Egypt's new health care law has medical community worried

The Egyptian Cabinet's approval of a new health care law raised concerns over the potential for the bill to lead to the privatization of state-owned hospitals.

al-monitor A man walks in front of an ambulance arriving at El Salam Hospital, in Hurghada, south of Cairo, Egypt, July 14, 2017.  Photo by REUTERS/Mohamed Aly.
Ahmed Gomaa

Ahmed Gomaa


Topics covered

cairo, salaries, law, doctors, ministry of health, health care, hospital

Nov 16, 2017

CAIRO — The Egyptian government's approval Oct. 25 of a new health care draft law has sparked fears within the Egyptian Medical Syndicate (EMS) and among local health specialists over the government's tendency to privatize public hospitals, especially those that might not meet the quality standards set by the new law. The draft law has now been referred to the House of Representatives for discussion and approval.

In a bid to get rid of the old system wherein Egyptians pay high prices in return for hospital and clinical treatment, the government approved the new health insurance law. This draft law, media reports say, also aims to improve the conditions of government hospitals suffering from several problems, as it stipulates a health care system whereby citizens should enjoy excellent health services.

Under Law No. 79 of 1975, which is currently in force, citizens’ contribution to health insurance accounts for 4% of their monthly wage — 3% of which is covered by employers and 1% by employees. Under the new draft law, citizens’ contribution accounts for 5% of their monthly wages, with 4% to be paid by employers and 1% by employees.

Egyptian Minister of Health Ahmed Emad Eddin said during a press conference held Oct. 25 that the standards set by the quality control body established by the new system should be met by all of the hospitals. Otherwise, he said, these would not be included in the system.

For its part, the EMS said the fate of government hospitals, doctors and medical staff is nebulous and voiced concerns that these would not be included in the new system. The privatization of public hospitals would infer high treatment costs. Mahmoud Fuad, a doctor, told al-Wafd newspaper on Oct. 28 that only 20% of the 660 government hospitals are committed to safety and infection control standards, meaning that many government hospitals would not be included in the new law.

Mona Meena, the EMS representative, voiced concerns over the state of uncertainty surrounding the health care law when it comes to the fate of government hospitals that do not meet the quality standards set by the law.

“The draft law that we have been informed of did not tackle the fate of the hospitals that do not meet the quality standards set by the law. Will they be shut down after having treated patients for years and years? What about the doctors, technicians and other people who work at those hospitals? These are questions that need to be answered,” she told Al-Monitor.

“There is a media campaign hailing the positive aspects of this law, but the government has yet to answer several questions. This law seriously affects the lives of Egyptians and will be relied upon in the medical services provided [to citizens], and we have to get answers to these questions,” she added.

"This law seriously affects the lives of Egyptians and will be relied upon in the medical services provided [to citizens]."

In the same context, Ehab el-Taher, the EMS secretary-general, described the negative aspects of the draft law in a Facebook post on Oct. 31. He pointed out that the new health care system will only contract public and private hospitals that have quality certificates.

The law, according to Taher, also fails to tackle the salaries of doctors and workers, and this will repel doctors and deepen the shortage of medical specialists.

Doctors earn low salaries, ranging from 1,218 Egyptian pounds ($69) to 6,365 Egyptian pounds ($361) per month, which leads them to emigrate at a time when [Egyptian] hospitals are suffering from a shortage of doctors. There is only one doctor for every 800 citizens.

Alaa Ghannam, a member of the governmental committee tasked with preparing the health care law, told Al-Monitor that the law aims to eliminate the disadvantages of the current system and is designed to reform the health care system in general. He stressed that the quality control body to be established under the new draft law will start reforming and including government hospitals in the new health care system once parliament approves the draft law. He denied rumors about those being sold to the private sector and said, “These hospitals are state-owned, so why would the state let go of them?”

Ghannam pointed out that government hospitals in five governorates will be contracted as part of the first phase of the health care law, and their conditions will be adjusted in accordance with the health requirements of the new law, knowing that the government will provide them with the necessary funds to do so.

Abdul Hamid Abaza, the head of the governmental committee tasked with preparing the health insurance law, told Ad-Dustour newspaper Nov. 1 that “the idea of contracting hospitals is very ordinary and is not intended to exclude government hospitals that do not meet the quality standards set by the law, nor is it aimed at privatizing them. Of course, the law provides for the development of hospitals, and this is one of the reasons the law was attacked for a long time based on concerns whereby hospitals that cannot enter the fray will be privatized, but this is not true. There is no privatization intention. The hospitals that do not meet the new quality standards will be given a chance.”

The new health insurance law in Egypt will be implemented in six phases, the first of which — from 2018 to 2020 — starts six months after parliament approves the law. It will be implemented in five governorates: Port Said, Ismailia, Suez, North and South Sinai. The law will be fully implemented across all governorates in 2031.

Mohammed al-Ammari, the head of the Health Committee in the House of Representatives, told Al-Monitor over the phone that the committee will start holding sessions with specialists, the EMS and civil society institutions to develop the health insurance law, explain the law details and answer the questions of all concerned parties and specialists.

Ammari said, “The new law is a quantum leap, as it provides the necessary health care to citizens. It goes in line with the Egyptian Constitution, which provides for the Egyptian citizens’ right to health care. This law will eliminate the negative effects of the current system amid depleted hospitals and poor health services.”

A source at the Egyptian Ministry of Health told Al-Monitor on condition of anonymity that those who drafted the law will participate along with several ministry officials in sessions to be held by the Health Committee of the House of Representatives in the coming days, in a bid to explain the details of the law articles and answer all the questions that the people have raised.

In an interview on “Hona al-Asema” on CBC on Oct. 29, Ali Hijazi, the head of the General Authority for Health Insurance, which is affiliated with the Ministry of Health, pointed out that the new law is binding on all citizens and said it allows everyone to have a health card at any hospital they choose, provided the hospital meets the quality standards. In order to get this card, citizens would have to pay a monthly contribution accounting for 1% of their monthly salaries.

Despite the importance of the new health insurance law for Egyptians currently suffering from bad health services, doctors are waiting for the government to dispel fears over their status and that of government hospitals that are incompatible with the new standards.

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