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Health Insurance Organizationin Egypt
byDr Abdel Rahman El-Sakka
Health Insurance Organization, Chaiman8 October 2012
Health Insurance Organization in Egypt
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 20th century
HIO Current Laws
Law 79/1975
Law 32/1975
Prime Minister Decree 1/1981
Law 99/1992
Law 86/2012 (Minister of Health Decree 380/1997)
HIO Current Laws (cont.)
Law 79/1975
Covers; Government, Public & Private employees
Premium: 4% of Total Salary (1% from beneficiary & 3% from employer)
HIO Current Laws (cont.)
Law 79/1975
Covers Pensioners
Premium: 1% of Salary
HIO Current Laws (cont.)
Law 32/1975
Covers; Government & Local Administrative Units Employees.
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
Covers widows (of HIO beneficiaries)
Premium: 2% of Salary
HIO Current Laws (cont.)
Law 99/1992 Covers school students 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
Covers neonates & preschool children (Voluntary!!)
Financing: 20 EGP annual Premium Co-insurance: One-third of outpatient
medications (except chronic diseases)
HIO Current Laws (cont.)
Law 86/2012 Covers neonates & preschool age children Awaiting the executive decree Financing:
8 EGP annual premium paid by child parent 12 EGP annual contribution for each student by
Ministry of Finance Awaiting the executive ministerial decree
HIO Current Laws (cont.)
Labor Injuries Insurance (Law 79/1975)
Covers all labor force covered by the law 79/1975 & others!!
Premium: 1% of salary (paid by employer)
13
Total Number of Beneficiaries (in thousands)140
318
521
1651
3225
4359
20671
26834
36659
38817
45004
46800
1965
1970
1975
1980
1985
1990
1995
2000
2005
2007
2010
2012
59%
8.3%
0.5%
Number of beneficiaries (in millions)
18.474
14.488
4.795 4.386
2.290.564
Students
Preschool
L79
L32
Pensioners
Widows
Census: June 2010
15
Percentage of beneficiaries according to LAWS
1.3%5.1%9.7%
10.7%
32.2%
41%Students
Preschool
L79
L32
Pensioners
Widows
Census: June 2010
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 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
19
372 Corneal transplantation
258 Bone marrow transplantation
358 Cochlear implantation
92 Liver transplantation
1300 cases of GH deficiency in children
High cost Services Provided in the Year 2011/ 2012
Long Acting Interferon Therapy
For more than 24,000
hepatitis C patient
20
High cost Services Provided in the Year 2011/ 2012
Services Provided in the Year 2011/2012
21
HIO provided school children diabetic patients with around 16.700 Insulin pen
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
Services Provided in the Year 2011/2012
Premium Vs Cost per Beneficiary(FY: 2010/2011)
25
Profit / Loss (in EGP)
Average Cost (in EGP)
Average Premium (in EGP) Categories
76 141 218 Law 79 (working Force)
(311) 389 78 Law 79 (Pensioners)
(207) 259 52 Widows
(79) 136 56 Law 32
(22) 38 16 Law 99
(138) 158 20 Preschool (Law 86)
Premium & Cost Sharing Vs Cost per Beneficiary(FY: 2010/2011)
Profit / Loss (in EGP)
Average Cost (in EGP)
Average Premium (in EGP) Categories
76 141 218 Law 79 (working Force)
(311) 389 78 Law 79 (Pensioners)
(207) 259 52 Widows
(71) 136 65 Law 32
(1) 38 37 Law 99 (+ earmarked tax)
(129) 158 29 Preschool (Law 86)
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
Main Challenges Facing the Current HIO
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