Is It Time For Egypt To Consider Expanding Universal Health Insurance Coverage Based on Needs: The Better Path To Replace Geographic Expansion

Expanding universal health insurance coverage in Egypt is a pressing necessity, but the method of implementation is crucial for its success. Egypt's current strategy involves a phased geographic rollout of the Universal Health Insurance System (UHIS), which focuses on gradually expanding coverage region by region, and governorate by governorate withing a region. While this approach aims to manage the transition smoothly and ensures that the cost does not exceed the budget, it falls short in addressing the urgent needs of the population comprehensively and equitably. Instead, a phased approach based on needs within the means we have, aligned with guidance from both the World Health Organization (WHO) and the World Bank, promises a more effective and fair solution.

The Limitations of the Geographic-Based Approach

The geographic-based approach currently adopted by Egypt involves a step-by-step implementation of UHIS across different governorates. While this method has its advantages, such as easier management of resources and logistics in smaller increments, it also has significant drawbacks:

1. Inequitable Coverage: Regions included later in the rollout suffer from prolonged periods of inadequate healthcare services and lack of adequate financial protection exposing these population to continue to spend on their healthcare out of pocket. This creates and perpetuates disparities between early and late adopters, exacerbating existing inequities in healthcare access and quality. With the slow rate of expanding universal health insurance by region and by governorate, this gap in coverage is increasing in absence of effective alternatives to serve those populations not covered by the UHIS.

2. Resource Allocation Challenges: Focusing on entire regions rather than areas with the highest need can lead to inefficient use of resources. Regions with less pressing healthcare needs may receive new services that are not based on need before areas experiencing critical shortages, resulting in misallocation of limited resources. On the other hand, the UHIS continue to accumulate reserves in a strict risk averse strategy to build resilience fearing what it seems an undefined risk not capitalizing on its actuarial and national health account studies.

3. Delays in Health Improvements: The geographic approach inherently delays health improvements for many citizens. People in later phases continue to face the same healthcare challenges, potentially for years, until the rollout reaches their region. These people, probably representing the majority of Egypt’s population, continue to lack access and to spend out of pocket suffering from the problems of the old health insurance system and the program for the treatment on the expense of state driving more people to opt out of the system.

The Needs-Based Approach: A Superior Alternative

A phased approach based on need, rather than geography, offers a more equitable and efficient path to expanding healthcare services. This strategy aligns with WHO guidance on making fair choices on the path to universal health coverage and World Bank guidance on expanding services gradually based on affordability and need. Here's why a need-based approach is superior:

1. Equitable Distribution of Resources: By prioritizing areas with the greatest healthcare deficiencies, a need-based approach ensures that those most in need receive attention first. This aligns with WHO's emphasis on equity, ensuring that vulnerable and underserved populations are not left behind.

2. Improved Health Outcomes: Targeting regions with the highest health burdens—such as high rates of disease, inadequate medical facilities, and poor health indicators—can lead to more significant and immediate health improvements. This method addresses the most pressing health issues first, reducing overall morbidity and mortality rates more effectively.

3. Efficient Use of Resources: A need-based rollout allows for better allocation of resources, ensuring that investments in healthcare infrastructure and services yield the maximum benefit. This prevents wastage and ensures that every dollar spent contributes to substantial health improvements.

4. Flexibility and Responsiveness: This approach is inherently more flexible and responsive to changing health landscapes. As new data on health needs emerges, resources can be reallocated to address emerging hotspots or crises, maintaining a dynamic and adaptive health system.

WHO and World Bank Guidance on Expanding Coverage of Healthcare Services

Both the WHO and the World Bank provide essential guidance for expanding coverage of healthcare services:

1. WHO Guidance on Making Fair Choices:

?? - Progressive Universalism: This principle advocates for prioritizing the most disadvantaged groups first to ensure that everyone, especially the most vulnerable, can access essential health services. A need-based approach aligns perfectly with this principle by targeting areas with the greatest healthcare deficiencies.

?? - Equity in Resource Distribution: WHO emphasizes the importance of fair resource distribution to achieve health equity. A need-based approach ensures that resources are directed where they are most needed, reducing disparities in healthcare access and quality.

?? - Financial Protection: WHO's guidance highlights the need to protect individuals from financial hardship due to health expenditures. By focusing on regions with the highest health burdens and the least capacity to pay, a need-based rollout can provide greater financial protection for the most vulnerable populations.

2. World Bank Guidance on Gradual Expansion:

?? - Affordability: The World Bank stresses the importance of expanding services gradually based on what is financially sustainable. A need-based approach ensures that resources are used where they can have the greatest impact, making the expansion more affordable and sustainable.

?? - Needs-Based Prioritization: The World Bank supports prioritizing services based on the greatest need, which aligns with WHO's emphasis on equity and efficiency. This ensures that health improvements are targeted and impactful.

?? - Sustainable Financing: By focusing on affordability, the World Bank's guidance helps ensure that health system expansions do not overburden the country's finances, leading to a more stable and sustainable healthcare system.

Conclusion

While Egypt's current geographic-based phased rollout of UHIS aims to systematically expand healthcare services, it falls short in addressing urgent needs equitably and efficiently. Adopting a phased approach based on healthcare needs would better align with both WHO and World Bank guidance on universal health coverage and gradual expansion based on affordability and need. This strategy ensures equitable distribution of resources, improved health outcomes, efficient use of funds, and a more responsive health system. For Egypt to achieve true universal health coverage, prioritizing need over geography is not only preferable but essential.