• Provide government funding to hold the verification and validation, and will recover the amount of the loan as soon as it enters into force, in order to facilitate the choice of checking the company and authentication in a timely manner to contribute to the final selection of the package the main systems and the subsequent development of the package necessary equipment for the project pilot provinces.
• expected when choosing a verification and validation that the company is working closely with procurement staff unity of implementation of the project under the supervision of the Chief of the General Authority for Health Insurance Administration.
160. In addition to the already mentioned above more immediate measures to mitigate the risk of procurement, with respect to more sustainable capacity building; Panel recommends encouraging the procurement staff of the General Authority for Health Insurance workers main center in Cairo to participate in external training and the training of purchases on-the-job offered to them Technical support Office, in connection with the procurement manual guidance and accountability of the World Bank in order to comply with aspects related to procurement contained the loan agreement.
161. The overall risk of the project in connection with the procurement big risks, and that after the implementation of risk mitigation measures.
169. economic and financial benefits for investment arise in the development of health insurance systems through a number of channels project. Which include the efficiency and effectiveness of the remedial management point of payment such as monitoring the levels of use of services and anti-manipulation and fraud, administrative efficiency and effectiveness of medical practices on the part of health care providers. They will show benefits over time, especially during the period of implementation of the pilot project in the governorates, and the period after the project at the national level, which of course depends on the mainstreaming of the project across the country. It follows that the expectations of the benefits is subject to a number of assumptions regarding baselines, effects, and timing. But it is possible to estimate the benefits of conducting various types of analyzes, and eat later, including specifically the duration of the project and experimental provinces breakeven caller analysis, and analysis of the net benefits of the pilot provinces on the basis of a conservative estimate of the expected effects.
170. can enter claims-efficient environment based largely on paperwork that enormous effects occur in a wide variety of areas, management systems, and not only with regard to the administrative aspects of the point of payment, such as: reduce the cost of claims processing, improve claims filed accuracy; so as not to be forced by their sponsors to be resubmitted as often happens, and reduce the cost of paper claims processing, and can also be monitoring the levels of use of treatment services on practicing medicine the same affect. Examples include: unnecessary duplication of tests laboratory, low internal bed occupancy at the hospital or the failure to use equipment to some sites, poor provision of care services Coordination rates resulting in patient hospital entry without the need for, and the waste of medicines and pharmaceuticals because of poor management, and medical errors, such as interactions adverse drug, and unjustified disparities in medical care, poor follow-up of chronic diseases, resulting in poor health outcomes and higher final cost.
171. It may be difficult to estimate the financial benefits that come from dealing with these issues, let alone access to a number that represents the basis of the current line of the body. Therefore, the following calculations are based on a subset of the benefits in the areas of: (a) anti-manipulation and fraud, (b) monitor the levels of use of services, (c) clinical practices, (d) administrative efficiency.
172. Based on the types of analysis described above, we find that the potential opportunity to increase the efficiency and effectiveness of investments in the project is that even under a relatively modest set of assumptions regarding the benefits listed above, the project is able to recover its costs through a geographical and limited space of the three pilot provinces . Benefits that are likely to bear fruit by the investment in the project to provide a potential equivalent to about $ 111 million per year and may lead (pilot governorates), or 7.5 per cent of total current expenditure on health care.
173. Moreover, to reach the break-even point of the project recovers any initial investments amounting to US $ 75 million costs, it should lead to the provision equivalent to 2.7 per cent only.
Second. Elements of the project and estimate revenue
174. spends Egypt to health services is about $ 85 per person per year, or about 6 per cent of GDP, which is equivalent to as much income and other medium-sized countries, but estimates indicate that the rate of increase will be faster than the economic growth rate of about 10 percent. Indicate the fact that spending on health care has a growing share of total spending – the need to strengthen control of the financing system the cost of the capacity, which may be difficult to achieve because of the fragmented nature of the health system now, because it can not any single entity to implement the necessary mechanisms for management and administration . For example, the General Authority for health insurance expenses list has seen an increase faster than its revenue increase over the past decade, leading to exposure to a permanent disability in the operation. And it refers actuarial recent analysis government requested conducted in order to strengthen the expansion of the social health insurance system process – that the Social Health Insurance Fund will face considerable pressure to increase spending, using a reasonable set of assumptions that relate to coverage, levels of use, and the benefits of this analysis. It will be the main driver for this is the assumed usage levels of health services by beneficiaries subscribers.
175. The Health Insurance Systems Development Project will be able – through his investment in a job point of paying an effective and uniform – to contribute to the response to this challenge by developing a business model proved its usefulness backed technology-based management system and would allow the buyer tools and health information services required.
176. increasing the national and international levels to provide the evidence and the evidence of the lack of efficiency of health care services, and the manipulation and fraud and improper use of resources. At a time when the only evidence of a small amount from Egypt are not available, and it basically as a result of the problem of lack of information and management designed this project to solve systems, there are strong grounds to believe that the interventions of the project will contribute to the reduction of total health care expenditures by an estimated 6 to 7 per cent, or the equivalent of about US $ 365 million to US $ 420 million a year, once the preparation and implementation of activities in all parts of the country. These are just a conservative estimate based on reasonable assumptions, it shows high overall economic rate of returns.