Why good? Why bad? New health insurance law discussed

CAIRO – 21 December 2017: The Egyptian Parliament finally approved the new national health insurance law, raising a stormy debate between the Egyptian Medical Syndicate opposing the draft law and parliamentarians.

After fruitful discussion that took over a month, Minister of Health and Population Ahmed Emad Eddin announced on December 19 the approval of the Council of Representatives on all articles of the new comprehensive universal health insurance law.

Egypt's health system has been criticized for years for not meeting standards. The new health insurance law proposed in October last year is considered a new government bid to overcome the shortcomings of the old system that was deemed inadequate and insufficiently safeguarding patients' rights.

Lawmakers defended the new law as it would boost the quality of health services in public hospitals. The old law used to cover health services for governmental and seasonal workers, while the newly approved amendments guarantee the same medical services to all citizens.

Despite positive impact hoped from the new law, more burden on the individual's income is feared as the law raises monthly insurance fees. Given the difficult economic conditions, the law amendments "would place a large burden on low-income families," Dr. Mohamed Hassan Khalil, coordinator of an independent health organization, told Egypt Today.

Khalil argued that the new law violates the constitution by allocating only 1.6 percent of the GDP to healthcare, instead of 3 percent as stipulated in Article 18.

Khalil added that a citizen had to pay only 1 percent of his income for the health insurance, while under the new law, if a person has four children, he will end up dedicating 9 percent of his salary to the medical services; divided as: 1 percent for him, 3 percent for his wife and one percent for the first two children. The person will pay 1.5 percent for additional children.

A citizen would also pay 7 percent of his income for undergoing operations and 20 percent for medical tests, which is "unsuitable for a country with many of its population below the poverty line," continued Khalil, a member of the Egyptian Medical Syndicate that has opposed the new law.

The new law set quality standards for medical facilities to meet as conditions to be covered in the new insurance system. With many public hospitals expected to fail in this test, some of them may resort to selling their shares to private companies, deputy head of the syndicate Mona Mina told Ahram Online.

The law will not cover foreigners, while for hospitals affiliated with the army, police or owned by the private sector, it will only be allowed to participate in the system if they meet conditions stipulated in the law, according to the health committee at the parliament.

For his part, the Minister of Health Ahmed Emad Eddin justified the increase of health budget to improve health services and render them sustainable and stable, aiming to avoid their collapse due to a lack of funding. He said the ministry reviewed several health insurance systems abroad before choosing the UK model to apply.

Other bids include an expected increase in the tobacco prices to fund the health system’s services. The rise is estimated to be between LE 7 billion and LE 8 billion.
"Egypt is no longer a socialist country mobilized to provide free health and education services," parliamentary spokesperson Abdel-Aal said, adding that "the subscription fees may be high in the beginning, but they will be affordable with the system gradually covering the entire country."

Besides, the new health insurance law stipulates that the government will fully cover health expenses for those who are unable to pay for their medical treatment, which is about 30 percent of Egypt's population, said the official spokesman of the Ministry of Health and Population.

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Article (40) deals with the sources of funding of the Authority. Megahed pointed out that article includes 9 points, all of which are concerned with the Authority's resources. It is also concerned with the collection of funds from other sources in order to finance the system, including P.T. 75 of the value of each pack of cigarettes sold in the domestic market, whether local or foreign, to be increased every three years by P.T. 25, plus LE 1 toll for each vehicle passing highways and LE 20 for each year when issuing or renewing the driving license. Also, LE 50 when issuing or renewing the license cars with a capacity of less than 1,600 CC and LE 150 for cars with a capacity of less than 2,000 CC and LE 300 for cars with a capacity exceeding 2,000 CC.

This comes in addition to LE 1,000 collected for each bed when issuing licenses of new hospitals and medical centers, LE 20 of the value of each ton of cement produced locally or abroad and LE 50 for every ton of iron manufactured locally or abroad. When opening new clinics and pharmacies, owners are to pay an amount ranging between LE 1,000 and LE 15,000 depending on several criteria.

The Minister of Health stated that ministry of social solidarity is committed to paying the value of the health insurance for unemployed persons eligible for unemployment compensation in accordance with the provisions of the Social Security regulations. The ministry is also committed to collect the contributions of health insurance due from different parties.

Article (42) states in the case of a delay in payment of contributions, an additional annual amount shall be imposed on the individual as a fine for the delay period. The additional amount shall be calculated in accordance with the rules provided for in the Civil Code.

According to Article (44), the financial status of the system shall be examined at least once every four years by one or more experts in the field of health who shall be assigned by the Prime Minister based on the nomination of the Minister of Finance and Minister of health.

Article (48) stipulates that the use of comprehensive social health insurance services requires that the beneficiary be a participant in the system and is paying their share. Individuals who do not join the universal health insurance from the beginning but decide to do so later will be obliged to pay the arrears via a one-off payment or in installments, except in case of an emergency, as defined by the authority.

Article (49) states that those insured shall bear their share and the employer's share during the duration of the internal or external loan and the unpaid special leave and shall be handed directly to the Authority except for childcare leave, scholarships, sabbatical leave and scientific assignments granted to the administrative units of the State.

Article (52) specifies that the bodies established under this law shall have an independent budget and shall begin their financial year at the beginning of the fiscal year of the State and shall end by the end of each year.

Article (53) determines that the provisions of the Law shall be suspended during the period of compulsory conscription, retention and summoning of the armed forces.
Article (59) determines that the Authority may provide its services to foreign residents or in accordance with the regulations it establishes, taking into consideration the requirement of reciprocity.

Article (62) stipulates that a penalty of imprisonment for a period of not less than six months and a fine of not less than LE 2,000 and not more than LE 10,000, or one of these penalties, shall be given to anyone who gives incorrect statements or refrained from giving the data provided for in this law. Not less than six months and a fine of not less than LE 20,000 and not exceeding LE 100,000, or one of these penalties, to any individual or group that hinders the work of employees of the Commission who are eligible to apply judicial seizure.

Article (63) asserts that a penalty of not less than one year and a fine of not less than LE 50,000 and not more than LE 70,000, or one of these two penalties, shall be imposed on each employee of the Authority who would illegally facilitate the attainment of medication or compensatory equipment. In such cases, the court shall confiscate medicine or compensatory devices, or its value, in favor of the Authority.

Somewhat similar to Article (63), Article (65) affirms that a penalty of imprisonment for a period of not less than six months and a fine of not less than LE 100,000 and not exceeding LE 200,000, or one of these penalties, for each employee of the Authority or service provider who shall assist any participant from not paying his share to the authority.