PROJECT PROFILE- How the gov’t envisions its Universal Healthcare Ins. scheme: First announced in 2016, the Sisi administration is working on rolling out a universal healthcare ins. program across all of Egypt’s governorates to provide citizens with healthcare coverage. Once it’s fully rolled out across the country, the EGP 600 bn scheme is designed to provide healthcare coverage to all citizens — regardless of income — through designated units while linking up all healthcare providers under the program through a digital backend that also stores patients’ medical information and history. Today, we break down the government’s vision for how the project will pan out — including how individuals will navigate the system and how private ins. companies will be looped into the system and receive payment.

Healthcare ins. for everyone: The impetus behind the government’s universal health ins. scheme is to provide health ins. services to everyone regardless of their financial capacity to pay the healthcare premiums or their employment type and status, according to the Universal Healthcare Ins. Authority’s (UHIA) website. The scheme aims at building 94 hospitals and 448 health units.

The scheme falls under the authority and scope of three separate government institutions:

• UHIA is tasked with managing and financing the scheme;
• Egypt Healthcare Authority (EHA) is in charge of the public hospitals and service
• providers part of the scheme’s network;
• The General Authority for Health Accreditation and Regulation (GAHAR) is mandated with ensuring quality control of services provided to subscribers and issues the necessary licenses for hospitals and service providers to become part of the network.

The timeline: The scheme aims to cover people in all of the country’s governorates by 2032 including individuals with special needs, financially vulnerable people, irregular workers, and those who are not covered by the Social Ins. Act.

So you want to receive healthcare services through the universal healthcare scheme. Here’s how you’ll go about it: Citizens can register to the system online via the government’s digital platform (Misr Al-Raqamiya) to begin accessing services under the program, according to the UHIA website. Individuals who want to register offline — or don’t have online access — can go through the process at the nearest healthcare center using their own ID card. For those looking to register a family, the ID of either spouse will be needed.

Say hello to having a family doctor: Completing the registration process automatically creates a medical file for the individual or family at the primary healthcare unit nearest to their place of residence. Once the file is created, a family doctor automatically gets assigned to the patient / family. The family doctor — a fixture of healthcare systems in some countries, including Canada — is meant to be a general practitioner who is the first point of contact for a patient seeking healthcare services. Family doctors are responsible for running checkups and tests and prescribing meds or tests as needed, before referring the patient to a specialist for a consultation. However, while patients are automatically assigned a family doctor upon registration to the scheme, they aren’t necessarily obligated to visit their family doctor when seeking medical services, and are instead able to choose their preferred service provider from the approved network.

Let’s talk about financing: Employers will be subject to premiums of 4% of each employee’s monthly salary once the scheme rolls out in their governorate as a compulsory subscription fee. Subscription in the scheme is compulsory for all employers. Individuals subscribing to the coverage plan will also pay premiums calculated as a percentage of their monthly salary. These premiums range between 1% (for unmarried users; employed, married spouses; and children of individuals who are subscribed to the scheme) to 3% (for a user’s unemployed spouse).

What’s the fate of private health ins. companies? Private health ins. companies will play an integral role by providing the services that are not included in the scheme’s coverage such as mental health, family planning, ambulance and preventive services, according to the UHIA website. Users can also sign up for a private health ins. plan if they wish to have a larger financial coverage limit and/or access to particular service providers that are not part of the universal health ins. scheme.

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