x Abu Dhabi, UAETuesday 23 January 2018

Patients and doctors have waited 10 years for reform legislation

But the bill to reform healthcare in Egypt is in limbo as politicians sort out the details.

CAIRO // When Alaa al Din Ghanaam, a healthcare activist, discusses Egypt's treatment at the expense of the state (TES) programme, he cannot help but quote Milton Friedman, the American economist: "There is nothing so permanent as a temporary government programme." TES, which was designed to distribute state money to poor patients for one-time medical procedures before it became the subject of a graft investigation in parliament this year, has acted as a "temporary" solution to Egypt's healthcare woes in one form or another since the late 1950s.

But according to healthcare officials, TES and its attendant abuses will be withdrawn when parliament passes the comprehensive healthcare legislation for which patients and doctors have been waiting for 10 years. Until then, healthcare professionals said, TES offers a lifeline to the country's hospitals and clinics, which can expect government financing to cover about three months' worth of annual operating costs, said Samir Fayad, a physician and the deputy of the leftist El Tagammu Party.

"It's well known that this is a temporary system. It's going to stop once the new national insurance law comes into action," said Hamdy al Sayyid, the chairman of the People's Assembly's health and environment committee and a prominent member of the ruling National Democratic Party (NDP). "That was going to be during this parliamentary session, but now there is talk that [the legislation] is going to be postponed to the next session for the new parliament."

Such "talk" of postponing passage of the new healthcare law never seems to stop, said Dr Ghanaam, the health and human-rights programme director at the Egyptian Initiative for Personal Rights (EIPR), a Cairo-based non-governmental organisation. Meanwhile, about half of Egypt's population scrapes by without real medical coverage. The problem, said Dr Ghanaam, is quite simple: wealthy Egyptians refuse to pay for the health care of the poor.

"I've been in the health ministry and health insurance for 25 years. Health is not on the agenda of the state, unlike other matters," he said. "Until now the public spending for health in the budget is less than five per cent of total spending. We're promoting that more than 10 per cent [of the budget] should be allocated for health." The latest iteration on healthcare reform - a piece of legislation that has been in limbo for 10 years - is not yet available for publication, ministry officials said, because politicians are still sorting out the details.

Despite the delays, most of those involved in the debate appear to agree on the bill's primary aims: to provide health care for all while separating the institutions that provide medical care from those that finance it. As it stands, Egypt's governmental insurance provider, the Health Insurance Organisation, also finances the hospitals and clinics - an arrangement health experts say is a clear conflict of interest.

"We are going to adopt the slogan that 'money will follow the patient'," said Mohammed Maait, the deputy minister for social insurance and pensions in the ministry of finance. "You, as a patient, can decide where to go, but within a system." Such sound bytes did little to mollify opposition-minded healthcare reformers during last year's parliamentary session, when activists loudly resisted what they said were ministry plans to privatise health care.

The Court of Administrative Justice ruled in favour of an EIPR lawsuit against the prime minister in 2008, declaring unconstitutional health ministry plans to form a private holding company that could buy and sell government-owned health facilities. Despite such hiccups, ruling party MPs have not given up. The latest draft bill, part of which EIPR was allowed to review, will find new ways of stumping up to cover a budget shortfall of 17 billion pounds (Dh11bn) the ministry of health said will be necessary to cover every Egyptian.

Instead of creating a semi-private holding company capable of financing itself, the treasury will foot the bill for the estimated one-third of Egyptians whose low incomes exempt them from paying taxes into the system. Premiums from employers and employees, as well as co-payments from patients, would cover yet another third of the cost. Such a plan would leave the final third of the costs open to debate. Ideas have been floated: increasing the paltry ten piastre tax on cigarettes, which are widely consumed in Egypt, could cover part of the financing gap. Taxes on alcohol, real estate and tourist hotel stays may cover the rest.