Purchasing health services under the Egypt's new Universal Health Insurance law: What are the implications for universal health coverage?
Egypt
health financing
health insurance
health service purchasing
universal health coverage
Journal
The International journal of health planning and management
ISSN: 1099-1751
Titre abrégé: Int J Health Plann Manage
Pays: England
ID NLM: 8605825
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
31
08
2021
received:
03
11
2020
accepted:
04
10
2021
pubmed:
3
11
2021
medline:
12
3
2022
entrez:
2
11
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 34725863
doi: 10.1002/hpm.3354
pmc: PMC9298344
doi:
Types de publication
Journal Article
Langues
eng
Pagination
619-631Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Organisme : Japanese Government
Informations de copyright
© 2021 The World Health Organization. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Références
Eur J Health Econ. 2004 Oct;5(3):259-62
pubmed: 15452741
Health Policy. 2006 Nov;79(1):79-91
pubmed: 16406131
Int J Health Plann Manage. 2022 Mar;37(2):619-631
pubmed: 34725863