Enhancing Egypt’s Primary Care System: The Gateway for Universal Health Insurance

Egypt is on the brink of a transformative journey in healthcare with the Universal Health Insurance System (UHIS). Egypt could set an ambitious initiative aims to bolster the country's primary care system by harnessing the potential of private sector engagement. Let's explore how this can be achieved and why it matters.

The Objective

The UHIS could set forth clear goals:

·       Strengthen Egypt's Primary Care System: Enhance private sector involvement to improve accessibility and ensure equitable healthcare delivery.

·       Expand Healthcare Access: Create a robust primary care system that efficiently refers patients to higher levels of affordable care.

The Current Landscape

Egypt’s primary care system, a cornerstone for effective healthcare delivery, faces significant challenges. Many Egyptians opt to bypass primary care providers, choosing pharmacists or specialists for their medical needs. This preference stems from perceived convenience, affordability, and accessibility, but it ultimately undermines the primary care system and leads to inefficiencies in patient referrals to higher levels of care.

Why Primary Care is Underutilized

Several factors contribute to the underutilization of primary care in Egypt:

· Accessibility and Convenience: Patients often find it easier to visit pharmacists or specialists directly rather than primary healthcare (PHC) providers.

· Self-Diagnosis and Seeking Specialists: Many individuals self-diagnose and consult specialists, bypassing the primary care system entirely.

· Fragmentation: The primary care sector is fragmented, with many small, informal clinics located in residential buildings, making it challenging for larger clinics to compete.

A Multifaceted Approach Forward

Enhancing Egypt’s primary care system under UHIS requires a comprehensive strategy. By integrating private providers, expanding primary care networks, and addressing regulatory hurdles, Egypt can create a stronger primary care sector, ensuring better health outcomes for all its citizens. Here’s how this can be done:

1. Regulatory Overhaul: Leveling the Playing Field

· Tackling Regulations: Address the regulatory environment that currently favors small, informal clinics, which creates an uneven playing field for larger clinics with higher operational costs and stricter regulations.

· Unified Rules: Create a unified set of rules and regulations for both public and private providers.

· Contractual Expansion: Allow providers to offer services from both public and private facilities, broadening the reach of primary care.

2. Addressing Sector Fragmentation: Building Networks

· Cohesive System Design: Develop a cohesive and efficient primary care system that integrates providers into a primary care network to enhance accessibility and coverage.

· Robust Networks: Establish primary care networks, including standalone clinics and integrated facilities with other providers like pharmacies, laboratories, and radiology centers, to improve access to high-quality, affordable care, especially in underserved areas.

· Expanded Services: Offer a broader range of services to make primary care more appealing and accessible to patients.

3. Value Creation Models: Linking Care Networks

· Affordable Care Hospitals: Invest in hospitals that provide affordable care to make healthcare accessible to a wider population.

· Spoke-Hub Model: Implement a system where primary care clinics (spokes) are connected to central hospitals (hubs), ensuring streamlined patient referrals and comprehensive care.

4. Private Health Insurance Market Development

· Complementary Services: Develop a list of non-essential health services to be covered under complementary private health insurance.

· Supplementary Services: Define rules for private insurers to develop supplementary insurance for essential health services and for private providers to deliver these services.

5. Supporting SMEs in Healthcare

· Financial Support and Incentives: Create financial support packages and offer tax incentives for small and medium-sized enterprises (SMEs) participating in UHIS.

· Simplified Processes: Simplify registration and accreditation processes for SMEs and address their unique challenges.

· Training and Technical Assistance: Implement training programs for clinical and managerial skills and offer technical assistance for best practices and regulatory compliance.

· Fair Contracting: Establish transparent contracting and reimbursement processes, promoting collaborative networks between SMEs and larger healthcare providers.

· Digital Health Solutions: Support the adoption of digital health solutions like electronic health records (EHRs) and telemedicine, and create innovation hubs for healthcare startups and SMEs.

· Public-Private Partnerships (PPPs): Promote collaborative PPP projects involving SMEs in UHIS delivery and facilitate shared resources and infrastructure to reduce costs and improve efficiency.

To turn this vision into reality, Egypt needs to:

· Engage Stakeholders: Work with private healthcare providers, policymakers, and patients to gather insights and foster collaboration.

· Launch Pilot Projects: Test and refine the proposed strategies through pilot projects.

· Monitor and Evaluate: Establish a framework for monitoring and evaluating the impact of these initiatives on primary care utilization and health outcomes.

By taking these steps, Egypt can create a primary care system using the private sector that is not only robust and efficient but also accessible and equitable, ensuring better health outcomes for all its citizens.

The Medical Syndicate Urges the President of Egypt Not to Sign the "Hospital Leasing" Law

Civil Society Develops Argument for Rejection

In recent days, Egypt’s Medical Syndicate has urgently appealed to the President not to sign the controversial law regulating the leasing of public health facilities to private sector companies, commonly referred to as the "hospital leasing" law. This appeal follows the House of Representatives' approval of the bill last week.

Initially returned for review on May 9, the law underwent amendments to reduce the allowed percentage of foreign workers and ensure service provision to state-funded healthcare beneficiaries. Despite these changes, which were perceived as favoring investor control, the law was approved by Parliament a few days later.

The Syndicate argues that the law jeopardizes the safety and health of citizens, destabilizes the health system, and lacks guarantees for the continued provision of services, particularly to low-income individuals. Concerns have been raised about the investor's commitment to treating social health insurance patients at the state's expense and the absence of clear criteria for selecting hospitals to be leased.

While the Syndicate supports private sector participation in creating and establishing new hospitals to enhance healthcare services, it opposes leasing existing government hospitals that primarily serve low-income Egyptians. The union warns that the law could jeopardize the jobs of 75% of workers in these facilities, including doctors, nurses, and administrators, as investors may choose to replace them or relocate them through the Ministry of Health. Additionally, there is apprehension about the possibility of investors hiring doctors from unrecognized universities, whom the union's general assembly has decided not to register.

Despite submitting their concerns to the Health Committee of the House of Representatives, the law was passed, sparking objections from doctors, representatives, and human rights organizations. They view the law as the state relinquishing its constitutional duty to provide health services, allowing private sector management that could compromise service fairness.

Key Objections from Civil Society

The Right to Health civil society organizations have further developed their arguments against the concession law, stating key objections:

1. Contracting Methods: The government can choose between public tender or direct agreement without needing parliamentary approval after presidential licensing.

2. Profit Limits: The law exempts investors from profit limits mandated by the "Public Utility Obligations" Law, potentially leading to high profits at the expense of public health.

3. Worker Job Security: The law threatens the stability of 75% of current health facility workers by allowing investors to replace them.

4. Quality and Access: Concerns exist about maintaining the proportion of beds allocated for government-funded treatment.

5. Regulatory Loopholes: The law allows significant flexibility for investors without ensuring necessary service quality and fairness.

Concerns About Implementation

Civil society raised additional concerns based on previous and practical experiences with private sector involvement in hospitals. This experience indicates a preference for well-equipped facilities in prime locations, often leading to higher costs without proportional quality improvements. The General Investment Authority had previously proposed numerous opportunities for private sector management of government health facilities.

Doctors criticize the law for making healthcare for the poor susceptible to profit motives. Before the law's official enactment, the government had already proposed leasing several hospitals to investors, raising further objections and fears.

Defense and Objectives of the Law

Proponents, including the Minister of Health and the Health Committee, claim the law benefits patients by not imposing additional financial burdens and enhancing service quality. The law aims to reduce government spending on healthcare, aligning with the state's policy of allowing private sector investment while maintaining public sector funding for essential services.

Call to Action

The Medical Syndicate calls on the President to reject the law, emphasizing its potential to harm public health and destabilize the health system. They stress the need for a more balanced approach that safeguards public health interests and worker security while encouraging private sector contributions to new healthcare infrastructure.