Dr. Mahmoud Farag, Health Systems 20/20 Presented April 23, 2012

1. better systems, better health
National Health Accounts (NHA) in Egypt
Overview and Key Findings
Dr. Mahmoud Farag
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

2. Evolution of NHA in Egypt
 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.
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3. Key Findings
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
33.0% 30.0% 33.0% 24.8%
Percent of THE
MOHP Expenditures Percent of
22.0% 23.0% 24.0% 16.5%
THE
Out-of-Pocket Expenditures as
51.0% 62.0% 60.0% 71.8%
Percent of THE
Pharmaceuticals as Percent of THE 36.0% 37.0% 26.0% 34.2%
Public Spending as Percent of GOE
5.0% 5.0% 4.3%
Expenditures
MOHP Expenditures as Percent of
4.0% 3.5% 2.8%
GOE Expenditures
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* THE: Total Health Expenditures

4. Key Findings
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)
7.5 23.1 42.5 61.4
(LE Billion)
Public Health Expenditures
2.5 6.8 13.9 15.2
(LE Billion)
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
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5. Sources of Financing:
Who Pays for Healthcare?
Households
continue to remain
the single largest
source of health
financing
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6. :Financing Agents
?Who Manages the Health Funds
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7. Providers:
Where Does the Money Go?
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
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8. Egypt Compared to other Middle
Income Countries in the Region
Health Spending
Government Out-of-Pocket
Percent GDP as Percentage of
Spending as Expenditure as
Spent on Total
Percentage of Percentage of
Health Government
THE THE
Budget
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.
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9. Summary of Overall Findings
 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.
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10. Summary of Overall Findings
 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.
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11. 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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12. NHA Implications on Health Sector
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13. 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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14. Institutionalizing NHAs
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 MOH
oCosting
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15. better systems, better health
Thank you
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