Private health insurance in Egypt Dr. Hala Massekh Health Insurance & Health Policy Consultant Chairman Assistant HIO PhD Public Health & MBA Ministry of Health & Population

Types of Health Insurance companies There are international as well as national companies; International companies are PUPA and ALICO There are some Insurance companies and many TPA companies that gives the managed health care services

Coverage Governmental Health Insurance cover around 52 % of population (80 Million on 2010 ) which are 42 million person Around 20 % of population are considered as poor by WHO & WB classification,which represents around 16 million person The remaining is 22 Million population Yet, enrolment of all private health insurance international, national and TPA does not exceed 2 million

1994/952001/ /082008/09 Total Population (Millions) Estimated GDP in (LE Billion) Total Health Expenditures (LE Billion) Public Health Expenditures (LE Billions) MOHP Expenditures (LE Billion) House Hold Expenditures (LE Billion) Pharmaceuticals (LE Billion)

Health Financing in Egypt Total Health Care Expenditure are L.E Billion ( 2008/09)

Financing of Health System

Common problems of TPA in Egypt There are main ten challenges: From Insurer / TPA perspective Prolonged cycle of claim processing Difficulty of getting bills /claims Complexity of Audit process Fraud from both clients and providers Manual or semi automated programs running the claim processing

The Challenges Difficulties in the cash flow due to delayed cycle Difficult /inaccurate reporting Need of a large team due to huge volume of claims From a Service provider perspective: Delayed provider payment From a End-customer perspective: Delayed reimbursement to clients

What Private Insurance In Egypt Need 1.It need a regulatory body to regulate and control market 2.It is in need that MOHP and HIO unify a claim form so that all hospital can issue same claim no matter who will pay for it 3.It also need a Software to help automation and speed of process

What Private Insurance In Egypt Need (cont.) 4. big insurance and reinsurance companies to cover the risk 5. It need a law to guarantee patients rights against mal practice and fraud from small companies.