الإنفاق الصحي في مصر

من موقع مفتوح المصدر Introduction to health expenditure in Egypt

Under the Constitution, the Ministry of Health and Population is responsible for the health of all Egyptian citizens, meaning that it shall work to improve all citizens’ health without discrimination, in particular by reducing the mortality rate of infants, mothers and pregnant women; limiting the impact of uncontrolled population growth; and reducing the burden that illness places on society, its productivity and its development.

In early 1996, the Ministry of Health and Population reevaluated the health sector, a step that made clear the need for comprehensive health reform. The same year saw broad debates that addressed the government’s ability to provide comprehensive care (preventive, primary care as well as curative care for all citizens). In November 1996, the Minister of Health and Population formed a committee to lead health reform and coordinate the efforts of the competent authorities to determine how to begin the process of reform.

This committee submitted a basic document for the Health Sector Reform Program, which identified the following goals:

• • The institution of phased-in, full state insurance coverage for the entire population through the establishment of a national health insurance fund.
• • The restructuring of health-service provision through both the public and private sectors, using a system based on the family health model.
• • Decentralization in the provision of services by reverting the planning and administration of these services to the provincial level.
• • The provision of health services—preventive, primary and curative—through family health units and centers and district hospitals.
• • The integration of health services in primary health-care units through a family doctor who acts as the gatekeeper to the health system.
• • Choice and competition between health-service providers in the public and private sectors.
• • Development of the necessary administrative and organizational systems and structures to implement reform.
• • A commitment to provide basic medications to all Egyptians at affordable prices4.

In order to begin implementing these reforms, the ministry needed a realistic assessment of expenditure on health care to use as the basis for strategic planning, and it developed the National Health Accounts (NHA) for this purpose5. In addition to being a tool of strategic planning, the NHA provides a comprehensive description of sources of expenditure (public and private), how funds move through the health system, the agencies administering them and intermediary players in the system. It is thus an analysis of total expenditure on health care, including public (government) spending, private spending and insurance spending.

Private expenditure consists of:

1. 1. Out-of-pocket spending
2. 2. Some part of insurance premiums, private and public
3. 3. Insurance co-payments
4. 4. User fees, public and private
5. 5. Out-of-pocket spending on medication

Public expenditure includes spending on health services and care from the state treasury, and it represents a percentage of the annual state budget. Insurance expenditure on health care includes funds paid by citizens (which are considered private expenditure), and this is the larger portion, as well as funds from the public treasury, the percentages of which are determined by insurance laws currently in force. The best example is Law 99/1992 for student insurance. Under that law, the student pays an annual premium of LE4 (private spending) as well as a co-payment of one-third the cost of medication (also private spending), while the government pays an annual premium of LE12 for each student (public spending from the state treasury).

To round out the description and analysis of the NHA, the ministry used data from the state treasury and the Ministry of Finance on funds allocated to health care through the Ministry of Health and other ministries that offer health services, such as the Ministry of Higher Education and the Ministry of Defense. It also relied on data about health spending from the Household Survey (a measure of private spending based on fixed samples) in order to assess the size and type of private expenditure and the components of out-of-pocket spending.

In its conclusion, the NHA report offers the following general recommendations to decision makers and strategic planners in the health-care sector:

• • Reform the health sector.
• • Restructure the sector to achieve integration.
• • Reorganize health expenditure and its structures within the framework of comprehensive insurance.
• • Redirect public and private expenditure on health care into a unified national fund to bear the risk of illness.

Remarkably, the report did not discuss several issues that lie at the heart of existing challenges, such as the fact that health-care spending as a percentage of the public budget is less than average in countries of the same socioeconomic level (the appropriate average is 8% to 10% according to the World Health Organization). In addition, steadily rising out-of-pocket spending has exceeded internationally acceptable rates, particularly for private clinic services and pharmacies—a reflection of the health system’s inefficiency and the disarray and lack of regulation in the medical market, which does not achieve the objectives of equitability and availability and leads to violations of the right to health. This is in addition to the substantial gap in the availability of health services between rural and urban areas and north and south.

The debate published here by the EIPR on health expenditure raises several questions about measures and policies implemented by the Ministry of Health, and whether they ensure the Egyptian citizen’s right to quality, efficient, equitable and accessible health care. There is also the basic question as to whether strategic planners and decision makers have benefited from the findings of the NHA report. It is clear that the study’s findings have been ignored when drafting and implementing policies in the decade since the Health Sector Reform Program was created, which has undermined and violated citizens’ right to equitable, accessible, comprehensive health care.

The following pages contain a summary of the discussion that took place in the EIPR offices. The debate, titled “The Challenges Facing Health Expenditure in Egypt,” was organized by the EIPR’s Health and Human Rights Program on Tuesday, 26 August 2008, with the participation of several experts in health and economics, as well as the EIPR’s staff.

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[4] Analysis of the Health Sector and Future Strategies in Egypt, basic document for the Health Sector Reform Program, 1996 (updated in 2001 and 2003).

[5] Although there is no universally accepted definition of what constitutes health expenditure, the NHA document of 1995 adopted the following definition, which will be used by this report: “Health expenditure is all expenditure on preventive care, training, rehabilitation, and health care, including population and food programs and emergency programs aimed at improving the health of individuals and the entire population. The report does not include expenditures on medical education and university training, but it does include training in the health sector of the Ministry of Health and Population.”

The Egyptian Initiative for Personal Rights encourages freedom of information.

Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

تقارير

2015

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• Family Planning in Egypt is a Financial Investment Benefit- Cost Analysis of Egypt Family Planning Program, 2014- 2050

2014

• 2014 EGYPT UPR BRIEFING-THE RIGHT TO HEALTH

2013

• EGYPT Nutrition Landscape Analysis Report 2012
• United Nations Development Assistance Framework for Egypt (2013 – 2017)

2011

• Health and the New Post-Revolution Social Contract Egypt in the Transitional Period: Experiences from Developed Countries

2009

• EGYPT NATIONAL HEALTH ACCOUNTS: 2008/09

2007

• • Assessment of Trade in Health Services in Egypt in Relation to the GATS

2003

• Has Improved Availability of Health Expenditure Data Contributed to Evidence-Based Policymaking? Country Experiences with National Health Accounts

• • • • Figure 4: Household Out-of-Pocket Expenditures as a Share of Total Health Care Spending in Egypt ...17
      • Informing discussions to restructure primary health care in Egypt: The Egyptian Ministry of Health and Population (MOHP) and collaborating international agencies (World Bank, USAID, and European Commission [EC]) used findings from NHA as well as nonfinancial data to initiate a policy dialogue that led to the design and ongoing implementation of a primary health care restructuring initiative. NHA results contributed to the promotion of this initiative by showing that Egypt spent nearly 4 percent of its gross domestic product (GDP) on health care, with household out-of-pocket expenditures amounting to almost 50 percent of total expenditures and the MOHP accounting for less than 20 percent of the total (see Figure 4). While the sum spent on primary care should be adequate to provide a set of basic services to all, most of these resources were not organized or allocated efficiently. The burden of expenditures was inequitably distributed, with the poor paying the largest share of their income for care. This form of financing also resulted in lower levels of access by the poor and those living in rural areas. Such findings provided the then Egyptian Minister of Health and Population with the needed information to convince the People’s Assembly, the public, and those working within the MOHP of the need to significantly restructure the way primary health care was organized and financed in Egypt. In addition, NHA provided valuable information to the World Bank, USAID, and EC to inform their own discussions with the government. Consequently, the Minister of Health and the international donors, through a series of discussions, were able to arrive at a mutually acceptable reform agenda as well as receive financing support.3

0000

• Introduction to health expenditure in Egypt
• Social Vulnerability Analysis of the Health Sector Reform Program Assistance in Egypt
• Egypt Healthcare System Past and Future - Amrou Abdelkader M.D
• Challenges Facing Health Expenditure in Egypt - Report on the proceedings of a roundtable discussion: Health and Human Rights Program Egyptian Initiative for Personal Rights September 2009
• The Distribution of Health Care Resources in Egypt: Implications for Equity An Analysis Using a National Health Accounts Framework
• Managing yearly healthcare Budget & Funding: Practical Insights from Egypt Health System
• The Distribution of Health Care Resources in Egypt: Implications for Equity An Analysis Using a National Health Accounts Framework

1999

• Health Expenditure Review: Alexandria, Egypt

1995

• Health Care Utilization and Expenditures in the Arab Republic of Egypt 1994-95

EMRO

الفرد يدفع من جيبه الخاص 59% من الإنفاق الصحي

إنفاق الحكومة على الصحة حوالي 5.8 من الميزانية

• http://applications.emro.who.int/dsaf/EMROPUB_2014_EN_1792.pdf?ua=1

2013

Health expenditure - total (% of GDP) in Egypt

Health expenditure; total (% of GDP) in Egypt was last measured at 5.06 in 2013, according to the World Bank. Total health expenditure is the sum of public and private health expenditure. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. This page has the latest recorded value, an historical data chart and related indicators for Health expenditure - total (% of GDP) in Egypt.