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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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Health insurance organization in egypt by dr abdel rahman el sakka

Health Insurance Organizationin Egypt

by

Dr Abdel Rahman El-Sakka

Health Insurance Organization, Chaiman

8 October 2012


Health insurance organization in egypt

Health Insurance Organization in Egypt

  • The pic of HIO


Health insurance organization hio

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


Hio current laws

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)


Hio current laws cont

HIO Current Laws (cont.)

Law 79/1975

  • Covers; Government, Public & Private employees

  • Premium: 4% of Total Salary (1% from beneficiary & 3% from employer)


Hio current laws cont1

HIO Current Laws (cont.)

Law 79/1975

  • Covers Pensioners

  • Premium: 1% of Salary


Hio current laws cont2

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)


Hio current laws cont3

HIO Current Laws (cont.)

Prime Minister Decree 1/1981

  • Covers widows (of HIO beneficiaries)

  • Premium: 2% of Salary


Hio current laws cont4

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


Hio current laws cont5

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)


Hio current laws cont6

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


Hio current laws cont7

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)


Total number of beneficiaries in thousands

Total Number of Beneficiaries (in thousands)

59%

8.3%

0.5%


Number of beneficiaries in millions

Number of beneficiaries (in millions)

Census: June 2010


Percentage of beneficiaries according to laws

Percentage of beneficiaries according to LAWS

Census: June 2010


Hio provides services to beneficiaries all over egypt from alexandria to aswan

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)


Scope of services

Scope of services

  • Preventive

  • Diagnostic

  • Therapeutic

  • Rehabilitation


High cost services provided in the year 2011 2012

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


High cost services provided in the year 2011 20121

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


High cost services provided in the year 2011 20122

High cost Services Provided in the Year 2011/ 2012

Long Acting Interferon Therapy

For more than 24,000

hepatitis C patient


Services provided in the year 2011 2012

Services Provided in the Year 2011/2012

  • HIO provided school children diabetic patients with around 16.700 Insulin pen


Services provided in the year 2011 20121

Services Provided in the Year 2011/2012

Gamma Knife Treatment

For 300 cases

of Brain Tumor


Services provided in the year 2011 20122

Services Provided in the Year 2011/2012

Renal Dialysis

  • 13,000 patients

  • 33 owned dialysis centers

  • (632 Haemodialysis device)

  • 455 contracted centers


Services provided in the year 2011 20123

Services Provided in the Year 2011/2012

Chemotherapy

197,000 visits for chemotherapy sessions


Premium vs cost per beneficiary fy 2010 2011

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


Premium cost sharing vs cost per beneficiary fy 2010 2011

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


Main challenges facing the current hio

Main Challenges Facing the Current HIO

  • Incomplete coverage

  • Different Laws & Systems

  • Unrealistic rates of premium


Main challenges facing the current hio1

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)


Health insurance organization in egypt by dr abdel rahman el sakka

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


Health insurance reform in egypt

Health insurance reform in Egypt

Aiming at:

  • Universal coverage

  • Sustainable financing resources

  • High level quality health care

  • Unifying the laws

  • Payer/provider split


Health insurance organization in egypt by dr abdel rahman el sakka

Thank you


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