A dispute over the price of medical tests has prompted Egypt’s journalists’, lawyers’ and engineers’ syndicates to suspend the renewal of contracts with Al Borg, Al Mokhtabar and Alfa laboratories. The syndicates say the chains’ proposed increases substantially exceed the medical-profession tariff used as a benchmark in their agreements.
In an official statement, the Egyptian Journalists Syndicate said the contracts required the laboratories to follow the agreed benchmark. It said their rates had risen more than 30% above those available at other laboratories, with a further increase of about 42% proposed at the end of 2024. The syndicate rejected the increase and sought to retain the previous rates; the laboratories’ refusal led it to suspend the contracts.
The dispute has brought two problems into the same debate: concerns about the pricing power of large diagnostic chains, and weak oversight of smaller laboratories that may operate without the necessary licences or equipment.
Union representatives and health-policy specialists interviewed by Zawia3 argue that both can leave patients paying more while facing uncertainty over the quality of the service they receive. Their allegations of anti-competitive conduct require scrutiny by the competent regulator; market size alone does not establish a breach of competition law.
How the pricing dispute developed
The journalists’ syndicate traces the dispute to late 2018. According to its account, a vacancy in the management of the Medical Professions Union prevented the normal approval of annual increases. A separate tariff for non-medical professional syndicates was subsequently introduced. In 2019, that tariff was roughly 10% above the doctors’ benchmark; the journalists’ syndicate accepted it despite its contractual terms, and the gap then widened over successive years to around 30%.
Two of the chains involved, Al Borg and Al Mokhtabar, belong to Integrated Diagnostics Holdings (IDH). Alfa is a separate business. IDH was formed in 2012 through the combination of Al Borg and Al Mokhtabar and is registered in Jersey, a British Crown Dependency. Jersey’s tax arrangements are often discussed in debates about offshore finance, but registration there does not by itself demonstrate tax evasion by a particular company.
The group provides laboratory diagnostics, molecular and genetic testing, and radiology across several markets. Its brands include Al Mokhtabar, Al Borg, Al Mokhtabar Sudan, Ultralab, Echo-Lab and Biolab. Its wider activities also include Wayak and Golden Care.
IDH’s network expanded from 235 branches in 2012 to 608 as of 30 September 2024, including 567 in Egypt, or approximately 93% of the total. A 2023 press report cited around 18,000 licensed laboratories across Egypt. Those figures describe different measures: a chain’s branches and the broader number of licensed facilities.
Some interviewees estimate that IDH captures more than half of diagnostic-market revenues. That claim depends on the market being measured, the year and whether hospital laboratories and other providers are included; the branch figures alone cannot establish such a share.
Fact-checking platform Matsda2sh examined IDH’s registration during the dispute. It identified registration number 117257 and an address at Capita Registrars (Jersey) Limited, 12 Castle Street, St Helier, Jersey JE2 3RT. It noted that the address also appeared in records associated with the 2017 Paradise Papers, published by the International Consortium of Investigative Journalists and its partners. Sharing a registration address with entities in an offshore database is not evidence of unlawful activity.
The company’s financial statements show net profit rising from approximately EGP 155 million in 2015 to EGP 468 million in 2023, with a much larger peak during the pandemic. Its results for the first nine months of 2024 report average revenue per test of EGP 142, up 23% from EGP 115 in the same period of 2023. This is an average revenue measure, rather than evidence that every test’s listed price rose by the same percentage.
Over those nine months, group revenue reached approximately EGP 4.1 billion and net profit EGP 724 million, an 87% increase from the comparable period. Egypt accounted for 82.1% of group revenue.
In May 2021, the International Finance Corporation announced an eight-year, USD 45 million loan to IDH to support expansion and access to diagnostic services in existing and new markets. The facility covered growth beyond the group’s established operations in Egypt, Jordan and Nigeria.
In Egypt, revenue increased 35% in the first nine months of 2024. The country operation’s EBITDA margin—earnings before interest, tax, depreciation and amortisation as a proportion of revenue—also stood at 35%, compared with 30.7% a year earlier. Revenue growth and a profit margin are separate indicators, even when their percentages happen to match.
The chart shows the geographical distribution of 2023 revenue: Egypt 82.7%, Jordan 14.7%, Nigeria 2.3% and Sudan 0.3%. It describes revenue, not the allocation of investment, and covers a different period from the nine-month 2024 figures above.
Negotiations and the power of large chains
Journalists’ Syndicate head Khaled El Balshy says his union worked with the engineers’ and lawyers’ syndicates to negotiate with the three laboratories. They asked the chains to apply the Medical Professions Union tariff, which he says already incorporated a 20% increase.
The syndicate then offered a further 5% above that benchmark in an effort to reach a compromise, he says. When the laboratories rejected the offer, El Balshy coordinated with Lawyers’ Syndicate head Abdel Halim Allam and Engineers’ Syndicate head Tarek El Nabarawy to refuse renewal. El Balshy characterises the chains’ conduct as monopolistic.
The Egyptian market is central to IDH’s business. The group reported serving 6.2 million patients in Egypt in the first nine months of 2024, approximately 94% of the patients it served across its markets.
IDH’s formation followed a series of acquisitions involving the UAE-based Abraaj Capital. Abraaj acquired 76.9% of Al Borg in 2008, increasing its holding to 99.3% by 2012. It also acquired 99% of Al Mokhtabar in 2012. The two transactions, reported at a combined EGP 2.044 billion, helped consolidate a major private diagnostics group.
Abraaj exited IDH in 2016, before the scandal that later engulfed Abraaj in 2018. Its exit therefore should not be presented as a consequence of that subsequent crisis.
Economic researcher Wael Gamal describes IDH as the largest player in Egypt’s diagnostic-testing market. He points to Abraaj’s role in bringing Al Borg and Al Mokhtabar together, and to the Egyptian market’s contribution of more than 80% of group revenue.
Gamal argues that the group benefited substantially from the pandemic, serving more than ten million patients across its operations in 2021 and recording a sharp increase in profit. In his view, concentration in the sector gives large providers substantial influence over prices.
Gamal calls on the Egyptian Competition Authority to investigate the sector and publish findings that establish—or rule out—anti-competitive practices.
He estimates the group’s share at more than half of sector revenues, but a precise assessment would require a clearly defined market and supporting data. He also points to the dependence of smaller laboratories on large chains for tests requiring equipment they cannot afford. Some, he says, function as intermediaries, limiting their ability to compete.
Gamal welcomes the syndicates’ joint stance. Their large combined membership, he argues, gives them purchasing power with which to resist rates they consider unjustified. He sees collective negotiation and regulatory scrutiny as complementary responses.
El Nabarawy says discussions with the laboratories lasted nearly two months. The chains nevertheless insisted on rates substantially above the medical-profession benchmark, he tells Zawia3. Such increases, he says, burden both individual members and the syndicates financing their care.
“The laboratories have not backed down so far, so the syndicate has sought alternatives by contracting with other laboratories offering members the same competence and quality, applying the agreed prices and maintaining good coverage across the governorates,” he says.
He views the dispute as a problem affecting all patients, not just syndicate members, and calls for the relevant state bodies to regulate the sector in accordance with competition and transparency requirements.
Licensing, quality and uneven oversight
Pricing is only one part of the problem. The Health Ministry’s department responsible for non-governmental treatment facilities and licensing periodically orders laboratories to close for licensing violations, failures in infection control or the employment of unqualified staff.
Alaa Ghannam, who leads the right-to-health programme at the Egyptian Initiative for Personal Rights and specialises in health-sector reform, argues that weak regulation allows both pricing abuses by powerful companies and the operation of facilities that do not meet required standards.
He describes distortions in the pricing of laboratory tests and radiology services, compounded by inadequate oversight. His proposed response combines competition-law enforcement, clearer pricing arrangements and stronger inspection of providers operating without authorisation.
Ghannam sees the syndicates’ action as a starting point for a wider examination of diagnostic services. In rural areas and Upper Egypt in particular, he says, insufficient supervision can affect how laboratories operate and the reliability of their results.
He also points to uncertainty over the total number of laboratories. Egypt’s Law No. 367 of 1954 regulates qualifications, registration and licensing in medical chemistry, bacteriology and pathology. It imposes requirements that vary by profession and qualification; holding a degree in medicine, science, pharmacy, veterinary medicine or agriculture does not automatically entitle every graduate to practise laboratory medicine.
Rasha Abdel Hadi*, a doctor working at a laboratory in Giza, describes practices she encountered while training in several laboratories before joining a larger facility. She alleges that unlicensed operation and the use of licences rented from other practitioners are widespread, especially in rural areas and Upper Egypt. Her estimate that thousands of facilities operate this way is an interviewee’s account, rather than a verified national count.
She says many small laboratories lack the equipment needed for certain tests and send samples to larger facilities through couriers who collect them each day. Such referral arrangements make the smaller laboratories dependent on the chains processing their samples. Outsourcing specialised tests is not in itself proof of illegality; licensing, sample handling, transparency and quality controls remain central questions.
Abdel Hadi also alleges that some laboratories pay doctors commissions for directing patients to them, undermining fair competition and creating potential conflicts of interest.
The large chains’ financial resources and expanding networks make them a principal destination for many patients, Abdel Hadi says, particularly for specialised tests requiring costly equipment.
She cites certain endocrine tests among the services for which physicians commonly refer patients to Al Borg, Al Mokhtabar or Alfa. Her account highlights the equipment gap between providers; it does not establish that no other Egyptian laboratory can perform those tests.
For patients, the unresolved challenge is access to testing that is both affordable and reliable. The syndicates’ dispute has exposed concerns about bargaining power and pricing, while testimony about licensing and oversight raises a parallel question: who ensures that every laboratory meets the standards on which patients depend?
