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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 Organization, Chaiman 8 October 2012. Health Insurance Organization in Egypt. The pic of HIO. Health Insurance Organization (HIO).

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slide1

Health Insurance Organizationin Egypt

by

Dr Abdel Rahman El-Sakka

Health Insurance Organization, Chaiman

8 October 2012

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)
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

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)
slide29

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
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