|
GOVERNMENT RE-EXAMINES HEALTH INSURANCE
BY AMENA BAKR
The government’s health-care plan has always
left a sour aftertaste. Subsidized health care introduced in the
1950s has become synonymous with long lines, surly nurses and overworked
doctors that treat patients like plush toys on an assembly line.
A quick stitch here and a prescription, then off to the next patient.
Fatigued and underpaid, Egyptian doctors at public hospitals and
health clinics examine an average of 17 patients an hour. The sick
often expire before receiving treatment; malpractices occur at an
alarming rate.
Even by its own diagnosis, the Ministry of Health has found that
its health insurance system – which covers over half the population
– is a failure. A survey it conducted last year indicated
that the majority of “patients show significant dissatisfaction
with the services offered,” explains ministry spokesman Abdel
Rahman Shahin. “The current system has a lot of failures and
is no longer appropriate for both the size of our population and
the advancements in medical care that have taken place.”
Over 36 million Egyptians receive state health care, while 21 million
have opted for private health care and 15 million – about
20 percent of the population – have no health coverage at
all.
The government plans to roll out a universal health-care system
that would cover the entire population by 2010, as promised by President
Hosni Mubarak during last year’s election campaign. But to
do so, it will need to figure out how to pay the additional coverage
for 15 million people, many of whom live below the poverty line
and are unable to afford health insurance at any cost.
Under the new scheme, the Ministry of Health will provide free health
care to those who currently have neither state nor private health
care due to financial constraints. “Egypt is a developing
country and not all people will be able to pay for health insurance,”
says Shahin, “but determining who is really in need of this
free service is difficult.”
State health-care subscribers currently pay a monthly fee that is
calculated based on the individual’s salary, with the average
payment ranging from LE 5 to LE 8 per month. The system generates
about LE 2.2 billion per year – a LE 600 million shortfall
that is covered by the Ministry of Health.
The new system will strain resources even further, requiring an
estimated LE 20 billion per year to finance, according to Shahin.
“At this point it is crucial for us to find ways to increase
the amount of money coming in so that this new system could be applicable,”
he says.
Making matters more complicated, the government has promised that
it will not increase the subscription fees of those already receiving
state health care. Instead, it hopes to woo private health-care
subscribers, mostly people working in the private sector and in
higher income brackets, by offering comparable services at a lower
price. If all goes as planned, the Ministry of Health expects to
generate LE 8 billion from corporate clients and individual subscribers.
The Ministry of Finance has pledged to pitch in another LE 8 billion,
but that still leaves it LE 4 billion short.
To bridge this gap, the ministry has been forced to think outside
the box, says Shahin. Yet its first target – smokers and drinkers
– seems all too obvious. The government recently introduced
a bill to parliament that would raise taxes on cigarettes and alcoholic
beverages by 10 percent. If passed, the new tax is expected to generate
an additional LE 1 billion per year to be used for funding the universal
health-care system.
Shahin says it only makes sense that smokers and drinkers should
carry the financial burden of the new system. “People who
smoke or drink are more likely to get lung and liver problems, so
by using this system they would be indirectly paying for their future
treatment,” he explains.
Meanwhile, the Ministry of Health is planning to cut costs by tightening
control on the medicine given to hospitals and clinics. “There
is a lot of waste in terms of medication as doctors here in Egypt
like to write a long list of prescriptions for their patients, when
only one medicine would be necessary,” says Shahin. And as
Egyptians receive all medicine in prepackaged boxes or tablet sheets,
the quantity of medicine in these packages often exceeds the amount
needed for the treatment, which means a lot of subsidized medicine
goes to waste.”
The plan, explains Shahin, is to introduce a prescription system
whereby patients receive the precise number of pills or tablets
they require for treatment. “We will try to adopt the American
system of giving the patient the exact number of pills [they have
been prescribed] in a labeled plastic container,” he says.
By doing so, and by urging doctors to be more economical in writing
prescriptions, the ministry hopes to save about 50 percent of the
LE 7 billion that is used to subsidize medications.
But will Egyptians accept their medicine in little plastic bottles?
Shahin admits it could be an uphill battle. “If we start giving
out medicine without a box people will think that it’s of
lower quality.” He says. “So we need to change the culture
[before we can] introduce such a system.”
While the success of the government’s health plan rests on
its ability to draw people away from private health care, service
providers that Business Monthly spoke to say it will be a tough
sell. “I don’t think the government will be able to
cover 100 percent of the population in such a short time and maintain
a good level of quality,” said a branch manager from Pharaonic
American Life Insurance Co. (Alico), speaking under condition of
anonymity. He added that the government will not only face financial
difficulties in implementing universal health insurance, it will
also face resistance from citizens skeptical about its ability to
provide high-quality services.
Alico, one of Egypt’s largest private health insurers, has
expanded quickly by offering an alternative to public health care.
Operating as a health maintenance organization (HMO), Alico provides
comprehensive health plans to over 3,000 client companies. Staff
of these companies are eligible to receive free treatment from seven
of the nation’s “top hospitals” for all approved
procedures. The plan also covers 80 percent of the cost of treatment
at other hospitals or private clinics.
But, certainly in comparison to public health care, it can be expensive.
Alico’s corporate premiums are based on the age and occupation
of each employee registered by the client under the plan. A 50-year-old
administrative assistant, for instance, would cost around LE 2,000
per year to insure, one branch manager told Business Monthly.
Cairo-based MEDMARK Health & Life, an adviser for UK-based health
care provider British United Provident Association (BUPA), is even
more expensive, but also boasts more flexibility than “directional
treatment systems” such as HMOs. “HMO systems basically
require the patient to go to the company’s doctor and the
doctor would then refer him to a specialist in the field of treatment
required,” says Karim Ramadan, marketing manager at MEDMARK
Health & Life. By restricting the client’s employees to
using only certified hospitals and clinics, the HMO is able to save
the employer money.
Following a slightly different track, in 2005 MEDMARK introduced
a corporate health scheme called Horizon Private Medical Insurance
(PMI), which allows the client’s employees to receive free
treatment anywhere within Egypt, with the costs fully covered by
the client. “The PMI scheme, starting from LE 200 per month
for personal coverage, is roughly 10 to 30 percent higher than HMO
schemes because it offers a wider range of options and more generous
coverage,” Ramadan explains.
Shahin says the government’s universal health-care scheme
will give patients unrestricted access to all public health facilities,
as well as the option for subsidized treatment in ministry-approved
private hospitals and clinics. “I think this will create competition
between the private sector and public sector,” he says.
Ramadan, however, believes it will take years before the government
is able to compete with private HMO systems. “It’s true
that there is a lot of progress being made, but due to overpopulation
and limited funding the government has to spread its resources really
thin, which will effect the quality of service and will exclude
a large segment of the market,” he argues.
To reach the entire population, the Ministry of Health is faced
with the challenge of increasing the numbers of public clinics and
hospitals. “Right now, we have about 600 clinics and 40 hospitals
that health-insured patients can go to, but the problem is that
they are mostly located in Cairo and Alexandria,” says Shahin.
“Some people in small villages in Upper Egypt must travel
for at least two hours to find a hospital.”
While the government claims it will double the number of public
health facilities over the coming year, Ramadan believes even if
it succeeds, there will always be room for private health insurance.
“I think that having good public health care has no relation
to whether a nation is developing or developed. In the UK, [for
example], BUPA managed to flourish because people were fed up with
waiting in lines to be treated via the [British government’s]
National Health Service,” he says.
Submit
your comment
Top
|
