Posted in: Friday, March 4, 2022 – 10:00 PM | Last update: Friday 4 March 2022 – 10:00 PM
Private investment in the health service has been rising recently, and there is no doubt that this is of importance, especially in light of the goals of comprehensive health coverage for regarding 103 million people for the new comprehensive health insurance system, and in light of a definite need for more health service institutions and family medicine units. The truth is that any investor in the health service (or the private health sector) aims for profit, and this is normal.
The volume of private sector investments during the fiscal year 2018/2019 in the health care sector amounted to 9.3 billion pounds, which represents 42% of the sector’s total investments during the same year, according to government data.
However, the necessary question is, are there standards and rules to organize this private investment according to a plan for the state that is supposed to be specific to the nature of the actual need of society and the health sector, and the location and size of this investment in line with what already exists of public investment for the state?
Does the state have strong measures to prevent the monopoly of this private sector, especially in the quality of high-profit, low-cost services such as radiology centers, laboratories, and hospitals with specific specializations? Monopoly is a real danger to the Comprehensive Health Insurance Fund and its negotiating ability on service prices, given that the Fund is the official and only agent for the people’s insurance subscribers’ funds. It is characterized by integrity and transparency, and is subject to the oversight of the people by a board of trustees representing stakeholders in the health system. Its role is to purchase the service from the public and the private with standards and quality at the lowest cost and through a clear negotiating power that ultimately serves the interests of the people.
These are basics for understanding the problem of investment in the health service on the part of the private sector. Without them, investment in health becomes without a clear goal, and the patient pays for it in the end from his own pocket. It is assumed that state agencies take this into account and strengthen its public sector to control the market and prevent and limit monopoly. .
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Over the past decades, IFIs have encouraged many governments of low- and middle-income countries to seek a role for the private sector in health, largely driven by the belief that governments in these countries have been too weak to provide all the health services needed to meet the needs of the population. This is in the famous World Bank report in 1993 (Investing in Health).
However, with the Covid-19 pandemic, the failures of the private health sector and its inability to deal with health crises of the size of Covid appeared, for example. In Egypt, for example, the public health sector formed the main wall to confront the Covid-19, with health NGOs such as Mersal, and the private health sector had no role. On the contrary, the main goal in front of the private sector was to maximize profit, for example, the overnight price crisis in hospitals. Especially when the private sector rejected the Ministry of Health’s regulation (10 thousand pounds) as a maximum night for the care of a person with Covid. And the prices of PCR analyzes are very high compared to even government laboratories or countries similar to Egypt, and this is understandable because the investor and the private sector in general are looking to increase their profits, but health is not a commodity measured by gain and loss or subject to market standards, hence the importance of open discussion or even concern regarding the increasing role For the private sector to expand its investments in the health sector.
While countries differ regarding what they believe is the appropriate role of the state in regulating the health care market, it is agreed that the main function of government is to play the role of the main regulator. However, the fact remains clear that the entry of profit-oriented private health companies or hospitals into the health system will raise the price of health services in general, compared to a health system in which health assets are owned by the state.
The health crisis of the private sector and its impact on the right to health is focused on three axes: (1) that the private sector is looking for the fastest and largest profit in a short time. For example, we did not find investment by the private sector in health in basic care units or in governorates that suffer from a lack of health infrastructure On the contrary, private sector investments are concentrated in the major governorates and in the second and third levels of health care, because the profit margin is greater than the investment in basic care. (2) The crisis of raising the price of the health service in general. and (3) the crisis of how to regulate relations between the state and private health service providers.
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The optimal approach is to invest in health on the part of the state, whether at the level of infrastructure in terms of facilities to serve the first and second levels of health care, or at the level of the human element.
In conclusion, the concept of investment in health is in fact a broader and deeper concept than simply allowing the private medical sector to expand in establishing or acquiring more investment hospitals and then benefiting from the funds of the new health insurance system. It also means investing in people and the health workforce. And also in the social determinants of health, whether in sanitation, clean drinking water, environmental determinants of health, or other factors that accumulate an added value to the concept of people’s comprehensive health, and not just borrow money from banks to establish hospitals that invest in disease and collect their profits from patients’ pockets, or from Public treasury resources allocated to health care and the new universal health insurance.
