The founding statement
The founding statement for the defense committee of citizen’s right to health
(Against privatization of health insurance)
The government’s attempt to pass the Prime Minister’s Decree No. 637 of 2007 on March 21 represents a monumental step on the road to full privatization of health insurance and treatment in Egypt. The decree means that beneficiaries of the health insurance will carry the burden of profits of a profitable investment Foundation which is the new holding company, such a company will deny the beneficiaries their ownership to structure of hospitals, clinics and pharmacies, which were built mainly by their money, and give it to the state by the book value which is less than the current market value. The Prime Minister’s decision gives the government the right to privatize and sell those hospitals, to establishment joint stock companies in partnership with individuals and organizations. Government’s statements that the new company is currently wholly owned by the State and is not intended to be sold or privatized, make no difference, for it is meaningless that the state gives it self the right to sell and then claim that it will not use this right. Rights of beneficiaries should be ensured through legislation, not by promises made by the state that it will not use the powers that it gets by law.
The way in which the government issued the resolution was also consistent with the content. As changing the ownership of health insurance and changing the structure of the providing the service from a service institution profitability company was not through the Legislative Council, but it came as an administrative decision. The resolution was signed, issued and published in the Official Gazette secretly during a one-day. The government claims it has been stated in the press during the last year of its intentions to establish holding companies in the field of health. But according to democracy and transparency, the government is supposed to publish the text in the press and discuss it in the media before approving it if there is faith really to involve beneficiaries in determination of their future and care to listen to different views on the subject.
The government continued concealing the truth and the draft Law on Health Insurance, which is prepared now. It also did not publish the budgets of health insurance and claims of heavy losses in those budgets. The government lately stopped repeating these claims after the opposition newspapers published the fact that there are multiple surplus in the health insurance budget in the last five years and the fact that it is in possession of the deposit of more than half a billion Egyptian pounds at the end of last fiscal year!
The government, in promoting to the privatization policy, claims that Egypt is a poor state so it cannot meet all the health needs of citizens, refers to the dissatisfaction of beneficiaries concerning some aspects of the insurance services and the current lack of quality in aspects of the services. But the government does not fund the health insurance; health insurance is financed by contributions from the beneficiaries. As the structure of health services outside the health insurance, the government did not spend annually, in the last ten years, more than 3.2% of total government expenditure on health, while WHO recommends spending between 5 to 10% of government spending on health. The core problem is government’s spending priorities; it does not meet the basic needs of citizens of education and health, while it grants enormous privileges to investors and sell all the State properties and assets to them cheaply. The government also is responsible for the failure of services by: depriving the government and the structure of the Ministry of Health from sufficient numbers of qualified physicians and employees, the low level of wages of doctors and employees, lack of budgets maintenance, repair and renovation of buildings and equipment, and inefficient management.
The real aim of these changes is the conversion of social health insurance to the health insurance business-for-profit that achieves the interests of investors, Arabs and foreigners in the direction of private provision of health services and to satisfy their appetite to devour the health insurance’s huge medical edifices cheaply, as it happened in all projects of establishing HOLDING COMPANIES as a stage in the direction of full privatization and an unprecedented rise in the cost of health services and to deprive citizens fully from the services provided to them now, whatever its flaws.
The basis for these changes is a health reform project, signed by Ismail Sallam, former health minister and the World Bank as a representative of foreign financial bodies (USAID and the European Union), which provides for the change of the role of Ministry of Health and health insurance by abandoning, gradually, their role of providing curative services and to be confined to policy making, setting quality standards, follow submission, compulsory vaccinations and ambulance road accidents, with a focus on buying service from the private sector, which tends to monopolize providing health services. Privatizing ownership of the huge governmental structure comes in three steps written by the World Bank: starts with privatizing the administration then transforming public institutions in the field of health to the holding companies managed on the basis of the profitability and ends by offering the structure for of sale and privatization. The logic of health reform that justifies those changes is that the main problem of medical treatment in Egypt is the lack of quality, and that quality can only be achieved through competition, ie, the private sector and privatization of the public sector in phases as mentioned above. For this funding should be separated from service to the sense of separation from service bodies for the benefit of current service provided through the bodies of the profitability of the private sector and the public sector, which tends to privatization.
The government has already begun to implement the privatization program as this plan is in the process:
Privatization of health care II (regular clinical) and third (Employment Prospects and Skill Requirements-developed): Through converting hospitals and health insurance to holding company operating on a commercial basis and involved in the competition with the private sector.
The government promots for converting Family Health to a System operates recovering medical expenses. This principle of cost recovery, will convert a doctor to a businessman, who doubles his/her income whenever reducing the number of prescribed drugs and the number medical reports requested and the number of patients transfered to hospitals. All this in the name of global rates without appropriate study to map disease in Egypt without an objective assessment of the impact of its interventions on the health of citizens. The fundamental error in this system is the trial to build primary health care on the basis of recovery of the expenses of treatment contrary to Egyptian and international experience in this regard.
Creating a system of primary health care must be based on the principle of State’s responsibility for the health of citizens and not on the recovery of expenditures and transferring initial requirements of health into goods to those who have the prices.
The government is aware that the privatization of medicine and adding to the medical service profits of service provider (whether governmental corporate profitability holding companies or private sector) and profits of insurance service (private medical insurance companies, which will regulate the provision of service through the issuance of multiple insurance) will lead to a huge increase in cost.
The solution it offers is: Reduction of the scope of service: it will not be a comprehensive care insurance for all curative services; primary and secondary tertiary, but only on primary health care and only secondary and thirdly, but it will be limited to primary health care and only secondary services exiting Employment Prospects and Skill Requirements.
(Minister gave an example by the treatment of renal failure insurance services!) And forming multiple insurance packages, so that health insurance services which will be provided to the uninsured is limited, in the foreseeable future, to primary health care, reducing the scope of the current insurance, as explained, on primary care and secondary (regular clinical), while the third Employment Prospects and Skill Requirements developed is left care entirely to private, expensive, companies. This represents a violation of the principle of equality among citizens to receive treatment services by developing principle of commercial and health insurance packages multiple treatment so that every citizen could become a client to pay as much as he/she can, plus the contribution of citizens upon receipt of the service by paying one third of the cost of operations, examinations, accommodation and medicine (whatever the cost!).
The government moved on two points: First, the amendment of the contractual relationship between the beneficiary of the health insurance and health insurance, and the amendment of the form of ownership of the structure of medical services, in the future it will amend the structure of the Ministry of Health as well. Despite the government’s repeated attempts since 2000 to pass a bill to change the health insurance that changes the contractual relationship, it did not succeed so far, it seems that campaigns criticizing the project led by the Union of Workers and civil society were the main obstacles in passing the decree so far. The Health Minister says that the project will end in next June or July and will be recognized in the next parliamentary session.
The second axis is to change the form of ownership of hospitals, insurance structures and the Ministry of Health converting them into holding companies in preparation for selling, which has already begun by the resolution of the current Prime Minister. It is reported that there is now a project to the sale and transfer of Heliopolis Hospital and transferring educational hospitals and institutes affiliated to the Ministry of Health to a holding company!
The final outcome of this law is to transform the treatment of service at cost basis to commodity in the market as a room for high profits for the domestic, Arab and international private sectors hungry for massive profits either from monopoly of providing services or to purchase the governmental assets structure of medical insurance cheaply. The other side of that coin is the high cost of treatment to turn into a burden in a society which more than half of its members languishing under the poverty line. This decree will deprive beneficiaries of health insurance from health care services developed Employment Prospects and Skill Requirements (third) and forcing them to pay rate (often a third) of the cost of primary care and clinical regular (second).
The government’s claim that the needy will not be harmed through the privatization because the Ministry of Social Affairs will provide them treatment expenses is not true. The government defines those needy as about three million families or 16 million individuals (absolute poor or extreme food-estimated by the government) while the government itself estimates a similar number of relatively poor (poverty basic needs). But there are other government estimates, including a study by the Council of Ministers decided that 74.5% of citizens per capita income of less than eight pounds almost daily, which is less than the relative poverty line of two dollars. The biggest problem is the conversion of the right to health to a donation provided after “poverty certificate.”
Funding raised in all systems of social health insurance in the world is through contributions (an average of needs, measured mainly on cost and not on the basis of the cost), and through symbolic fee (and not a burden on the overwhelming entry), as well as through general taxation from the State budget-particularly to the sectors of non-organized labor on a collective basis and not from the Ministry of Social Affairs, that is to say; support system, not charity to the poor.
The social health insurance, applicable in Western Europe, Canada, Japan and even in Israel is a non-profit body to provide basic health services, based on equality of citizens to receive a single, comprehensive package of health services, while the government is trying to introduce the priciple of the health insurance business (American) profiteering : treatment of the disease, profiting from treatment planning process through multiple insurance policies, and the distinction between citizens deserve full medical service, and others do not deserve only limited services. It is the right of beneficiaries of health insurance to look for cost savings by building hospitals and the appointment of doctors instead of buying the costing service from the private sector. It is also their right to defend themselves against robbing their properties and their structure of hospitals which offers them medical services in cost price, instead this service is going to be offered loaded with profit for both government holding company or corporate special later. We call and defend the reform of current insurance system and the structure of current services and not to dump it and its management on the basis of profitability preparing it to sell to private sector. Reform will be achieved by the beneficiaries and their representation control in management, as well as the application of scientific management foundations and quality standards of professional and scientific.
The Defense of citizen’s right to health of all citizens, calls for bodies and civil society organizations to agree on following demands:
1. No to the Prime Minister’s decision to convert health insurance to a holding company based on the privatization of management on the basis of profitability and has the right to sell and privatize it, Yes to reform the current insurance while continuing as a non-profit service.
2. No to the issuance of laws and decisions in secret, No to the confidentiality of health insurance decree, Yes to transparency and democracy, Yes to hearing committees in the People’s Assembly listening to all views.
3. No to deprive the insured of advanced health care, which includes by the insurance currently, Yes to one comprehensive package for all primary levels of care and regular clinical and Employment Prospects and Skill Requirements (secondary and tertiary) and the rehabilitation of each insured.
4. No to push the proportion of the cost of testing and treatment, yes to pay averages contributions with a maximum nominal fees.
5. No insures shoulder insured lucrative new mediator for a new medical insurance companies, yes to the non-profit service organizations to provide the service.
6. No to privatization of primary health care as the “fund” family health, yes to reform primary care without built on the foundations of business and doubling the initial cost of care responsibility of the state and are not required to make a profit.
7. Not for achieving quality through competition that converted medical services into commodities, yes to the development of quality control through the democratic management and control of stakeholders from users dependent on international standards.
Committee for the Defense of the right to health in May 2007 bodies involved in the incorporation:
1. The Coordinating Committee of human and trade union freedoms
2. The development of health and environment
3. The Hisham Mubarak Center for Law
4. Secretariat workers Grouping Party
5. Kefaya movement
6. Horizons for socialism (Cairo)
7. Horizons for socialism (Mahalla)
8. Justice Center
9. Workers for Change
10. Center of the Earth
11. Dar services union
12. The March 9 movement
13. The Arab Network for Human Rights Information
14. Egyptian initiative for personal rights