Major controversy and responses caused by the statements of Minister of Health Ahmed Emad El-dein after he announced that his ministry is proposing a legislation to introduce fair pricing for all health services offered by the private sector, whether within hospitals and clinics or analysis and radiation centres.
Citizens have the right to receive humane health services with prices suitable for their income, especially in countries where the state does not have full insurance to cover for all individuals, according to Emad El-dein.
Egypt is witnessing major price increases in health services, whether for surgeries, analysis, or examinations.
The proposal of the minister was met with rejection from the Healthcare Providers’ Chamber, which is affiliated with the Egyptian Federation of Industries (FEI), and it was also met with rejection by investors in the healthcare sector.
Daily News Egypt examined the views of each of the Health Ministry and the Doctors’ Syndicate in order to understand better their opinions and whether the government will be able to enact the proposal.
Society dialogue before proposing the pricing to the parliament
Our main aim is to protect citizens from the price increases of examinations in hospitals and clinics
Ali Mahrous, chairperson of the Central Administration of Free Treatment and Licensing at the Ministry of Health, told Daily News Egypt that work is ongoing on a study to determine the pricing of the healthcare services in the private sector.
Mahrous revealed that the study will soon be subject to a society dialogue with all concerned parties, including the parliament, where it will be issued with a law to be mandatory for all in order to restore discipline to the medical sector.
Mahrous said that the current proposal will be presented to the parliament once its final wording is reached, to turn it into a binding law for all parties. He explained that the sector needs intervention from the state, especially that pricing of healthcare services is determined by owners of hospitals and clinics without any controls.
Mahrous revealed that the proposal includes determining the value of the examination to be EGP 100 as a maximum for general practitioners, EGP 200 for specialists, EGP 400 for consultants with PHD, and EGP 600 for college professors.
Mahrous explained that the aim of the proposal is to bring back discipline into the medical sector.
Mahrous went on to explain that there are hospitals that have been licensed for more than 30 years without any developments or studies to see the validity of these hospitals. The current laws have been present since 1954 and were amended in 1982. The main problem lies in providing licenses once without regularly reviewing them to make sure they suit the updates.
He added that the past period witnessed several reports and complaints due to the exaggerated prices by some private hospitals and beauty centres, noting that prices vary from one hospital to the other. There are also differences between announcing the pricing lists to the public and when hospitals predetermine the prices and bind patients to them.
He added that each private hospital has its own pricing, and major differences would be felt if you compare between the prices of private and public hospitals.
Regarding the details of the proposal, Mahrous said that a study is underway to classify hospitals into five classes, where each one will belong to a class based on the services of the hospital.
Mahrous emphasised that the private sector acquired 70% of the healthcare services, noting that there are issues in the medical sector regarding the licensing of hospitals and organisations who obtained hospital licenses while their total areas do not exceed 80m and comprise of two rooms. These so-called hospitals cannot be considered hospitals.
As for the most prominent issues in the medical sector, Mahrous said that the main issue is the pricing of medical devices and tools, which are mostly imported, by 95%. The prices of these tools doubled, while other tools’ prices became three times their old prices. After the flotation, the price of medical fridges jumped from EGP 2,000 to EGP 6,000.
Mahrous stressed that hospitals must be classified based on their offered services and must have mandatory pricing.
Several issues must be paid attention to, including calculating the increase in the prices of imported tools, because the aim of this classification is to protect the rights of citizens.
Unfortunately, the health ministry plays no role in deciding the price lists of hospitals; however, it will play this role in the future where the prices will be publicly announced.
Mahrous noted that since late 2016, the prices of hospitals hiked by nearly 10%.
He stressed the importance of deciding the material return to doctors based on their different degrees in order to avoid the complaints about expensive clinic bills.
He demanded consumers to file complaints to the Consumer Protection Agency (CPA) if exaggerated prices were noticed.
“There are certain standards according to which hospitals work; however, they are not implemented, so I suggest the laws to be amended and reviewed every three years, because some hospitals have been licensed for more than 30 years without developments or studies to check on the validity of these hospitals to operate,” he said.
Determining prices of healthcare services is a right of the syndicate, not the ministry: Doctors’ Syndicate
Discussions with health officials to look into the proposal and discussing its implementation
Ehab El Taher, the secretary general of the Doctors’ Syndicate, told Daily News Egypt that the syndicate is the only party specialised in pricing the value of examinations in clinics, not the Health Ministry.
El Taher pointed out that in terms of the fees of doctors for examinations and surgeries, article No. 46 of law No. 45 for year 1969 said that the council of the syndicate must have a table of the maximum value of the fees received by the doctors in cases of consultations, treatment, and surgeries. The table then will be approved by the health ministry.
Regarding the tables of health service prices in hospitals and private medical facilities, El Taher explained that these tables are determined by a joint committee formed of four representatives of the Health Ministry, three of the Doctors’ Syndicate, and a representative of private sectors chosen by the syndicate.
In accordance with Article 12 of the Medical Facilities Law No. 51 of 1981, which stipulates that “a decision by the Minister of Health shall be formed by a committee representing the Medical Syndicate and the Ministry of Health and a representative from owners of the medical establishments”, the committee provided for in the previous paragraph shall determine the fees for accommodation and services provided by the establishment. A decision shall be issued by the competent governor, taking into account the cost elements approved at the license. The medical establishment shall be obliged to announce its list of prices in a visible place. The Directorate of Health Affairs is concerned with these prices for registration.
Article 23 of the Executive Regulations of the Medical Facilities Law stipulates that the committee shall determine the wages of accommodation and services for medical establishments.
El Taher revealed that the Medical Syndicate sent letters to medical scientific societies to express their opinion on the value of physicians’ fees for each scientific level according to different expertise and specialties. Some of the responses have already been received by some scientific societies.
To confirm that, after the completion of the proposals of scientific societies will be held an extended workshop involving members of the Health Committee of the Parliament and experts of health economics and representatives of the Ministry of Health and the medical syndicates in the republic and some civil society organisations concerned with health, so that the decision is taken on the basis of objective and scientific data, taking into account the rights of citizens and doctors at the same time.
The proposal negatively affects the health sector: Chamber of Health Care Providers
Dr. Alaa Abd El Megeed, head of the Chamber of Health Care Providers, said to Daily News Egypt that the proposal of the Ministry of Health to place a compulsory pricing for the prices of health services in hospitals and clinics of the private sector will negatively affect the required competitiveness in this sector and on national and foreign capital working in this field.
Ahmed Abo Ras, the official spokesperson for the Chamber of Health Care Providers in the private sector of the Federation of Egyptian Industries, said that the proposal proposed by the Ministry of Health on determining the value of medical examination in the private clinics includes “overpriced” prices, of physicians to raise the value of their medical examination.
Abo Ras explained that the Medical Syndicate is the only body legally competent to determine the price of medical examination for doctors, not the Ministry of Health, in accordance with Chapter 4 of the Medical Syndicate Law, pointing out that it is necessary to separate the price of medical examination for doctors in private clinics and the prices of medical services provided in hospitals. This requires extensive discussions between representatives of the Ministry of Health and the Association of Doctors and Providers of Health Services to discuss the reasons for the rise in prices of those services, including high prices of utilities such as electricity and wages of workers.
The official meeting of the Chamber of Health Care Providers in the private sector indicated that the next monthly meeting of the chamber, scheduled to be held in the next few weeks, will witness the invitation of Dr. Ali Mahrous, head of the Ministry of Health’s Free Treatment Department, to discuss the proposal of the Ministry of Health, medical examination at private clinics, and prices of other medical services, in order to reach a satisfactory solution to all parties.
Abo Rass added that the chamber affirms its keenness on the Egyptian citizen’s right to treatment. The members were instructed to carry out their national duty not to overstate the cost of providing health services to citizens. In light of the high cost of providing health services and the need to bear part of this cost, the decisions to reduce the cost of the health service should be studied in order to comply with the laws and be enforceable.
The chamber is concerned that the state may take decisions that may negatively affect the competitiveness required in this sector, and on the national and foreign capital working in this field; therefore, it calls for the study of the decisions in this regard thoroughly.
Abo Ras added that the chamber, with the citizen’s constitutional right to enjoy a humane and decent health service, confirms that this will be achieved with the issuance of the Comprehensive Social Security Law, which the state is seeking to issue as soon as possible.
Abo Ras explained that the process of determining the prices of providing the health service in general is subject to the cost of the service, which varies according to geographical location, medical equipment, scientific degree of the treating physician, the exact specialisation of the medical establishment, its legal form, the level of accommodation, and the prices of the inputs.
Khaled Samir: pricing health service will suffocate the investor, prices should be indicative
The director of Dar Al-Oyoun Hospitals and Centres and a member of the Chamber of Health Providers Federation of Industries said that there are four main factors that determine the pricing of health services in Egypt. First: the Ministry of Housing and the Urban Communities Authority, which offer the new lands at very high prices reflected in the high cost of the necessary investment. Secondly, the liberalisation of the exchange rate (100% of medical technology, equipment, and machinery imported); and thirdly: the aging of health services and the enormous technological development (medical services are developing with huge technological advancement, which necessitates prescription as an important price effect) (Supply and demand and the impossibility of determining the price of any service according to free market mechanisms).
Samir believes that the price should lead to the availability of health services. The most important effect of pricing is availability. The philosophy on which pricing must be based is the availability of the service, which is to ensure that the price that makes the service available is the decision of the Central Bank of Egypt (CBE) to liberalise the exchange rate.
“I do not think that the state encouraging investment will suffocate the investor and control the pricing of the service, which is contrary to logic and law, but I think that the ministry is considering the pricing of guidance and not compulsory, something that should encourage the ministry to do, many Egyptian health institutions do not have specialised cadres, and is able to help health entities identify price components that achieve the required balance,” said Samir.
He added that determining the price is one of the most important reasons for the low emergency service despite the success of the state in providing ambulance services, which developed wonderfully, and that have a market price that competes with different service providers, thus we reached the price to the right number for everyone.
Absence of the appropriate price for the cost of the emergency service, which the state pays for the citizen and pays through the social health insurance of the hospitals, makes the service at its worst, and makes it a mirror in the institutions and the provinces and equal to what is paid (remember what happened and is happening so far with regard to the forced pricing of medicine).
A medical investor, who asked not to be identified, said the state should leave doctors and private hospitals to pay for supply and demand. Especially, for example, the identification of EGP 600 of the value of the consultant professor will push many doctors to raise the value of disclosure, because a small proportion of consultants revealed EGP 600 or more.
He said the government should urgently complete the comprehensive health insurance scheme and make it actually comprehensive.