Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

better systems, better health

National Health Accounts (NHA) in Egypt

Overview and Key Findings

Dr. Mahmoud Farag

Evolution of NHA in Egypt

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Since 1994, the MOHP in collaboration with USAID, has been a pioneer in the area of NHA.

Egypt was among the first low and middle income countries to conduct National Health Accounts.

Lead the NHA efforts in the region: First round: 1992 -93 Second round: 2001-02 Third round: 2007-08 Fourth round 2008-09

Lack of institutionalization has meant sporadic production and use of NHA.

Key Findings

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  1994/95 2001/02 2007/08 2008/09 THE* per Capita (LE) 127.0 346.0 566.4 800.1 Percent of GDP Spent on Health 3.7% 6.0% 4.8% 5.9% Public Health Expenditures Percent of THE 33.0% 30.0% 33.0% 24.8% MOHP Expenditures Percent of THE

22.0% 23.0% 24.0% 16.5%

Out-of-Pocket Expenditures as Percent of THE

51.0% 62.0% 60.0% 71.8%

Pharmaceuticals as Percent of THE 36.0% 37.0% 26.0% 34.2% Public Spending as Percent of GOE Expenditures

  5.0% 5.0% 4.3%

MOHP Expenditures as Percent of GOE Expenditures

  4.0% 3.5% 2.8%* THE: Total Health Expenditures

Key Findings

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  1994/95 2001/02 2007/08 2008/09

Total Population (Million) 59.2 66.7 75.1 76.8 GDP* Estimates (LE Billion) 203.1 385.0 896.5 1040.0 Total Health Expenditure (THE) (LE Billion)

7.5 23.1 42.5 61.4

Public Health Expenditures (LE Billion) 2.5 6.8 13.9 15.2 MOHP Expenditures (LE Billion) 1.6 5.2 10.2 10.1 Household Expenditures (LE Billion) 3.8 14.3 25.5 44.1 Pharmaceuticals (LE Billion) 2.7 8.6 11.0 21.0

* GDP and GOE expenditure data from Ministry of Finance

Sources of Financing: Who Pays for Healthcare?

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Households continue to remain the single largest source of health financing

Financing Agents: Who Manages the Health Funds?

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Providers: Where Does the Money Go?

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In 2008/09, spending at private facilities accounted for 64 percent of total health spending. Of this spending, pharmaceuticals and private clinics accounted for half of all health spending in Egypt

Egypt Compared to other Middle Income Countries in the Region

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Percent GDP Spent on Health

Government Spending as

Percentage of THE

Health Spending as

Percentage of Total

Government Budget

Out-of-Pocket Expenditure as Percentage of

THE

Algeria 4.49% 83.85% 10.65% 15.30%Djibouti 8.54% 76.07% 14.15% 23.60%Egypt 5.90% 24.80% 4.30% 71.80%Iran 6.30% 45.72% 11.40% 51.68%Jordan 9.10% 62.20% 11.35% 33.40%Lebanon 8.76% 48.99% 12.39% 39.95%Libya 2.80% 75.88% 5.38% 24.12%Morocco 5.33% 34.97% 6.17% 56.13%Syria 3.23% 45.13% 6.01% 54.87%Tunisia 5.95% 49.57% 8.90% 42.52%Sources: World Health Organization (WHO) NHA data, Egypt NHA results, Jordan NHA Report Egypt has highest burden of out-of-pocket spending. Government spending both as a percent of THE and Budget is the lowest.

Summary of Overall Findings

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The private sector remains the primary provider of outpatient services accounting for 80% of all visits: Private clinics and pharmacies are main private providers. More visits occur at MOHP hospitals as compared with MOHP

outpatient facilities.

The Ministry of Health and other public providers account for 62% of all inpatient admissions.

Summary of Overall Findings

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There are a number of differentials in per capita spending: Urban areas spend more than rural areas. Major cities spend the most and rural upper Egypt the

least. Females spend more than Males. Those in the highest income quintile spend nearly 4.5

times as compared with those in the lowest income quintiles.

The insured spend less as compared with the uninsured.

Inequity

Highest income quintile uses over twice as many outpatient visits as compared with those in the lowest income quintile

Highest income quintiles spend four times more on outpatient care and over ten times as much on inpatient care

However, the poor spend a higher proportion of household income on health as compared with the rich

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NHA Implications on Health Sector

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Policy Implications

Increase public investments in health. Need for “smart spending”.

Need to address inequities between rich and poor, urban and rural.

Fast-track comprehensive insurance reforms Comprehensive pharmaceutical reforms Make the private sector a true partner

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MOHP can not tell on a monthly basis what it spends by governorate, by hospital, by primary health care facility or by program. •Hospitals and primary health care centers do not have information on the cost and efficiency of services they produce.•Put a system in place whereby:

oNHA,oExpenditure tracking routine activities of the MOHoCosting

Institutionalizing NHAs Institutionalizing NHAs

Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

better systems, better health

Thank you