Are We Doing Enough to Include All the Poor and Vulnerable Under Egypt's Universal Health Insurance System?

Egypt's Universal Health Insurance System (UHIS) promises to provide comprehensive healthcare coverage for all Egyptians, particularly targeting the poor and vulnerable. However, questions remain about whether the current implementation truly meets these objectives.

Recent legislative efforts in the form of providing subsidies to cover the insurance premiums of the poorest citizens and the Prime Minister's decree expanding targeting vulnerable groups, alongside existing social programs like Takaful and Karama, illustrate Egypt's commitment to social equity.

This article explores the current state of UHIS in reaching the poor, identifies key challenges, and proposes a way forward for a fairer and more equitable healthcare system.

Legal Framework: UHIS Law No. 2 of 2018

The UHIS Law No. 2 of 2018 is a landmark legislation aimed at transforming Egypt's healthcare system to ensure that all Egyptians have access to quality healthcare without financial hardship. The law mandates universal insurance coverage, ensuring every citizen is included, with a particular focus on the poor and vulnerable populations. It provides government subsidies to cover insurance premiums for the poorest citizens and requires mandatory participation from all Egyptians for risk pooling, either through direct payments or government support, to create an inclusive and financially sustainable healthcare system.

Prime Minister Decree on Expanding Vulnerable Groups

A Prime Minister's Decree issued in November 2023 clarified the definition of poor and vulnerable groups eligible for coverage under Egypt's Universal Health Insurance System (UHIS). Eligibility includes beneficiaries of solidarity programs like Takaful and Karama, social security, and child pensions however setting a limit not to exceed the poorest 30 percent of the population. It also covers unemployed individuals, those unfit to work, people in social and health care institutions without income, individuals with disabilities, residents of disaster-affected areas, and those with insufficient income to meet basic needs. These criteria are to be reviewed and adjusted every two years to maintain their relevance and effectiveness.

Limitations of the Ministry of Social Solidarity “Takafoul and Karama” Program Due to Insufficient Resource Allocation from the Ministry of Finance

Despite the legal safeguards provided by Egypt's Universal Health Insurance System (UHIS), significant gaps persist in the coverage of the poor and vulnerable. As of 2022, Egypt’s national cash transfer programs, Takaful and Karama, have reached 17 million poor beneficiaries, covering approximately 16% instead of estimated poverty rates reaching 30% of the population. The capped funding from the Ministry of Finance for the Ministry of Social Solidarity's cash transfer program, Takafoul and Karama (T&K), means that a considerable portion of the poor remains uncovered. As a result, excluding of poor people from T&K program leads to exclusion from Egypt’s universal health insurance system, leaving many impoverished families without essential healthcare services.

Administrative Burdens Hindering Eligible Beneficiaries to Automatically Enroll in the UHIS

Beyond insufficient funding and exclusion of a substantial number of the poor limiting eligibility, one of the primary obstacles hindering the poor from accessing the Universal Health Insurance System (UHIS) in Egypt is the administrative burden it imposes on those who are eligible. The requirement for manual registration to complete the enrollment process presents a significant challenge, as many impoverished individuals find the process daunting and inaccessible. Moreover, a lack of information about eligibility criteria and enrollment procedures further exacerbates the issue, leaving potential beneficiaries unaware of their entitlements. Navigating the bureaucratic obstacles associated with enrollment can be particularly daunting for those with limited education or resources, compounding the administrative burden faced by the poor in accessing essential healthcare services under the UHIS.

Proposing a Way Forward

To create a fairer and more equitable UHIS, Egypt must address these challenges head-on:

1. For those who are eligible, move toward Automatic Enrollment: The government should streamline the process by automatically enrolling eligible individuals into the UHIS, reducing the administrative burden and ensuring broader coverage.

2. Increase Funding for T&K to expand eligibility: The Ministry of Finance needs to allocate more resources to the cash transfer programs and accordingly to the UHIS, ensuring that all eligible poor and vulnerable populations are covered to reach the estimated Egypt’s poverty rate.

3. Simplify Procedures/ Be Poor Sensitive: Simplifying the registration and eligibility verification processes can make it easier for the poor to access their entitled benefits. Treat the Poor with respect, avoid overburdening them with unnecessary requirements either administrative or financial.

4. Raise Awareness: Implementing widespread awareness campaigns to educate the poor about their rights and how to access UHIS services is crucial.

5. Strengthen Monitoring and Evaluation: Establishing robust monitoring and evaluation mechanisms can ensure that the UHIS is effectively reaching and serving the poor and vulnerable populations.

Conclusion

Egypt's UHIS holds great promise for transforming the healthcare landscape and ensuring that every citizen has access to necessary health services. However, to fulfill this promise, it is essential to address the systemic barriers that prevent the poor and vulnerable from accessing these benefits. By implementing automatic enrollment, increasing funding, simplifying administrative processes, raising awareness, and strengthening monitoring, Egypt can move towards a more inclusive and equitable healthcare system that leaves no one behind.