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Purchasing health services under the Egypt's new Universal Health Insurance law: What are the implications for universal health coverage?
Author(s) -
Khalifa Ahmed Yehia,
Jabbour Jean Yacoub,
Mataria Awad,
Bakr Magdy,
Farid Mai,
Mathauer Inke
Publication year - 2022
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.3354
Subject(s) - universal health care , business , universal design , universal coverage , purchasing , health insurance , health services , universal law , actuarial science , health policy , environmental health , economic growth , health care , law , economics , marketing , political science , medicine , computer science , population , world wide web
Background Egypt's Universal Health Insurance (UHI) Law of 2018 implies major transformation to the health financing system. This commentary provides an assessment of the purchasing arrangements as stipulated by the UHI Law and Bylaw, their implications and contribution to progress towards universal health coverage (UHC). The purpose of this assessment is to inform the multi‐year implementation process of the Law and propose options for progress towards UHC. Methods Guided by an analytical framework on purchasing, the qualitative analysis was based on the review of the legal provisions and structured discussions with key stakeholders. Results The Law foresees important changes, such as a purchaser‐provider split, stricter referral rules and regulated cost‐sharing. However, several purchasing aspects were not sufficiently specified in the legal provisions, for example benefit design and provider payment methods. It remains unclear for decision‐makers how to proceed, hindering the Law's effective implementation. There are also concerns about the mixed provider payment system creating incoherent provider incentives. Conclusion In view of the remaining legal unclarities on purchasing, progress towards UHC is restrained. Benefits design and the provider payment system should be further specified with a clearer governance structure around the purchasing decision‐making processes. Additional technical options for strategic purchasing are suggested.