Following the independence in the fifties of the last decade, the modern Arab country that provides education, health and labor to all citizens emerged. Until this day, the Egyptian state still provides healthcare services in the heavily subsidized Ministry of Health-related hospitals, to enable the poor people of receiving healthcare services on the one hand, and to achieve justice in receiving medical serves and a more just redistribution of the income on the other hand. Despite the financial support, there is reluctance in receiving medical services from public healthcare units and hospitals. Many patients prefer receiving healthcare from the private sector over the public sector. For example, the population health survey issued in 2014 had indicated that only a quarter of all births took place in a public health facility that provides healthcare services, while 60% of the births took place in private healthcare facilities. Another cause for concern is that even among the poor in Egypt, there is preference for private healthcare services which necessitates additional costs over the subsidized public healthcare service. Regarding the reasons for being reluctant to resort to public healthcare services, female respondents to the population health survey indicated that the major obstacle to receiving medical services is that the providers of healthcare services fail to come to work.
The government support is almost equally distributed among the various economic categories
In a recent study published in 2015 assessing the fairness in distribution of government support to healthcare services in Egypt to measure the beneficiaries of public treatment, while taking their economic levels into consideration, it appeared that government support is almost equally distributed among the various economic categories. For instance, the poorest 40% in Egypt receive about 43% of the support budget, while the richest 60% in Egypt receive about 57% of the volume of support for medical services. Researchers from Harvard University have also reached a similar conclusion on the situation in Egypt. Based on those results, it cannot be said that adopting the policy of non-directed support in Egypt has attained its justice-related goals. It might have contributed to advancing the citizens’ health, but that policy has not succeeded in achieving social justice in redistributing the incomes among the various economic groups.
If this system continues to provide support without any reform, the waste of the limited economic resources in Egypt would continue; however, the protection of the poor requires the reengineering of the support system in Egypt so as the value of support decreases with the increase in income. While the Egyptian government is aiming at applying the comprehensive health insurance system over three phases over 10 years, it is possible to resort to simple methods, such as geo-targeting, to target the poor and the people in need on the short-run, to enable the improvement of justice in the distribution of support. When comparing the non-directed support system with the geographic targeting system in Mexico, Venezuela and Jamaica, it appeared that that geographical targeting system is both useful and effective in delivering support for the poor.
In the last ten years, the Egyptian government has made great strides in identifying the places and characteristics of the poor. For example, we know where the one thousand poorest villages are located in Egypt and we now have what is known as the poverty map; we also have data on the rates of the prevalence of unemployment in the provinces and villages of Egypt. As a first step, it is possible to increase the size of the support to the health centers in those poor areas where the rich do not live. This is known as geographical targeting; it can be accompanied by other means of targeting methods such as the “simple means test”. This test depends on assessing simple properties of the family reflecting the economic situation, such as the family members’ level of education, the age and job of the head of the family, and the number of children in the household. But we must highlight here that the social protection programs that are preoccupied with targeting the poor and apply strict criteria for accepting some citizens may exclude certain people among the poor and turn into incapable programs, especially if they are related to access to health care.
Ahmed Rashad is a researcher in development economics, health economics, and applied econometrics. He holds a PhD in Economic Development and Socio-economic Inequalities in Health.
The views expressed here are solely those of the author in his/her private capacity and do not in any way represent the views of neither the Arab Development Portal nor the United Nations Development Programme.