Abstract
A major restructuring of the service delivery, financing, and provider payment is underway in the Alexandria governorate as part of the health reform initiative being undertaken by the Ministry of Health and Population. While two rounds of National Health Accounts studies were conducted at the national level, not enough information existed at the level of the Alexandria governorate. The purpose of this report is to fill this important information gap and to use the results in developing methods to finance the cost of the basic benefits package, which will be made available under the reform initiative. This is the first time in Egypt that the National Health Accounts methodology has been used to develop expenditure estimates at a sub-national level.
In FY97 total health spending in Alexandria is estimated to have been LE 867.9 million. This was equivalent to LE 260.78 per capita (US$ 76.93). Per capita expenditures in Alexandria are more than twice the national average. Public funds accounted for 30 percent of total health financing. Private funding accounted for 70 percent with the bulk coming from household out-of-pocket expenditures that represented 59 percent of all health expenditures. Fifty-one percent of the funds passed through financial intermediaries and 49 percent were transferred directly to providers. Purchase of drugs accounted for 33 percent of total health spending with the majority of it being out-of-pocket expenditures by households. Fifty-eight percent of the population was covered under HIO insurance schemes. The proportion of individuals in Alexandria with insurance is higher than the national coverage rate of 37 percent.