The Critical Role of Fairness and Equity in Egypt's Universal Health Insurance System

Fairness and equity stand as cornerstone principles in public policy, wielding significant influence in public, political, and legal spheres. In the realm of universal health coverage (UHC), these values play a pivotal role, shaping both the motivation for UHC and the choices made on the path to its attainment. As Egypt strives towards UHC, it must grapple with the imperative of making progress fairly and equitably, particularly in expanding priority services, including more people, and reducing out-of-pocket payments.

Fairness and equity fundamentally revolve around the distribution of benefits and burdens in society.? While the precise definitions of these concepts may vary, they are often used interchangeably. Within this framework, two key dimensions emerge: horizontal equity, which demands equal treatment of relevantly similar cases, and vertical equity, which necessitates appropriately unequal treatment of dissimilar cases. These standards guide the distribution of health benefits, service coverage, and financial contributions to the health system.

In the pursuit of UHC, countries must balance the objectives of fairness and benefit maximization.

While fairness concerns the distribution of benefits across individuals, benefit maximization focuses on maximizing the total sum of benefits for society. Often, policies that are deemed most fair also yield the greatest sum of benefits. However, there are instances where the fairest policy may not align with the one maximizing benefits, requiring careful consideration and balancing of objectives.

Three guiding considerations emerge for choices on the path to UHC:

1. Fair distribution: Coverage and use of services should be based on need, with priority given to policies benefiting the worse-off groups.

2. Cost-effectiveness: Priority should be accorded to the most cost-effective policies, ensuring the optimal allocation of resources to generate maximum health benefits.

?3. Fair contribution: Contributions to the health system should be based on ability to pay rather than need, promoting the separation of service use from payment.

These guiding considerations offer direction for addressing critical issues of distribution on the path to UHC. However, they must be balanced against each other and other relevant concerns, emphasizing the need for nuanced decision-making and policy implementation.

In navigating Egypt's journey towards UHC, a steadfast commitment to fairness and equity is essential. By aligning policies with these principles and carefully weighing competing objectives, Egypt can chart a course towards a more inclusive and equitable healthcare system, ensuring that all citizens have access to essential health services without facing undue financial hardship.