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Health care insurance is the hope of citizens
Brother and sister labourers
Health care insurance system has started to be applied in Egypt since the mid-sixties, when the country started to build a strong productive state, in an unequivocal way that guarantees a good health for the citizens. Therefore, the public institution of the healthcare insurance was established in October, 1964, on Alexandria. Many laws were passed then, where those laws fostered the philosophy of the social solidarity and equality among all citizens in receiving treatments, and protecting the citizen's right of health care insurance. Those rights were protected by the current social insurance laws, like law no.79, 1975, and its amendment; law no.112, 1980; law no.108, 1976, and its amendments. In addition, there were many confirmations that those rules would be protected, in order to guarantee the country's advance in all aspects.
The health care system in Egypt:
Heath care system in Egypt suffers a great mess, as it consists of many unrelated sub-systems; the healthcare insurance system, the free treatment system, the state afforded treatment system, and the private system. All those different, unrelated, systems make the health care services in Egypt a huge anarchy, where we can't exclude the health care insurance system from that anarchy. Although the different laws, issued for regulating the health care system, aimed to guarantee the rights of hierarchical health care insurance system for all citizens, and to endeavor the raise of the services efficiency; those laws couldn't achieve any of such goals till now. On fact, there are many attempts to regulate the healthcare insurance system in Egypt, especially the main healthcare insurance system that suffers, after more than fifty years, many defects; citizens disapprove the level of the services and the efficiency of those who serve them. They denounce the stoppage of revamping the healthcare system. In addition, the shortage, or nearly the absence, of the insurance services in the countryside represents a great shortage in the health care insurance system. Such shortage could be easily found on those regions that have poor, or even absent, coverage comparing to the urban areas. On those areas, insurance coverage didn't exceed 37% of the whole population. In addition, health care expenditure is a problem that is considered as one of the main foreclosures that hinders any attempt to reform the healthcare insurance system; where the rate of families spending on health services are 60% of the total expenditure on health. Moreover, the health care insurance part, in the general budget, has been deteriorated; it didn't exceed 5% of the amount of spending in the balance sheet.
The new law of the healthcare insurance:
The government has tackled its efforts to finish the new healthcare insurance project. It dubbed it "the comprehensive law of social healthcare insurance. This law is considered as a fore step towards the advance of the Egyptian community, because it did, for the first time, connect the healthcare system with the current systems and laws of the social insurance. However, by looking at the clauses of the new law, it is apparent that it, profoundly, ruins the social and economical rights gained by many sectors of the Egyptian society. Those gained rights were granted by laws issued for so many years; more than half century, but the new law, reflecting the new policy of privatization that is adopted by the Egyptian regime, stated the new deformed system of the healthcare insurance.
The new law represents a grave violation to the rights of workers and poor:
In the defining clause number1, the law mentioned the incapable sectors, without a clear detection. It left detecting those sectors to the prime minister, based upon the clarification of minister of social solidarity and minister of finance.
Clause 4, relating to the health care insurance services, referred to what would be granted by the current healthcare insurance, in stead of referring to what is stated by the current law of the health care insurance (Law no.79, for 1975; law no.32, 1975; law no.99, 1992). Such a clause represents an intentional ignore that assure the weakness of the current healthcare system, its inability to offer the services stated in the law, and inability to be developed. Even more, this clause affirms that the new law will offer the same services offered by the old one, without any real revamp.
Clause 5 speaks about the personal healthcare disasters. The new law didn't explain, clearly, what is meant by the personal healthcare disasters, leaving the detection of the rate and the applicable cases to the decision of the prime minister, based upon the reports of the minister of social solidarity, and the minister of health, which affects negatively the monetary fund of the healthcare insurance. This problem, dangerously, refers to the fact that many acute diseases, like cancer, viral hepatitis, and cardiac diseases, which urgently requires huge amount of money for its treatment, would be out of the insurance coverage. Excluding such diseases from health care insurance represents a deep violation to what was stated by the world health organization regarding the issue of personal disasters. The world health organization considered the personal disaster as cases related the ability of the family to pay for its healthcare; where any medical spending that exceeds 40% of the family income is considered as disastrous, with no need to mention the nature of the disease or whether it is chronic or not. In addition, the new law ignored speaking about the total or partial disability cases, and the medical committees that detect the disability percentage, according to the social legislations. That tendency of the new law threats all those who work by wages, and covered by the healthcare insurance, in case they suffer any disability.
Funding:
There are continuous debates about the deterioration of the economic circumstances for many sectors in the Egyptian society because of the raise of prices and decrease of wages, which negatively affected the Egyptian family, so it became impossible for families to spend on their medical needs. Such impossibility is clear in the cases of workers, retired persons, and employed persons with variable and temporarily incomes. The core of the idea of healthcare insurance is the solidarity between members of the society via contribution box; the member in the health care insurance pays for medical service offered to him in advance, in the form of paid subscription. However, the new law increases the amount of the subscription for each member, in addition to additional expenses. Clause 7 stated the percentage of the shares to be paid by the insured person in the medicine prices and medical services costs, which shall not exceed 20% of the hospital costs. For example, when an individual has a surgery of replacing a joint, a medical case that spreads among old people that costs 100 thousand pounds, he would pay 20 thousand pounds for the surgery. This constitutes a grave violation to the social insurance laws that guarantees the right of healthcare insurance. Then, clause 9 states that public safe does pay the full amount of the subscription for children, children who strayed from education, and students at schools, universities and institutions, who are eligible for total or partial support, according to what is detected by minister of health and social solidarity. This clause is vague, as it didn't detect the conditions, or the nature of the rating to be followed by the two ministers to detect who have the right to be granted the support.
1- The head of the family is responsible for paying the subscriptions of the unemployed espouse, and sons fostered by the parent; children before education, strayed child from education, and unemployed sons. In case of the death of the head of the family, the legal guardian should pay the subscriptions of the children. In addition, schools, universities, and private institutions are obliged to take subscriptions from children, while paying educational fees. Those clauses prove that the law deals with individuals, not a society. The law doesn't consider the family as a social unit, and deals with the family in an individualistic way, which increases the burden of the family. It is clear that problem of excessive birth of children exists, in a touchable way, among farmers and poor people, who suffer from an increasing deterioration of incomes. Therefore, they wouldn't be able to pay the amounts of the subscriptions. The aforementioned clause contradicts, totally, with the country allegations of supporting law income persons.
Clause 8, part 2: This part states the prices of the luxurious services, to be afforded by the beneficiary out of the insurance coverage, which is ranged between 5-20 pounds per each day of staying at hospital, with a maximum level 50 pounds of the costs. This part affirms that the new law will lead to unequal medical service to all participants, which contradicts with the concept of healthcare insurance and its laws; that all medical services must be granted to all citizens with equality. This law affirms that healthcare insurance would not stay away from privatization.
Clause 11 states that a national department for organizing, surveillance, and application of the quality of medical services should be established, based upon a decision from the president of the republic, where its specializations and system of its work should be extended. This clause is vague, and it doesn't detect the participating elements in the departments or its components, which paves the way for private companies and investors to intervene in the project. The clause, also, denied any role for the current healthcare insurance department in the organization, or the surveillance; in fact, the law ignored the members of the healthcare insurance and their rights to supervise, also it ignored the role of the current administration and the general assembly as well. Therefore, this law affirmed that the healthcare insurance shall be an item used in investments and privatization.
The center considers what was stated in the clauses of that law, especially the parts pertaining to the social gains that were acquired by the Egyptian society after a long struggle, as a profound prejudice and breach, committed by the country government, against the constitution and the international organizations; the country adopted private policies that only helps a junta of beneficiaries, ignoring the public good of the majority of the Egyptians. The center calls upon the human rights organizations to confront that project, and to invite different syndicates, governmental institutions, different departments, newspapers, and the legislators of the country to discuss this law, hinder its pass, and prepare an alternative law.