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)

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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

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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)

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Scope of services

Preventive

Diagnostic

Therapeutic

Rehabilitation

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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

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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

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High cost Services Provided in the Year 2011/ 2012

Services Provided in the Year 2011/2012

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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

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Services Provided in the Year 2011/2012

Chemotherapy

197,000 visits for chemotherapy sessions

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Services Provided in the Year 2011/2012

Premium Vs Cost per Beneficiary(FY: 2010/2011)

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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

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Thank you