1 / 31

Health Insurance Organization in Egypt by Dr Abdel Rahman El- Sakka

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).

munin
Télécharger la présentation

Health Insurance Organization in Egypt by Dr Abdel Rahman El- Sakka

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Insurance Organizationin Egypt by Dr Abdel Rahman El-Sakka Health Insurance Organization, Chaiman 8 October 2012

  2. Health Insurance Organization in Egypt • The pic of HIO

  3. 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

  4. 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)

  5. HIO Current Laws (cont.) Law 79/1975 • Covers; Government, Public & Private employees • Premium: 4% of Total Salary (1% from beneficiary & 3% from employer)

  6. HIO Current Laws (cont.) Law 79/1975 • Covers Pensioners • Premium: 1% of Salary

  7. 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)

  8. HIO Current Laws (cont.) Prime Minister Decree 1/1981 • Covers widows (of HIO beneficiaries) • Premium: 2% of Salary

  9. 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

  10. 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)

  11. 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

  12. 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)

  13. Total Number of Beneficiaries (in thousands) 59% 8.3% 0.5%

  14. Number of beneficiaries (in millions) Census: June 2010

  15. Percentage of beneficiaries according to LAWS Census: June 2010

  16. 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)

  17. Scope of services • Preventive • Diagnostic • Therapeutic • Rehabilitation

  18. 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

  19. 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

  20. High cost Services Provided in the Year 2011/ 2012 Long Acting Interferon Therapy For more than 24,000 hepatitis C patient

  21. Services Provided in the Year 2011/2012 • HIO provided school children diabetic patients with around 16.700 Insulin pen

  22. Services Provided in the Year 2011/2012 Gamma Knife Treatment For 300 cases of Brain Tumor

  23. Services Provided in the Year 2011/2012 Renal Dialysis • 13,000 patients • 33 owned dialysis centers • (632 Haemodialysis device) • 455 contracted centers

  24. Services Provided in the Year 2011/2012 Chemotherapy 197,000 visits for chemotherapy sessions

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

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

  27. Main Challenges Facing the Current HIO • Incomplete coverage • Different Laws & Systems • Unrealistic rates of premium

  28. 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)

  29. 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

  30. Health insurance reform in Egypt Aiming at: • Universal coverage • Sustainable financing resources • High level quality health care • Unifying the laws • Payer/provider split

  31. Thank you

More Related