Health Systems

And The Cycle Of

Health System
Reform
Prepared By :

Dalal Sulaiman

Bushra Albalawi

Abdulrahman Aljhani

Abdou

Supervised By :

Prof. Dr:Malay Zayed

Objectives
By the end of this lecture every student will be able to :
Describe health system in Egypt
 Define health care system Explain challenges to Egypt's
 Discuss goals of health system health system
 Enumerates Elements of the health care Identify the concept of health
system system reform.
 Explain objectives of health care system Discuss goals of health system
reform.
 Discuss Qualities of a good healthcare
Assess the needs for health system
system
reform.
 Apply health care system Model
Summarize health system reform
 Differentiate Levels of organization of strategies.
health care systems and health care Discuss Universal health insurance
delivery
 Recognize aspects of health care system
Outlines
 Introduction
 Goals Of healthcare Reform
 Definition Of Health Care System
 Need for Health System Reform
 objectives of health system
 Health Sector Reform Strategy in
 Qualities of good health system
 Levels of health care delivery system Egypt
 Universalhealth insurance
 Model of Health system
 References
 Aspects Of Health Care System
 The Egyptian Health Care system
 Organization of the health care
system in Egypt
 Challenges to Egypt's health system
Introduction
 The definition of health systems has enormous variations, especially regarding
the boundaries of the health system (Figueras & McKee, 2012). According to
the World Health Organisation a health system consists of all organisations,
people and actions whose primary intent is to promote, restore or maintain
health..
 Health Systems

NBER Center of Excellence’s Definition of a Health System

Ahealth system as a group of healthcare organizations (e.g., physician practices,
hospitals, skilled nursing facilities) that are jointly owned or managed (foundation
models are considered a form of joint management). health systems are required to
include at least 1 general acute care hospital, 10 primary care physicians, and a total of
50 physicians all located within a single hospital referral region.
 Health Systems
 A health system is, therefore, more than the pyramid of publicly owned
facilities that deliver personal health services but include the institutions,
people and resources involved in delivering health care to individuals.
 The main goal of any Health system activities is to promote, restore and
maintain health.
 Related concepts
 Health resources are all the means of the health care system available for its
operation, including manpower, buildings, equipment, supplies, funds, knowledge
and technology.
 Health system infrastructure includes services, facilities, institutions or
establishments, organizations, and those operating them for conducting the
delivery of a variety of health services and programs.
 The main objectives of each national health
system
 1) Universal access to a broad range of health services;
 2) Promotion of national health goals;
 3) Improvement in health status indicators;
 4) Equity in regional and socio-demographic accessibility and quality of care;
 5) Adequacy of financing with cost containment and efficient use of resources;
Cont, objectives of each national health system
 6) Consumer satisfaction and choice of primary care provider;
 7) Provider satisfaction and choice of referral services;
 8) Portability of benefits when changing employer or residence;
 9) Public administration or regulation;
 10) Promotion of high quality of service;
 The World Health Organization (WHO) lists the
qualities of a good healthcare system as
 Safe and effective: The care that is delivered takes into account individuals’
unique needs, preferences, and values.
 Timely: Wait times have been minimized to avoid potentially harmful delays in
care.
 Equitable: All residents and citizens are able to access the care they need.
 Integrated: The full range of healthcare services are available throughout a
person’s life.
 Efficient: Benefits have been maximized and waste has been minimized.
The WHO Health System Framework
Source: WHO, 2007 (2).
  The four basic designs healthcare systems . All
Health Systems these models differ in both how they are funded
and how healthcare is delivered.
models  Publicly funded systems are paid for with
taxation, while privately funded systems are paid
for with individual contributions to a collective
fund, like an insurance company.
 Facilities that deliver healthcare can be either
owned by the government or privately owned
by an organization, like a corporation or a
nonprofit.
The Beveridge Model: In this model health care is
provided and financed by the government through tax
payments.
• In this model, many but not all hospitals and clinics
are owned by the government.
• The cost of treatment in this model tends to have low
costs per capita, because the government, being the
sole payer, controls what doctors can do and what they
can charge.
• It is the purest example of total government control.
The Bismarck Model "Mixed Model"
This model uses insurance system which is
financed jointly by employers and
employees through payroll deduction.
Private hospitals and clinics are the major
players in this model.
Bismarck model is found in France,
Netherlands, and Japan.
The Private insurance
Model
Funding of the system is
based on premiums, paid into
private insurance companies
Out-of-Pocket Model
The basic rule is that the rich
get medical care; the poor stay
sick or die.
Levels of organization of health
care systems and health care
delivery
 Self-care implies largely unorganized health
activities carried out by individuals, families,
neighbors, friends and workmates. These include
the maintenance of health, prevention of disease,
self-diagnosis, self-treatment.
 WHO has shown interest and pointed out that Self-care
traditional and alternative medicine consist big
potential, which might be useful for improvement
of the health status of the population.
  Primary professional (medical) care is a care of
the “first contact” of the individual with the
health care service, which is provided in
ambulatory settings by qualified health
professionals (general practitioner-GP, family
Primary doctor, or nurse).
professional  The most common role of the physician is “gate
keeper”, which means that the doctor is
(medical) care empowered to treat and cure broader scope of
illnesses and conditions (up to 85% of health care
problems in a community without recourse to
specialist), and to select and refer patients to
higher levels of the health care system when
necessary.
 Secondary or intermediate level of care is
general specialist care, delivered by “general
specialist doctor” for more complex conditions,
which couldn’t be resolved by the general
practitioner or primary professional care level.
 General specialists (surgeons, internal Secondary or
medicine specialists, gynecologists,
psychiatrists etc.) usually deliver this type of
intermediate level of
care through specialized services of district or care
provincial “general hospitals.
  Tertiary or central level of care is sub-specialist
care including highly specific services, which
might be delivered in specialized institutions or
by highly specialized health professionals - sub-
Tertiary or central
specialists i.e. neurosurgeons, plastic surgeons,
level of care
nephrologists, cardiologists etc.
 The specialized institutions, which provide this
type of care are, also, educational institutions for
health manpower (university hospitals, university
clinics, etc.).
 Health care system in Egypt:
 Egypt has a diverse health system with numerous public and private healthcare
providers.
 Egypt’s healthcare sector is regulated and governed by the Ministry of Health
(“MoH”), also known as Ministry of Health and Population (“MoHP”).
 The government sector
 The government sector represents activities of ministries that receive funding
from the Ministry of Finance (MOF). This means that government providers
receiving budgetary support from the government general revenues (MOF)
 Government providers are permitted to generate their own income through
various means, including charging user fees in special units or departments known
as economic departments. Income from these non-budgetary sources is classified
as “self-funding.”
The parastatal sector
 The parastatal sector is composed of quasi-governmental organizations
in which government ministries have a controlling share of decision
making, including the Health Insurance Organization (HIO), the
Curative Care Organization (CCO), and the Teaching Hospitals and
Institutes Organization (THO).
Parastatal sector
 The Curative Care Organization (CCO) is a nonprofit system
established in 1964 under the ultimate authority of the MOHP.
CCOs operate 11 hospitals, which together account for about 1.5
percent of Egypt’s total hospital beds.
 Parastatal sector
 General Organization of Teaching Hospitals and Institutes: It is
established 1975. It includes nine institutes and 12 hospitals distributed
over Egypt.
 The twelve THO hospitals are distributed as follows: four hospitals in
Cairo, 8 hospitals out of Cairo. Ex: teaching Ahmed Maher hospital.
Parastatal sector
 Health Insurance Organization: There are four broad classes of
HIO beneficiaries:
1. Governmental employees affiliated with the public sector,
2. Personnel affiliated with private organizations,
3. School children in the various types of schools
4. Newborns.
Parastatal sector
 University hospitals: the major universities and university hospitals.
University hospitals are regarded as secondary and tertiary care facilities and
tend to be much more advanced in terms of technology and medical expertise in
comparison with MOHP facilities.
 These university hospitals are operated under the authority of Ministry of
Higher Education. There are 110 hospitals and serve 18 million of patient
The private sector
 The private sector includes for-profit and nonprofit organizations and covers
everything from traditional midwives, private pharmacies, private doctors, and
private hospitals of all sizes. Also in this sector are a large number of
nongovernmental organizations (NGOs) providing services, including
religiously affiliated clinics and other charitable organizations, all of which are
registered with the Ministry of Social Affairs (MOSA).
 Challenges to Egypt's health system
How does the system work?
 The health system in Egypt is governed by the Ministry of Health and
Population with five sectors of administration including: central administration
for the minister’s office, curative health services, population and family planning,
preventative health services, and administration and finance.
 Challenges to Egypt's health system
1- Expenditure and Funding Sources:
 In terms of the financing philosophy of the Egyptian health system, it can be
classified as being based on the “out-of-pocket model”, that suffer from many
development problems related to poverty, unemployment and low level of
education, follow this model (out-of-pocket model), based on the fact that ‘the
rich get health care and the poor get sick or die
Challenges to Egypt's health system
2- Weakness of the health insurance System:
 The Personnel of the service Institutions are treated at hospitals of the general
health insurance authority, Where hospitals provide poor a medical service due to
their limited potentials.
 The rest of the Egyptian people are treated through the system of ‘Treatment at
the state’s Expense’ at the hospitals of the Ministry of Health and the university
hospitals.
Challenges to Egypt's health system

3 – In-Efficient Management Of The Health System:

 At Ministry of health Level is due to the centralized control, extensive

Infrastructure, and governmental responsibility for health care for all Individuals

and extensive governmental involvement In the pharmaceutical sector.

4 - Complex Organizational Structure Of The Health System:

 There are multiple public and private sources of finance and delivery of health care

and limited governmental oversight of the private sector.

Challenges to Egypt's health system
5 – In-Efficient health services delivery:
 Shortcomings in human resources include low capacities and skills, mal-
distribution of physicians across geographic regions and specialties and
insufficient salaries and incentives.
 Additionally, the health facilities’ infrastructure (building, furniture and
maintenance) is deteriorating .
 Health system Reform
What Do We Mean by “Health System Reform”?
 Not everything that changes, or causes change, is a health system reform
 Purposeful efforts to change the system to improve its performance
 “little r” reforms; Small changes to one or a few features of the system
 “Big R” Reforms; Large changes to more than one feature of the system
  Health outcomes needed to be improved.

 Organizational structure needed to be reformed.

 The financing system needed to be more equitable and

efficient.
Need for Health  The service delivery system needed to be restructured.
System Reform
 The distribution, efficiency, and quality of the human

resource base needed to be improved.

 The pharmaceutical sector needed to be more efficient

and high quality.

Goal of health care Reform
The underlying goal of health care Reform can be summarized into 4 key
categories:
1-Expand affordable access to healthcare coverage to all citizens and get everyone
paying into the system.
2-Improve the quality of care that consumers receive.
3-Increase science and transparency technology
4-Promote preventive care and wellness.
Strategies of Health Sector Reform
 Strategies of Health Sector Reform:
The government of Egypt (GOE) has articulated as its long-term goal the
achievement of universal coverage of basic health services for all its citizens.
It has also stated as its priority objective, the importance of targeting the most
vulnerable groups in the population, emphasizing in particular the need to the
population, emphasizing in particular the need to identify approaches that have
the most impact in reducing infant and maternal mortality rates.

The health sector reform
strategies are assisted through
the Health Sector Reform
Program (HSRP).
 Expanding the social health insurance
coverage from 47 percent (in 2003) of the
population to universal coverage based on the
“family” as the basic unit. An affordable and
cost-effective package of basic health services
based on the priority health needs of the
population will be provided.
• Reorganizing services so that they are provided
through a holistic family health approach.
 Provision of the basic package will be based on
competition and choice among the different public and Strategies of Health
private service providers, under a single Public and Sector Reform
Health Insurance Fund (PHIF) using incentive-based
and other provider payment mechanisms.
  Strengthening management systems and developing
a regulatory framework and institutional
relationships to ensure quality of care and to
Strategies of Health support the reform of the health sector.
Sector Reform  Developing the domestic pharmaceutical industry
and reducing government involvement in the
production of pharmaceuticals while strengthening
its role as a financier.
Universal insurance coverage
 The Egyptian government is targeting to eradicate
the current difficulties witnessed in the Egyptian
health sector by improving the quality of health
services and infrastructure provided to all Egyptians.
 Therefore, the Universal Healthcare Act proposes
the implementation of an incorporated database for
all insurers
Other major goals include:
 Upgrading of medical facilities with the latest medical instruments.
 Coverage extension to all family members as opposed to breadwinners only.
 Creation of a smart card system that will tie-up recipients with their insurance claims.
 In 2016 a new law intends to cover 100% of all Egyptians.

 The new system will be rolled-out in 6 phases over a 15-year period.

 According to Egypt plan 2030 the country seek to achieve universal health coverage

(UHC), including financial risk protection, access to quality essential health care

services, and access to safe, effective, quality, and affordable essential medicines and

vaccines for all.

Universal health insurance bill
1. Every citizen has the right to health and to comprehensive health care which

complies with quality standards.

2. The State shall maintain and support public health facilities that provide health

services to the people and shall enhance their efficiency and their equitable

geographical distribution

3. Government spending to health equivalent to at least 3% of Gross National Product

(GNP), which shall gradually increase to comply with international standards.

4. The State shall establish a comprehensive health insurance system covering all

diseases for all Egyptians.

 References
 Murray, M. and Langan, J. (2011): leadership and management in nursing chapter 1 the health
care system environment for nursing leadership library of congress cataloging- in- publication data..
 Elden, N. M. K., Rizk, H. I. I., & Wahby, G. (2016). Improving Health System in Egypt:
Perspectives of Physicians. Egyptian Journal of Community Medicine, 34(1).
 Thomas.E, 2010, Health economics and financing, 4th Edition,
 Kaiser Public Opinion Spotlight: The Public, Managed Care, and Consumer Protecti
ons
, June 2004, accessed 2007-10-05.
 http://www.healthdecisions.org/LearningCenter/Facts.aspx.
 https://dhsprogram.com/pubs/pdf/SPA5/02chapter02.pdf
 https://www3.paho.org/hq/dmdocuments/2010/64-Maximizing_Quality_Care_HSR-
Role_Quality_Assurance_Strategies.pdf