their taxes.
Nonetheless, more funding options will be deducted from other sources such as cigarettes, highways fees, car or driving license renewal or extraction, medical centers, clinics, pharmacies and pharmaceutical companies. The previously mentioned sources funds will be collected by the competent authorities such as the Ministry of Health, the Ministry of Interior, and the Ministry of Transport. This shall be transmitted to the General Authority for Health Insurance ( GAHI ).
The new Universal Health Insurance Law Art.43/2 of 2018, stipulated that an additional annual amount will be imposed on individuals or companies who are late in making their payment obligations under the new Law.
Anyone who informs authorities with fraud or incorrect information, and tries to refrain from providing the required information regarding duties to be paid, shall be penalized as per Art.62/2 of 2018, with a no less than six months custody and/or a fine between 2,000 EGP and 100,000 EGP.
Any employee who is working under any authority, who shall assist participants in not paying their financial shares, shall be penalized as per Art.65/2 of 2018, with a no less than six months custody and a fine between 100,000 EGP and 200,000 EGP.
Health improving and implementing Universal Health Coverage ( UHC ) is endorsed by the World Health Organization ( WHO ) and is a worldwide goal. Aiming Coverage for the entire state population with high quality Healthcare service is crucial, while eliminating financial hardship especially for low-income patients in case of the need for medical treatment.
There is no denial that the Universal Health Insurance Law is a significant move forward for the Healthcare sector in Egypt. However, the hiatus between public and private Healthcare in Egypt highlights the ambivalence between the quality of Healthcare services and Healthcare providers in both sectors.
Universal Health Insurance will need to be followed by a complete health sector reform which addresses all the health system and public health issues. Also, adding enough financial resources could steer the health system in Egypt towards better quality services.
Implementation process will take 15 years and during this period not only establishing hospitals or regulating the sector should be the answer. But, the authorities must focus on a very critical function which is the purchasing of health services since it implies making deliberate decisions on behalf of the population on which services to purchase, how to purchase and from whom.
Independence of the three bodies ( GAHI, GAH, GAHAR ) established through the new Universal Health Insurance Law from the mandate of the Ministry of Health which is a complete reform for the health sector in the state. It will start by re-registration of all doctors and members of the medical profession to the three Universal Health Insurance bodies and obtaining accreditation certificates from them as soon as the system is activated in their governorates.
To sum up, Healthcare is vital to all human beings because no one can live a decent living standard without having access to an affordable Healthcare system. Unfortunately, many families had suffered during the Covid-19 pandemic around the world because they couldn’t afford a decent Healthcare to support them, and therefore many lives were lost. Not to mention, people who die everyday because they can’t afford their insulin or other expensive medicines not supported by Healthcare. That is why everyone should have the privilege of a Universal Health Coverage, where a son doesn’t need to worry about his mother’s chronic disease and how he’s going to assist her. If people’s health isn’t taken care of, how do we expect efficient productivity by our workers?