Health reform for children: the Egyptian experience with school health insurance

In June 1992, the People's Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it e ffectively increased the number of beneficiaries covered by the Health Insu rance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1 993. This paper first examines the policy processes for the introduction of this innovation in Egypt's health system. Next, the paper discusses the im plementation and consequences of the new policy in terms of coverage, finan cing, benefits, and delivery of services, along with data on utilization an d expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitm ent and the proposed program and solutions are acceptable to the key stakeh olders. Second, compromises and trade-offs are essential to construct a pol itically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long t erm may undermine the reform's capacity to achieve the anticipated equity e nhancements and can potentially undermine the financial sustainability of t he reform. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.