Dr. Ziad Bahaa-Eldin
Published in Arabic in El-Shorouq newspaper on Monday December 25th 2017
The health insurance law passed by the parliament last week has both defenders and opponents. Some saw it as a first step toward universal social insurance, but others feared it bring additional financial burdens without improving health service. Still others rejected it entirely, seeing in it designs to privatize the Egyptian health sector.
I think the law is a historical achievement for Egyptians. It should be welcomed, especially by those concerned with social justice, because it establishes the necessary statutory framework for universal health coverage. But it’s not this law alone, which will enter into force in six months, that will bring this about.
The final outcome will depend on numerous factors extending over the coming years. Dozens of implementing regulations will be issued by the president, the prime minister, and ministers of health, finance, and social solidarity. New agencies will be created, and committees will be formed comprising representatives of the state, the private and civic sectors. Assets and employees must be shuffled, and hospitals, health units, clinics, and labs upgraded. A new generation of primary care doctors must be trained, and the preliminary stages of the experiment will be evaluated prior to expansion.
Hence the battle will not end with the adoption of the Law, that’s when it will begin. Every interested person should remember this and continue to monitor, and evaluate, to ensure that the law’s noble goals are realized.
In matters of legislation there is an important distinction between self-executing laws and laws that require subsequent implementing regulations and ancillary policies to enter into force. A law raising a certain tax, for example, is self-executing, meaning it enters into force immediately upon publication in the Official Gazette. In contrast, the creation of a new education system, the improvement of the investment climate, or new traffic regulations cannot be implemented merely by the passage of a law. They require a set of policies and implementing programs that translate their goals into concrete actions. This second set of law is known as enabling laws. They don’t have an immediate result, but instead set up the legal framework necessary to implement policies and programs that will bring a result.
The new health insurance law is an enabling law. In fact, it only addresses four principal issues. First, it provides for the incremental division of the current Health Insurance Authority into three new authorities: one for the provision of healthcare, another to monitor the quality of health services, and a third to administer the insurance system. Second, the law establishes a legal instrument to determine and price the health services that will fall under the insurance umbrella. Third, it address the determination of premiums, fees, and taxes to be paid by employees, employers, consumers, and companies, as well as the share of the public treasury needed to sustainably finance this new insurance system. Finally, the law establishes a legal regime for the improved efficiency of hospitals and health services, into which all Egypt’s governorates will be incorporated in the next 13 years.
So the new law will not bring about an immediate advance in health services or comprehensive health coverage for all citizens. These outcomes are entirely dependent on the aforementioned decrees, policies, and programs subsequent to the law. If these are properly applied, the law will succeed in providing health protection for Egyptians. If not—if hospitals aren’t outfitted, doctors not trained, and services not fairly priced—it will just be a law that was briefly celebrated then ignored.
The passage of the law is an important step; without it, the conditions and potential for change would not exist. But more important is that everyone who is interested in the issue, both supporters and critics, continue to monitor the law, apply pressure, and scrutinize the details of implementation on which the fate of the law depends. We can work to make it successful, or we can leave it to wither and fail.