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National Health Accounts (NHA) in EgyptOverview and Key Findings Dr. Mahmoud Farag
Evolution of NHA in Egypt • Since 1994, the MOHP in collaboration with USAID, has been a pioneer in the area of NHA. • Egypt was among the first low and middle income countries to conduct National Health Accounts. • Lead the NHA efforts in the region: • First round: 1992 -93 • Second round: 2001-02 • Third round: 2007-08 • Fourth round 2008-09 • Lack of institutionalization has meant sporadic production and use of NHA.
Key Findings * THE: Total Health Expenditures
Key Findings * GDP and GOE expenditure data from Ministry of Finance
Sources of Financing: Who Pays for Healthcare? Households continue to remain the single largest source of health financing
Financing Agents: Who Manages the Health Funds?
Providers: Where Does the Money Go? In 2008/09, spending at private facilities accounted for 64 percent of total health spending. Of this spending, pharmaceuticals and private clinics accounted for half of all health spending in Egypt
Egypt Compared to other Middle Income Countries in the Region • Egypt has highest burden of out-of-pocket spending. • Government spending both as a percent of THE and Budget is the lowest.
Summary of Overall Findings • The private sector remains the primary provider of outpatient services accounting for 80% of all visits: • Private clinics and pharmacies are main private providers. • More visits occur at MOHP hospitals as compared with MOHP outpatient facilities. • The Ministry of Health and other public providers account for 62% of all inpatient admissions.
Summary of Overall Findings • There are a number of differentials in per capita spending: • Urban areas spend more than rural areas. • Major cities spend the most and rural upper Egypt the least. • Females spend more than Males. • Those in the highest income quintile spend nearly 4.5 times as compared with those in the lowest income quintiles. • The insured spend less as compared with the uninsured.
Inequity • Highest income quintile uses over twice as many outpatient visits as compared with those in the lowest income quintile • Highest income quintiles spend four times more on outpatient care and over ten times as much on inpatient care • However, the poor spend a higher proportion of household income on health as compared with the rich
Policy Implications • Increase public investments in health. Need for “smart spending”. • Need to address inequities between rich and poor, urban and rural. • Fast-track comprehensive insurance reforms • Comprehensive pharmaceutical reforms • Make the private sector a true partner
Institutionalizing NHAs • MOHP can not tell on a monthly basis what it spends by governorate, by hospital, by primary health care facility or by program. • Hospitals and primary health care centers do not have information on the cost and efficiency of services they produce. • Put a system in place whereby: • NHA, • Expenditure tracking routine activities of the MOH • Costing