1. Health Insurance Organization in Egypt by Dr Abdel Rahman El-Sakka Health Insurance Organization, Chaiman 8 October 2012

2. Health Insurance Organization in Egypt The pic of HIO

3. 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

4. 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)

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

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

7. 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)

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

9. 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

10. 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)

11. 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

12. 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. 13 Total Number of Beneficiaries (in thousands) 59% 8.3% 0.5%

14. Number of beneficiaries (in millions) Census: June 2010

15. 15 Percentage of beneficiaries according to LAWS Census: June 2010

16. 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

17. Scope of services Preventive Diagnostic Therapeutic Rehabilitation 17

18. 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. 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

20. Long Acting Interferon Therapy For more than 24,000 hepatitis C patient 20 High cost Services Provided in the Year 2011/ 2012

21. Services Provided in the Year 2011/2012 21 HIO provided school children diabetic patients with around 16.700 Insulin pen

22. Gamma Knife Treatment For 300 cases of Brain Tumor Services Provided in the Year 2011/2012

23. Renal Dialysis 13,000 patients 33 owned dialysis centers (632 Haemodialysis device) 455 contracted centers 23 Services Provided in the Year 2011/2012

24. Chemotherapy 197,000 visits for chemotherapy sessions 24 Services Provided in the Year 2011/2012

25. Premium Vs Cost per Beneficiary (FY: 2010/2011) 25 Profit / Loss (in EGP) Average Cost (in EGP) Average Premium (in EGP) Categories 76 141218 Law 79 (working Force) (311) 38978 Law 79 (Pensioners) (207)25952 Widows (79) 13656 Law 32 (22) 3816 Law 99 (138) 15820 Preschool (Law 86)

26. Premium & Cost Sharing Vs Cost per Beneficiary (FY: 2010/2011) Profit / Loss (in EGP) Average Cost (in EGP) Average Premium (in EGP) Categories 76141218 Law 79 (working Force) (311) 38978 Law 79 (Pensioners) (207)25952 Widows (71) 13665 Law 32 (1)3837 Law 99 (+ earmarked tax) (129) 15829 Preschool (Law 86)

27. Incomplete coverage Different Laws & Systems Unrealistic rates of premium Main Challenges Facing the Current HIO

28. 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

29. 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

30. Health insurance reform in Egypt Aiming at: Universal coverage Sustainable financing resources High level quality health care Unifying the laws Payer/provider split 30

31. Thank you