Health Insurance Organization in Egypt by Dr. Essam Anwar HIO Assistant Chairman

Health Insurance Organization in Egypt The pic of HIO 2

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 3

HIO Current Laws  Law 79/1975  Law 32/1975  Prime Minister Decree 1/1981  Law 99/1992  Minister of Health Decree 380/1997 4

HIO Current Laws (cont.) Law 79/1975  Covers; Government, Public & Private employees  Premium: 4% of Total Salary (1% from beneficiary & 3% from employer) 5

Law 79/1975  Covers Pensioners  Premium: 1% of Salary HIO Current Laws (cont.) 6

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.) 7

Prime Minister Decree 1/1981  Covers widows (of HIO beneficiaries)  Premium: 2% of Salary HIO Current Laws (cont.) 8

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.) 9

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.) 10

Labor Injuries Insurance (Law 79/1975)  Covers all labor force covered by the law 79/1975 & others!!  Premium: 1% of salary (paid by employer) HIO Current Laws (cont.) 11

Total Number of Beneficiaries (in thousands) 56% 8.3% 0.5% 12

Number of beneficiaries (in millions) Census: June

Percentage of beneficiaries according to LAWS Census: June

Scope of services  Preventive  Diagnostic  Therapeutic  Rehabilitation 15

HIO provides services to beneficiaries all over Egypt from Alexandria to Aswan HIO Owns:  38 hospitals  600 clinics  78 Labor injuries centers  34 general medical committees  > 7000 school clinics  Outsourcing (contracted): (640 hospitals – 1141out-patient clinics) 16

Nasr City Hospital (Cairo) 17

Gamal Abdel-Nasser Hospital (Alexandria) 18

El Mogamaa Hospital (Tanta) 19

Beni-Swaif Outpatient Clinic (Beni Swaif) 20

Organ Transplantation Lab. (Nasr City Hospital) 21

Physiotherapy & Rehabilitation Centers (51 centers) 22

14 Spiral CT (with triphasic facility) 23

18 highly equipped modern Ambulances 24

Services Provided in the Year 2011 Surgical Operations # 350,421 41% major & extra major 25

Cardiac Services Diagnostic Cardiac Cath: 35,417 Therapeutic Cardiac Cath:7,176 Open Heart Surgery: 5,470 Services Provided in the Year

Renal Dialysis  1,508,461 hemodialysis sessions for 13,000 patients  33 owned dialysis centers  455 contracted centers Services Provided in the Year

Chemotherapy 197,000 visits for chemotherapy sessions Services Provided in the Year

Growth Hormone Therapy for 1300 cases of GH deficiency in children Services Provided in the Year

Services Provided in the Year 2011  234 Corneal transplantation  250 Bone marrow transplantation  287 Cochlea transplantation  92 Liver transplantation 30

Long Acting Interferon Therapy For more than 17,000 hepatitis C patient Services Provided in the Year

Services Provided in the Year 2011 HIO provided school children diabetic patients with around 13,000 Insulin pen 32

Premium Vs Cost per Beneficiary Profit / Loss (in EGP) Average Cost (in EGP) Average Premium (in EGP) Categories Law 79 (working Force) (281.05) Law 79 (Pensioners) (98.03) Law 32 (25.42) Law 99 (160.75) Preschool (51.35) HIO Beneficiary 33

Main problems facing current HIO  Near one half of population has no health insurance coverage  Different laws & systems dealing with beneficiaries “The more laws the less justice”, Marcus Tullius Cicero  Unrealistic rates of premium that have been fixed and unchanged since 1964 (financial sustainability is at risk)  Unclear (implicit) Benefit Package  HIO is the payer and service provider 34

Health insurance reform in Egypt Aiming at:  Universal coverage  Sustainable financing resources  High level quality health care  Unifying the laws  Payer/provider split 35

Thank you