In the government’s telling, the first phase of the Universal Health Insurance rollout was a

success

. And with that success in hand, it says now that the scheme is ready to expand.

Six years ago, people in Port Said, Ismailia, Suez, South Sinai, Luxor and Aswan — the first governorates to see the rollout of the 2018 law  — were brought into the new system.

The promise was something better than the old model, a healthcare system built on social solidarity. People would pay less out of pocket. They would find a place in hospitals. Medicines and treatment would be there when they needed them.

But patients across those six governorates who spoke to Mada Masr over recent months describe months-long shortages of critical medicines and medical devices and appointment scheduling bottlenecks. Many, who were enrolled in the program whether they wanted to join or not, are now being effectively denied healthcare over unpaid insurance contributions that have climbed in some cases into the tens of thousands of pounds.

“All we hear is that the system is a success, but what we see is something completely different,” says a resident of Aswan. What is on the ground is a service well below even the minimum standard, he says.

The problems in the first phase were not unforeseen. Several officials and health policy experts involved in the drafting of the law at the time tell Mada Masr that the objections they raised nearly a decade ago remain at the heart of the challenges patients face today.

Nonetheless, the government is pressing ahead. While Health Minister Khaled Abdel Ghaffar says the government is preparing amendments to the law to address shortcomings that emerged during implementation, the state is already heavily

promoting

the second phase that will expand the scheme to another five governorates, starting with Minya, a heavily populated governorate with one of the highest poverty rates in the country.

Mada Masr spoke with health sector officials, specialist researchers, MPs and beneficiaries of the system to examine the main crises and challenges that emerged during the first phase, and whether they are now being carried into the scheme’s expansion.

***

One of the most common complaints patients living in the first-phase governorates raise is the shortage of medication.

For Mohamed Yasser, from Port Said, it was Budelizer, an inhaled medication used to treat asthma and chronic obstructive pulmonary disease. When his monthly prescription ran out, he was told the drug was unavailable through the scheme. It stayed that way for nearly six months.

During that time, Yasser had to buy the medication himself from private pharmacies, where the two boxes he needs each month cost around LE500 — even as he continued paying more than LE400 a month into the insurance scheme. Sometimes, he says, he could not find the medication or a substitute.

Getting medication through the system is itself consuming, Yasser explains. Patients must first book an appointment through the call center, then wait in a long queue at a family medicine clinic for a doctor to renew the prescription, before heading to the pharmacy, then to the cashier for the required fees and finally back to pick up the medication.

Every time, Yasser has to repeat the same process, which takes long hours, even though he is not seeking a medical examination but just renewing a prescription he takes regularly. Sometimes, there are no appointments available, and he is told to come back the following week, by which point he has already run out of the medicine. Other times, the doctor prescribes three packs, but the pharmacy dispenses only one because supplies are running low, forcing him to cut his dosage.

Because he kept having to cut back on the medication, his condition deteriorated, he says. Eventually, he filed a complaint with the Universal Health Insurance Authority demanding that the medication be made available again, noting that it had previously been dispensed routinely through the system before suddenly disappearing.

Khaled, an Al-Azhar school teacher in his mid-forties who lives in the Aboul Rish neighborhood in Aswan, has run into the same problem.

He depends on regular insulin injections and diabetes medication. Yet attempts to obtain them through his designated insurance hospital have repeatedly failed.

“They told me, ‘buy it from outside, when you get paid,’” he tells Mada Masr. Despite around LE800 being deducted from his salary …