{"id":16861,"date":"2026-07-14T17:05:00","date_gmt":"2026-07-14T15:05:00","guid":{"rendered":"https:\/\/zawia3.com\/?p=16861"},"modified":"2026-10-07T03:49:35","modified_gmt":"2026-10-07T01:49:35","slug":"health-insurance","status":"publish","type":"post","link":"https:\/\/zawia3.com\/en\/health-insurance\/","title":{"rendered":"Universal Health Insurance Amendments Raise Fears Over the Fate of Earmarked Funds"},"content":{"rendered":"

At the end of June 2026, the House of Representatives approved a bill<\/a> amending provisions of Universal Health Insurance Law No. 2 of 2018<\/a>. Under the amendments, the solidarity contribution is treated as tax revenue, with the Egyptian Tax Authority responsible for examining, assessing and collecting it through the annual income-tax return. The proceeds go to the state treasury, which must automatically transfer an equivalent amount in full to the Universal Health Insurance Authority.<\/p>\n

The amendments also allow the solidarity contribution to be deducted as a cost when calculating taxable income, reversing the earlier prohibition on deducting it. Under the original law<\/a>, the contribution is 2.5 per thousand\u20140.25%\u2014of annual gross revenues of sole proprietorships, companies and economic public authorities, across commercial, industrial and service activities. It is one of the system\u2019s sources of sustainable funding.<\/p>\n

The amendments provoked parliamentary debate<\/a>. MPs warned about undermining the authority\u2019s financial independence, using its money for other purposes or delaying transfers, and questioned whether oversight safeguards were sufficient to deliver earmarked money on time.<\/p>\n

MP Diaa al-Din Dawoud warns<\/a> about removing item 9 of Article 40 of the 2018 law, which assigned the solidarity contribution directly to the insurance authority. The new arrangement, he says, turns it into general tax revenue received by the Finance Ministry through the Tax Authority, then made available as an allocation under the public budget\u2019s Chapter Four on subsidies, grants and social benefits.<\/p>\n

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Dawoud opposes the changes, fearing a repeat of what he describes as the government\u2019s appropriation<\/a> of social insurance and pension funds. He says the contribution is fundamental to actuarial calculations of sustainable financing and services for beneficiaries, and calls for a safeguard preventing the Finance Ministry from accessing it for other purposes.<\/p>\n<\/blockquote>\n

MP Ahmed Farghali also rejects changes<\/a> to the Income Tax Law linked to financing universal health insurance. He considers transferring solidarity contributions to the treasury rather than earmarking them directly for the authority a change in the system\u2019s financing philosophy.<\/p>\n

The 2018 law explicitly dedicates the 2.5-per-thousand contribution to funding and sustaining the system, he says. Subjecting it to tax collection threatens the authority\u2019s resource independence and contradicts the purpose for which it was imposed.<\/p>\n

During the parliamentary discussion, Farghali questioned government assurances<\/a> about transferring proceeds, saying he did not see a sufficient legal obligation to guarantee full and timely remittance. He requested clearer safeguards and cited social insurance funds, warning of a repeat of what he described as the Finance Ministry\u2019s earlier appropriation of them and its consequences for pensioners.<\/p>\n

Farghali criticised the ministry\u2019s record in meeting insurance obligations. According to his account, it had not paid its required contribution for people unable to afford coverage, and entities under it had also failed to pay amounts owed. This left him uneasy about transferring management of the resources to the ministry.<\/p>\n

He said the collection mechanism was being changed after the insurance fund accumulated around EGP 242 billion, with expected annual proceeds near EGP 52 billion. The money should be dedicated entirely to expanding insurance and improving services, he argued.<\/p>\n

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Farghali said the system still covered only around 6% of Egypt\u2019s population. Expansion requires financially independent resources and sufficient reserves to sustain care, rather than directing the money to other budget purposes.<\/p>\n<\/blockquote>\n

MP Mostafa Bakry agreed that the solidarity contribution is not general tax money but a source earmarked for healthcare. He called for explicit provisions requiring immediate transfer to the insurance authority after collection, with compensation for late remittance equivalent to Treasury-bill yields.<\/p>\n

During the debate, Bakry said<\/a> the authority recorded surpluses of approximately EGP 15 billion in 2022\u20132023, the state covered about EGP 3.5 billion for treatment of those unable to pay, and the draft budget contained approximately EGP 175 billion in tax proceeds. These are figures he cited during the discussion; the article does not present them as interchangeable measures of the fund\u2019s balance.<\/p>\n

To reassure MPs about resource independence, the House approved a proposal<\/a> by Rawia Mukhtar, deputy chair of its Manpower Committee, stating that proceeds should go to the treasury but be remitted immediately and in full to universal health insurance, combining collection discipline with protection of the system\u2019s rights.<\/p>\n

Observers nevertheless say the practical effect will depend on implementation, the Finance Ministry\u2019s compliance and the implementing regulations, expected within sixty days of the bill\u2019s approval. Those regulations are to define collection, transfer and oversight procedures. The article describes the position at its original publication date.<\/p>\n

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Critics Question the Law\u2019s Financing Philosophy<\/h2>\n

Mahmoud Fouad, head of the Right to Medicine Association, says the amendments, particularly Finance Ministry collection through the Tax Authority, raise concerns about future funding and keeping resources in healthcare. Parliamentary discussions exposed questions about protecting contributors and beneficiaries and directing payments towards the services for which they were designated.<\/p>\n

He says contributors pay to obtain healthcare, not as general taxpayers. Moving the proceeds into the treasury could allow them to finance other sectors according to budget priorities, he fears, unless binding safeguards ensure the full amount returns to the insurance fund.<\/p>\n

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\u201cThe amendments are linked to an attempt to reduce the public budget deficit by incorporating resources designated for universal health insurance. That contradicts the law\u2019s philosophy of independent, sustainable financing for the system,\u201d Fouad told Zawia3.<\/p>\n<\/blockquote>\n

\u201cEarlier experiences saw money earmarked for particular purposes used to cover other financial needs. We fear a repeat if universal health insurance resources become part of general state revenues,\u201d he added.<\/p>\n

Fouad points to Finance Ministry delays in paying health bodies, including the Egyptian Authority for Unified Procurement, which he says affected medicine and medical-supply availability in hospitals.<\/p>\n

He fears the same problems could affect insurance resources and the system\u2019s ability to serve beneficiaries. He calls for clear, binding safeguards reserving the money for healthcare and protecting citizens paying for treatment rather than for unrelated budget items.<\/p>\n

Dr Alaa Ghannam, head of the Egyptian Initiative for Personal Rights\u2019 Right to Health programme, criticises adoption of the amendments without sufficient public discussion. A major social-protection issue requires broad participation by experts and stakeholders before substantial changes, he says.<\/p>\n

The key change concerns collection of community contributions: formerly collected directly for universal health insurance, they are now collected by the Finance Ministry on the grounds of avoiding double taxation and recognising their tax-like character, Ghannam explains.<\/p>\n

\u201cTransferring collection to the Finance Ministry may be administratively acceptable, particularly alongside calculating the contribution on profits rather than revenues, an option discussed when the law was drafted,\u201d he told Zawia3. His reference to a profits-based contribution is a proposal; the amendments described in the report make the payment deductible but retain gross revenue as its calculation base.<\/p>\n

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Ghannam insists that all proceeds must reach the insurance fund without delay or collection-cost deductions, remain in a separate account and not be absorbed into the general budget.<\/p>\n<\/blockquote>\n

He identifies urgent health priorities, including access to insulin pumps for children with diabetes, and calls for activating the rare-diseases fund to provide treatment and care. His remarks concern access and rights, rather than individual medical treatment decisions.<\/p>\n

Ghannam also urges a transparent, objective evaluation of the first phase of universal health insurance before expanding to the second. Publishing its strengths, weaknesses and lessons would help improve implementation in subsequent governorates and achieve the system\u2019s goals, he argues.<\/p>\n

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A Contribution on Revenue, Not Profit<\/h2>\n

Under Law No. 2 of 2018, the solidarity contribution was charged to companies at 2.5 per thousand of gross revenue, not net profit. Businesses objected because they owed it whether profitable or loss-making, and it was not deductible for income-tax purposes. Ashraf Abdel Ghani, head of the Egyptian Tax Experts Association, described this as an additional burden.<\/p>\n

The amendments address part of that problem by making the contribution deductible, reducing the tax burden. Abdel Ghani remains concerned that calculating it on revenue rather than profit disregards companies\u2019 different financial circumstances.<\/p>\n

He says Tax Authority collection is not entirely new: contributions were already paid with tax returns and received by the Finance Ministry before transfer to the insurance authority. Previously, however, the Tax Authority lacked direct legal jurisdiction to pursue collection as part of the liabilities it supervised.<\/p>\n

\u201cThe amendment gives the Tax Authority powers to follow up these amounts and include them in collection procedures, improving compliance after difficulties caused by the absence of a body directly responsible for monitoring payment,\u201d Abdel Ghani told Zawia3.<\/p>\n

Ensuring remittance to the insurance authority is the responsibility of oversight bodies, particularly the Central Auditing Organization and the House and Senate, he says. They must ensure the money funds the purpose for which it was collected.<\/p>\n

The changes\u2019 success therefore depends not only on collection rules but on effective oversight guaranteeing that all proceeds reach the authority, sustain its financing and fulfil its founding objectives, Abdel Ghani argues.<\/p>\n

Economist Dr Elhami al-Mirghani says the 2018 law has not achieved its goals after eight years. At the time of reporting it operated in only six governorates\u2014Port Said, Ismailia, Suez, South Sinai, Aswan and Luxor\u2014leaving twenty-one others outside. Approximately 6.4 million people benefited out of a population of 108.6 million: less than 6%.<\/p>\n

The law created a wide financing base, he explains: levies on cigarettes and tobacco products, motorway tolls, driving and vehicle licences, medical-facility licences, company and establishment revenues, a share of hospital revenues and a dedicated stamp duty. Resources are collected nationwide while actual benefits remain limited to a few governorates.<\/p>\n

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\u201cThe Universal Health Insurance Authority recorded a cumulative financial surplus of approximately EGP 220.3 billion by April 2026, while total revenues reached EGP 281.3 billion, driven by investments and cash balances. These figures reflect resources not being directed towards expanding the system and increasing beneficiary numbers,\u201d al-Mirghani told Zawia3. These figures refer to his stated measures and reference date, which differ from other MPs\u2019 figures earlier in the report.<\/p>\n<\/blockquote>\n

Al-Mirghani criticises Finance Ministry changes bringing those levies into general budget revenues, arguing that this contradicts their designated purpose of funding universal health insurance. Seeking to use them to close the budget deficit rather than complete coverage reflects, in his view, failure to achieve the basic goal of insurance for all citizens.<\/p>\n

The government says the amendments unify and improve collection without compromising the system\u2019s rights. Experts and observers say success will depend on practical compliance with full, timely transfers to the authority and on legal and oversight safeguards in the implementing regulations against diversion.<\/p>\n

With the system still limited to a few governorates at the time of publication, the central challenge is not simply managing resources but using them to expand coverage and sustain financing, achieving the law\u2019s purpose of universal health insurance for all citizens.<\/p>\n","protected":false},"excerpt":{"rendered":"

Parliament approved changes routing solidarity contributions through the treasury, with a requirement for full transfer to health insurance. MPs and experts question safeguards, financial independence and the slow expansion of coverage.<\/p>\n","protected":false},"author":4,"featured_media":10685,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"footnotes":""},"categories":[413],"tags":[],"kateb":[1550],"class_list":["post-16861","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-society-en","kateb-aya-yasser"],"jetpack_featured_media_url":"https:\/\/zawia3.com\/wp-content\/uploads\/2024\/09\/\u0627\u0644\u0635\u062d\u0629-\u0632\u0627\u0648\u064a\u0629-\u062b\u0627\u0644\u062b\u06291-\u0627\u0644\u0645\u0648\u0642\u0639-\u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a.png","_links":{"self":[{"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/posts\/16861","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/comments?post=16861"}],"version-history":[{"count":2,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/posts\/16861\/revisions"}],"predecessor-version":[{"id":16863,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/posts\/16861\/revisions\/16863"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/media\/10685"}],"wp:attachment":[{"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/media?parent=16861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/categories?post=16861"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/tags?post=16861"},{"taxonomy":"kateb","embeddable":true,"href":"https:\/\/zawia3.com\/en\/wp-json\/wp\/v2\/kateb?post=16861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}