Abstract
Aim
The Government of Egypt has embarked on a process of reforming health care financing in the country. Under the influence of external advisers it, has so far focused on social health insurance as the main funding mechanism. Other options, in particular tax-based financing, have hardly been considered. In this article, social health insurance and taxation-based financing are analysed on their ability to meet Egypt's stated health policy goals and their viability.
Subjects and methods
Review of current health care financing arrangements in Egypt, of potential areas for improvement, and of stated health policy goals. Analysis of social health insurance and taxation-based financing on their ability to meet the stated policy goals and their viability.
Results
Although both funding mechanisms have distinct advantages and disadvantages when applied to the Egyptian health system, tax-based financing seems better able to meet the official policy goals of the Government of Egypt than social health insurance on grounds of efficiency, equity and technical feasibility.
Conclusions
The Government of Egypt will have to raise public health expenditure substantially to finance care at an adequate level. Expanding and refining the present tax-based financing scheme, rather than switching to an insurance-based scheme seems the technically superior strategy. Other measures to improve the coordination of financing, such as the creation of a single fundholding agency, are needed as well as tighter regulation of private providers and the pharmaceutical market.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abel-Smith B (1994) An introduction to health policy, planning and financing. Longmans, London
Ali Dau K, El-Amach HM (1997) Social safety nets: the social development fund in Egypt. In: Kanaan TH (ed) The social effects of economic adjustment on Arab countries. International Monetary Fund, Washington, DC, pp 98–127
Barnum H, Kutzin J, Saxenian H (1995) Incentives and provider payment methods. Int J Health Plann Manage 10:23–45
Donaldson C, Gerard K (1993) Economics of health care financing. The visible hand. Macmillan, London
Fargues P (1997) State policies and the birth rate in Egypt: from socialism to liberalism. Popul Dev Rev 23:115–138
Figueras J, Saltman R, Mossialos E (1997) Challenges in evaluating health sector reform: an overview. London School of Economics and Political Science, London
Food and Agriculture Organization (1996) Fact sheet: women, agriculture and rural development. Food and Agriculture Organization, Rome
Hertz E, Hebert JR, Landon J (1994) Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: results of a cross-national comparison. Soc Sci Med 39:105–114
Kandela P (1998) Oversupply of doctors fuels Egypt's health-care crisis. Lancet 352:123
Le Grand J (1998) Financing health care. In: Feachem Z, Hensher M, Rose L (eds) Implementing health sector reform in Central Asia. World Bank, Washington, DC, pp 75–85
Litvack J, Bodart C (1993) User fees plus quality equals improved access to health care: results of a field experiment in Cameroon. Soc Sci Med 37:369–383
Ministry of Economy (2000a) Monthly economic digest Feb. 2000. Ministry of Economy, Arab Republic of Egypt, Cairo
Ministry of Economy (2000b) Quarterly economic digest Oct.–Dec. 1999. Ministry of Economy, Arab Republic of Egypt, Cairo
Ministry of Foreign Trade (2004) Quarterly economic digest April–June 2004. Cairo, Arab Republic of Egypt
Ministry of Health and Population and Harvard School of Public Health (1998a) Egypt Provider Survey Report. Cairo and Boston, Ministry of Health, Arab Republic of Egypt and Harvard School of Public Health
Ministry of Health and Population and Harvard School of Public Health (1998b) Health Care Utilization and Expenditures in the Arab Republic of Egypt 1994–95. Ministry of Health and Population, Arab Republic of Egypt, and Harvard School of Public Health, Cairo and Boston
Mossialos E, Le Grand J (1999) Cost containment in the EU: an overview. In: Mossialos E, Le Grand J (eds) Health care and cost containment in the European Union. Ashgate, Aldershot, pp 1–154
OECD (1992) The reform of health care. A comparative analysis of seven OECD countries. OECD, Paris, France
Partnerships for Health Reform (1999) A new Egyptian Health Care Model for the 21st Century. Partnerships for Health Reform for the Ministry of Health and Population of the Arab Republic of Egypt, Bethesda and Cairo
Popkin BM, Lu B, Zhai F (2002) Understanding the nutrition transition: measuring rapid dietary changes in transitional countries. Public Health Nutr 5:947–953
Rafeh N (1997) Private health insurance in Egypt. In: Schieber GJ (ed) Innovations in health care financing. World Bank Discussion Paper No. 365, Washington, DC, pp 115–125
Rannan-Eliya RP, Nada KH, Kamal AM, Ibrahim Ali A (1998) Egypt National Health Accounts 1994/95. Department of Planning, Ministry of Health and Population, Arab Republic of Egypt, and Data for Decision Making Project, Harvard School of Public Health, Cairo and Boston
Rutten F (1993) Policy implications of the COMAC-HSR project. In: van Doorslaer E, Wagstaff A, Rutten F (eds) Equity in the finance and delivery of health care: an international perspective. Oxford University Press, Oxford, pp 88–100
Salem MA (2002) Policy Research in Egypt's Health Sector Reform. Working Paper No. 13. The Alliance for Health Policy and Systems Research, Geneva
Sallam I (1998) Health care in Egypt. Lancet 352:1632
Saltman RB, Figueras J (1997) European health care reform. Analysis of current strategies. WHO, Regional Office for Europe, Copenhagen
Savedoff WD (2004) Is there a case for social insurance? Health Policy Plan 19:183–184
Schieber G (2004) Health reform in the MENA region: the future is now. 2004. Beirut, Lebanon, Global Medical Forum Foundation Middle East Summit, 12 May 2004
The Economist (1999) A survey of Egypt: new and old. The Economist, pp 1–18
The Economist (2003) Pocket world in figures. The Economist, London
UNDP (1999) MicroStart Pilot Project: Component I Technical Service Provider. Egy/99/011. United Nations Development Program, New York
UNDP (2003) Human development report 2003. United Nations Development Program, New York
Wagstaff A (1992) Equity in the finance of health care: some international comparisons. J Health Econ 11:361–387
World Bank (1998) Project appraisal document for a proposed credit in the amount of SDR 66.8 million (US$90.0 million equivalent) to the Arab Republic of Egypt for a health sector reform program. World Bank, Washington, DC
World Bank (2004a) Egypt, Arab Republic at a glance. World Bank, Washington, DC
World Bank (2004b) World development report 2004. World Bank, Washington, DC
World Health Organization (2004) World health report 2004: changing history. World Health Organization, Geneva
Acknowledgements
I would like to thank Professor Anne Mills from the London School of Hygiene and Tropical Medicine for her helpful comments to an earlier draft of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gericke, C.A. Financing health care in Egypt: current issues and options for reform. J Public Health 14, 29–36 (2006). https://doi.org/10.1007/s10389-005-0006-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-005-0006-4