1. How to improve the public services in the health sector reform

2. HEALTH SECTOR REFORM The Government of Egypt has embarked on a process of reforming health care system and financing in the country it has focused on social health insurance as the main funding mechanism.

3. The Egyptian health profile According to world bank criteria, Egypt is a lower middle income country 35% of its population under 15 years of age Work force forming 28% The poor bear a proportionately higher burden of health care spending as percentage of household income The lowest quintile income group spent about 10% of household income on health care compared with 7% by the highest quintile income group

4. The Egyptian health profile The wealthiest quintile income group captured 35% of the total government health expenditure The poorest quintile group received less than 12% of the government health expenditure 80% of the physicians conduct private clinics in addition to their public employment

5. 68% percent of total clinics based care is delivered at the private health centers Pharmaceutical consumption and spending is 50% higher than in comparable countries

6. The Egyptian health profile the inequality in distributing health services across Egypt, created a 67 per cent gap in public health spending between urban and rural areas of Egypt Upper Egypt has a higher number of individuals who cannot afford health care a higher percentage of spending goes to Egyptian urban areas,”

7. Income share held by lowest 20%-highest10% in EGYPT

8. Healthcare spending in EGYPT healthcare spending aims to ensure “health services for citizens and provide them with treatment requirements in hospitals and medical centers, taking into consideration improving the living standards of doctors and nurses.”

9. Healthcare spending in EGYPT The share of the GDP( Gross domestic product )spent on the health jumped from 3.7 percent in 1996 to 6 percent in 2004

10. Healthcare spending in EGYPT sum of LE24.9 billion was allocated to healthcare spending, comprising 4.7 per cent of the total budget this year. “The ministry of finance has allocated for the year 2011/2012 around LE277.9 billion to satisfy the social dimension and provide the biggest amounts of funds to run services in education and health sectors and to support systems of subsidies, pensions and social security for citizens,”

11. Health care provider in Egypt 1. MOHP 2. HIO 3. Curative care organization 4. University hospital 5. Defense ministry 6. Interior ministry 7. Private sector

12. SOCIAL HEALTH INSURANCE COVERAGE Provided through the HIO Coverage rate52%of the population,including1/3 of the active labor force School children and infants formed 80%of the population under HIO coverage HIO contracts with public and private providers Contracting and outsourcing comprises1/3 of the total HIO expenditures

13. Private sector Cons Unregulated private health facilities unregulated and unorganized private insurance market Lack of standardization and accreditation norms implementation by the healthcare providers

14. The path to universal coverage (message from WHO report 2010) At a time when money is tight, my advice to countries is this:  Before looking for places to cut spending on health care, look first for opportunities to improve efficiency.  All health systems, every where, could make better of resources, whether through better procurement practices, broader use of generic products, better incentives for providers

15. why to promote social health insurance ?  Social health insurance provides an important additional source of revenue for the health system  By separating the purchasing of health care from its provision and encouraging selective contracting between providers (including private sector ones)social health insurance systems are able to achieve better quality health care at a lower cost

16. The challenges facing the expansion of social health insurance 1. Ability to recover from the aftershocks of the revolution and resume pre-revolution high growth rate 2. Ability of building the health insurance administration system 3. level of poverty and society willingness to subsidize the poor 4. No efficient and functional provider network

17. The challenges facing the expansion of social health insurance Large proportion of patient seek care in the private sector Private provider often offer services which are perceived by users to be more attractive Serious deficiencies in technical quality are often present in governmental sector

18. The Road Map Three key strategic objectives: 1. Facilitating private sector development in health care 2. Enhancing the provision of public services 3. Promoting equity

19. Health-Service Approaches Directing more health benefits toward the poor through “targeting” Promoting primary and essential health care Improving the quality of services Developing public-private partnerships Reorganizing health resources

20. Why hospitals? Hospital occupancy rate is below 50% 30-40% of nosocomial infections in hospitals and 50% of deaths in emergency cases are due to improper case management 83% of the total hospital care takes place at public hospitals

21. HEALTH INSURANCE HOSPITALS IN EGYPT  38 hospitals, covering whole EGYPT  9549 beds  1bed for every 3867 beneficiaries  488 renal dialysis machine  2090 open heart surgery-costing 12.598 million pounds  71 renal transplantation operation-costing 690.5thousand pounds  80 bone marrow transplantation-costing 5590thousand pounds  53.247 cancer patients costing 94.8million pounds (data -year 2006)

22. Public hospital in Egypt  412 public hospitals  208,000 beds  1bed for every 496 citizens  1 physician for every 440,000 Of the population

23. Objectives of HIO hospital reform plan  Equal access to hospital services for all insured Egyptians  Make governorate hospitals as –self sufficient as possible in providing hospital care  Make hospitals operated to high capacity and managed to high levels of service quality

24. 1. ICUS-PICU 2. NICUS 3. EMERGENCY 4. CTSCAN 5. MRI

25. HOSPITAL REFORM New human-resources development strategies to rationalize the number of doctors in each specialty Increase the number of nurses Ensure continuing medical education to all medical and paramedical workers with standard training certifications on national level

26. Getting Health reform Right Financing Payment Organization Regulation Persuasion

27. Social health insurance seems better able to meet the official policy goals of the government of Egypt on grounds of efficiency, equity and technical feasibility.

28. What can be done? Raise public health expenditure to finance care at an adequate level. Switching to an insurance-based scheme is a superior strategy. Creation of a single fundholding agency

29. What can be done? improve quality and financial sustainability through competition public sector agencies should become more accountable (tighter regulation of private providers). Wider Range & Types of health service providers