In Egypt, health services are delivered by a multitude of public service providers (the ministry of Health (MOH), ministries of Higher Education, Defense, the Interior, etc.), the Health Insurance Organization (HIO), Non-Governmental Organizations (NGOs) and an expanding network of private practitioners and medical facilities. Even though presence of multiple providers could imply competitive services, in reality, there is very limited or no performance assessment mechanisms or quality assurance.
In 2008/2009, the HIO reported its coverage of an approximate 42.8 million Egyptians, or 57% of the population. Yet, this figure does not translate to utilization of services: out of the 42.8 million people covered by the HIO, only 8% use HIO facilities for outpatient care. Repeated observations and systems analyses describe an ailing health system that is overused and underfunded. In remote areas, doctors and specialists are rarely available, hospitals are lacking basic hygiene and medications and nursing staff are scarce, forcing patients to seek services and consumables elsewhere.
The deterioration of public health service providers made the private ones particularly appealing; in 2008/9 private, out-of-pocket health expenditures reached 72% of total health spending by households, compared to 60% in 2001/02. Despite the relative increase in the percentage of household budget spent on health, more and more families cannot afford paying for their healthcare. This trend is reflecting the uncompensated increase in prices of healthcare services and puts doubts on the realization of this population’s right to health, specifically in terms of affordability and access to health services.
Egyptian health outcomes, as a part of the Arab world collective health outcomes, have witnessed considerable inequalities. Researches in some cases showed alarming bias in healthcare service delivery, favoring the wealthiest 20% of the population. Moreover, as the lower-income groups are the most vulnerable, they are most affected by discrimination created by private out-of-pocket payments, directly influencing their access to quality health services. This reveals that the mode of financing is not only an indicator of the role of the state in healthcare but also it is an essential determinant of health service accessibility.