Health Insurance Organization in Egypt by Dr Abdel
Health Insurance Organization in Egypt by Dr Abdel Rahman El-Sakka Health Insurance Organization, Chaiman 8 October 2012
Health Insurance Organization in Egypt n The pic of HIO
Health Insurance Organization (HIO) § The social health insurance system (HIO) in Egypt has been in existence since 1964 § HIO was the outcome of many legislations started in the early decades of the 20 th century
HIO Current Laws n Law 79/1975 n Law 32/1975 n Prime Minister Decree 1/1981 n Law 99/1992 n Law 86/2012 (Minister of Health Decree
HIO Current Laws (cont. ) Law 79/1975 n Covers; Government, Public & Private employees n Premium: 4% of Total Salary (1% from beneficiary & 3% from employer)
HIO Current Laws (cont. ) Law 79/1975 n Covers Pensioners n Premium: 1% of Salary
HIO Current Laws (cont. ) Law 32/1975 n Covers; Government & Local Administrative Units Employees. n Premium: 2% of Basic Salary (0. 5 % from beneficiary & 1. 5 % from employer , in addition to some cost sharing)
HIO Current Laws (cont. ) Prime Minister Decree 1/1981 n Covers widows (of HIO beneficiaries) n Premium: 2% of Salary
HIO Current Laws (cont. ) Law 99/1992 n Covers school students n Financing: § 4 EGP annual premium paid by student § 12 EGP annual contribution for each student by Ministry of Finance § Co-insurance: One-third of outpatient medications (except chronic diseases) § Earmarked Tax: 10 piasters per pack of cigarette
HIO Current Laws (cont. ) Minister of Health Decree 380/1997 n Covers neonates & preschool children (Voluntary!!) n Financing: § 20 EGP annual Premium § Co-insurance: One-third of outpatient medications (except chronic diseases)
HIO Current Laws (cont. ) Law 86/2012 n Covers neonates & preschool age children n Awaiting the executive decree n Financing: § 8 EGP annual premium paid by child parent § 12 EGP annual contribution for each student by Ministry of Finance n Awaiting the executive ministerial decree
HIO Current Laws (cont. ) Labor Injuries Insurance (Law 79/1975) n Covers all labor force covered by the law 79/1975 & others!! n Premium: 1% of salary (paid by employer)
Total Number of Beneficiaries (in thousands) 59% 8. 3% 0. 5% 13
Number of beneficiaries (in millions) Census: June 2010
Percentage of beneficiaries according to LAWS Census: June 2010 15
HIO provides services to beneficiaries all over Egypt from Alexandria to Aswan HIO Owns: § 22 regional administrative branches § 38 hospitals § 354 polyclinics § 829 (GP) clinics inside factories, § 78 Labor injuries centers § 34 general medical committees § > 8000 school clinics n Outsourcing (contracted): (640 hospitals – 3286 out-patient rural clinics) 16
Scope of services § Preventive § Diagnostic § Therapeutic § Rehabilitation 17
High cost Services Provided in the Year 2011/ 2012 Cardiac Services Diagnostic Cardiac Cath: 13, 112 Therapeutic Cardiac Cath: 7, 176 Open Heart Surgery: 5, 470 18
High cost Services Provided in the Year 2011/ 2012 § 372 Corneal transplantation § 258 Bone marrow transplantation § 358 Cochlear implantation § 92 Liver transplantation § 1300 cases of GH deficiency in children 19
High cost Services Provided in the Year 2011/ 2012 Long Acting Interferon Therapy For more than 24, 000 hepatitis C patient 20
Services Provided in the Year 2011/2012 HIO provided school children diabetic patients with around 16. 700 Insulin pen 21
Services Provided in the Year 2011/2012 Gamma Knife Treatment For 300 cases of Brain Tumor
Services Provided in the Year 2011/2012 Renal Dialysis § 13, 000 patients § 33 owned dialysis centers § (632 Haemodialysis device) § 455 contracted centers 23
Services Provided in the Year 2011/2012 Chemotherapy 197, 000 visits for chemotherapy sessions 24
Premium Vs Cost per Beneficiary (FY: 2010/2011) Categories Average Premium (in EGP) Average Cost (in EGP) Profit / Loss (in EGP) Law 79 (working Force) 218 141 76 Law 79 (Pensioners) 78 389 (311) Widows 52 259 (207) Law 32 56 136 (79) Law 99 16 38 (22) Preschool (Law 86) 20 158 (138) 25
Premium & Cost Sharing Vs Cost per Beneficiary (FY: 2010/2011) Average Premium (in EGP) Average Cost (in EGP) Profit / Loss (in EGP) 218 141 76 Law 79 (Pensioners) 78 389 (311) Widows 52 259 (207) Law 32 65 136 (71) Law 99 (+ earmarked tax) 37 38 (1) Preschool (Law 86) 29 158 (129) Categories Law 79 (working Force)
Main Challenges Facing the Current HIO § Incomplete coverage § Different Laws & Systems § Unrealistic rates of premium
Main Challenges Facing the Current HIO § Continuous advances in Healthcare Industry § Technology & Knowledge revolution; a paradigm shift § Unclear (implicit) Benefit Package § Opt out strategy (Low health risk group)
Main Challenges Facing the Current HIO § Voluntary enrolment of some groups § Extension of Occupational diseases list (financial burden) § HIO is the payer and service provider
Health insurance reform in Egypt Aiming at: § Universal coverage § Sustainable financing resources § High level quality health care § Unifying the laws § Payer/provider split 30
Thank you
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