New health insurance law in the House of Representatives

CAIRO – 28 November 2017 - Minister of Health and Population, Ahmed Emad Eddin Rady, attended the joint committee of the Health, Legislative, and Constitutional Affairs, as well as the House of Representatives’ Planning and Budget Committee, to discuss the new comprehensive health insurance draft submitted by the government, which was preliminary approved by the previous committees last week. The committee also included Ali Hegazi, assistant to Ministry of Health and Population for Health Insurance Affairs, and Mohamed Moaet, Deputy to the Minister of Finance.

The Minister explained that 14 articles out of 67 of the law were discussed; each article was talked about separately. The discussed articles were approved after undergoing the necessary amendments on them. The suggestions of the health committee were modified, including those regarding the committee from the Central Agency for Mobilization and Statistics (CAPMAS) with finance and solidarity committees. Article (9) of the draft was also modified in order to redefine the number of members of the permanent pricing committee for medical services to range from nine to 15 members.

Rady revealed that Article (4) is concerned with the establishment of the General Authority for Comprehensive Social Health Insurance (GACSHI) to be an independent legal entity with an independent and separate budget. The authority will be under the primary supervision of the Prime Minister with a special administration.

Rady also pointed out that Article (5) is concerned with the formation of the Board of Directors of the Authority, and that it states that the term of the Council is four years, to be renewed once. Article (6) stipulates that the Board of Directors of the Authority is the supreme authority of its affairs as well as setting the necessary policies required to accomplish its goal. Article (7) provides for the appointment of an executive director for the authority to administer it, where his term of office will be four years, to be renewed once.

The Health Minister explained that Article (8) stipulates that all administrative and financial assets – except medical assets – of the General Authority for Health Insurance along with its branches and entities associated to health ministry shall be affiliated to the GACSHI. It was stipulated in the draft that there will be a special committee in the GACSHI to be responsible for pricing the presented medical service, Article (10) states that GACSHI shall be responsible for following up the medical treatment of the insured patients in case they received a medical treatment at one of the medical entities which are not registered in the GACSHI.

Insured patients shall have the right to choose the treatment entities in case of emergency at one of the non-contracting medical entities, in such cases the GACSHI shall have the right to regulate the refund expenses in accordance with the applicable price regulations of the Authority.

The health minister added that Article (11) stipulates that the Authority shall have the right to exclude any service providers in cases where service providers are less focused towards the citizens. Whereas, Article (12) states that in the case of injury of the insured during work or because of work, the employer shall inform the GACSHI as soon as the injury takes place.

Rady noted that Article (13) is concerned with the issuance of disability certificates resulting from the incidence of any disease and its percentage. As for Article (14), the GACSHI is obliged to submit performance reports regarding its financial position and semi-annual financial statements to the Cabinet and House of Representatives at least once a year.

According to the new health insurance law, the government will fully cover health expenses for those who are unable to pay for their medical treatment. They are about 30 percent of Egypt's population. "The system will be applied gradually between 2018 and 2032," said Ali Hegazy, head of the General Authority for Health Insurance. He added that around 42 million citizens do not benefit from any health insurance services.

The current budget for this insurance reaches LE 8 billion annually, according to Hegazy; however, covering the appropriate services in accordance with international standards would require an additional LE 90 million annually.

Employees will be obliged to subscribe to the new health insurance system. It will cost between LE 1,300- 4,000 per year, depending on the income. However, citizens who cannot afford the fees will be exempted from paying any subscription fees.

The current insurance system only covers about 60 percent of the citizens, where each one used to pay only LE 112. However, due to its bad quality only six percent of citizens used its services.

Hegazy stated, the new program will be funded through the taxes imposed on cigarettes and tobacco, along with other items and other funding sources. "The new program will be introduced with high efficiency. It will also end the high cost of medical services provided by the private sector," said Hegazy.

According to Hegazy, all private hospitals will have to adhere to the prices set by the government. The bill, which has been developed over the past six years, was drafted by 22 health insurance officials, bankers, and academic physicians.