Healthcare financing in Egypt: a systematic literature review.

Abstract

Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

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“…The financing structure under the new healthcare system reform has led to the centralization of decision-making. Consequently, the burden on the government—as well as its control—has increased ( 9 ), which increases the suitability of conducting HTA at the central level ( 30 ).…”

“…The overall life expectancy increased from 64.5 years to 70.5 years in 2019 ( 6 ), reaching 72 years in 2020 ( 7 ), approaching the global average of 73 years ( 8 ). However, out-of-pocket payments are still considered the major source of healthcare financing in Egypt, accounting for more than 60% of the total healthcare expenditure ( 9 ). The risk of catastrophic health expenditure in Egypt is approximately 25%, which is higher than the average for middle-income countries (23%) ( 7 ).…”

“…Egypt is currently reforming its healthcare system to include universal health insurance (UHI) with broader coverage and better services than the existing insurance system. Upon implementation of the UHI system, its budget should surpass the current total health expenditure (THE), raising THE significantly as a percentage of the gross domestic product (GDP) ( 9 , 10 ).…”

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“…It supports researchers to observe patterns of interest in the data and integrate packages of new methodologies to cope with the field at high standard levels of quality ( 146 ). All of these tools and initiatives positively affect not only the health but also the financial mechanisms ( 147 ).…”

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“…Most of the doctors working in private clinics and hospitals are employed by the government. All of these private services are paid for out of pocket by individuals (11) .…”