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Health Insurance Organization in Egypt by Dr Abdel Rahman El- Sakka

Health Insurance Organization in Egypt by Dr Abdel Rahman El- Sakka Health Insurance Organization, Chaiman 8 October 2012. Health Insurance Organization in Egypt. The pic of HIO. Health Insurance Organization (HIO).

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Health Insurance Organization in Egypt by Dr Abdel Rahman El- Sakka

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  1. Health Insurance Organizationin 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 20th 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. Total Number of Beneficiaries (in thousands) 59% 8.3% 0.5%

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

  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)

  17. Scope of services • Preventive • Diagnostic • Therapeutic • Rehabilitation

  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

  19. High cost Services Provided in the Year 2011/ 2012 • 372 Corneal transplantation • 258 Bone marrow transplantation • 358 Cochlear implantation • 92 Liver transplantation • 1300 cases of GH deficiency in children

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

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

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

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

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

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

  26. Premium & Cost Sharing Vs Cost per Beneficiary(FY: 2010/2011)

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

  28. 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)

  29. 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

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

  31. Thank you

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