Keep Us Strong WikiLeaks logo

Currently released so far... 97115 / 251,287

Articles

Browse latest releases

Browse by creation date

Browse by origin

A B C D F G H I J K L M N O P Q R S T U V W Y Z

Browse by tag

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
ETRD EAGR ETTC EAID ECON EFIN ECIN EINV ELAB EAIR ENRG EPET EWWT ECPS EIND EMIN ELTN EC ETMIN EUC EZ ET ELECTIONS ENVR EU EUN EG EINT ER ECONOMICS ES EMS ENIV EEB EN ECE ECOSOC EK ENVIRONMENT EFIS EI EWT ENGRD ECPSN EXIM EIAD ERIN ECPC EDEV ENGY ECTRD EPA ESTH ECCT EINVECON ENGR ERTD EUR EAP EWWC ELTD EL EXIMOPIC EXTERNAL ETRDEC ESCAP ECO EGAD ELNT ECONOMIC ENV ETRN EIAR EUMEM ENRGPARMOTRASENVKGHGPGOVECONTSPLEAID EREL ECOM ECONETRDEAGRJA ETCC ETRG ECONOMY EMED ETR ENERG EITC EFINOECD EURM EENG ERA EXPORT ENRD ECONEINVETRDEFINELABETRDKTDBPGOVOPIC EGEN EBRD EVIN ETRAD ECOWAS EFTA ECONETRDBESPAR EGOVSY EPIN EID ECONENRG EDRC ESENV ETT EB ENER ELTNSNAR ECHEVARRIA ETRC EPIT EDUC ESA EFI ENRGY ESCI EE EAIDXMXAXBXFFR EETC ECIP EIAID EIVN EBEXP ESTN EING EGOV ETRA EPETEIND ELAN ETRDGK EAIDRW ETRDEINVECINPGOVCS EPEC ENVI ELN EAG EPCS EPRT EPTED ETRB EUM EAIDS EFIC EFINECONEAIDUNGAGM EAIDAR ESF EIDN ELAM EDU EV EAIDAF ECN EDA EXBS EINTECPS ENRGTRGYETRDBEXPBTIOSZ EPREL EAC EINVEFIN ETA EAGER EINDIR ECA ECLAC ELAP EITI EUCOM ECONEFINETRDPGOVEAGRPTERKTFNKCRMEAID EARG ELDIN EINVKSCA ENNP EFINECONCS EFINTS ECCP ETC EAIRASECCASCID EINN ETRP EAIDNI EFQ ECOQKPKO EGPHUM EBUD ECONEINVEFINPGOVIZ ENERGY ELB EINDETRD EMI ECONEFIN EIB EURN ETRDEINVTINTCS EIN EFIM ETIO ELAINE EMN EATO EWTR EIPR EINVETC ETTD ETDR EIQ ECONCS EPPD ENRGIZ EISL ESPINOSA ELEC EAIG ESLCO EUREM ENTG ERD EINVECONSENVCSJA EEPET EUNCH ECINECONCS ETRO ETRDECONWTOCS ECUN EFND EPECO EAIRECONRP ERGR ETRDPGOV ECPN ENRGMO EPWR EET EAIS EAGRE EDUARDO EAGRRP EAIDPHUMPRELUG EICN ECONQH EVN EGHG ELBR EINF EAIDHO EENV ETEX ERNG ED
KMDR KPAO KPKO KJUS KCRM KGHG KFRD KWMN KDEM KTFN KHIV KGIC KIDE KSCA KNNP KHUM KIPR KSUM KISL KIRF KCOR KRCM KPAL KWBG KN KS KOMC KSEP KFLU KPWR KTIA KSEO KMPI KHLS KICC KSTH KMCA KVPR KPRM KE KU KZ KFLO KSAF KTIP KTEX KBCT KOCI KOLY KOR KAWC KACT KUNR KTDB KSTC KLIG KSKN KNN KCFE KCIP KGHA KHDP KPOW KUNC KDRL KV KPREL KCRS KPOL KRVC KRIM KGIT KWIR KT KIRC KOMO KRFD KUWAIT KG KFIN KSCI KTFIN KFTN KGOV KPRV KSAC KGIV KCRIM KPIR KSOC KBIO KW KGLB KMWN KPO KFSC KSEAO KSTCPL KSI KPRP KREC KFPC KUNH KCSA KMRS KNDP KR KICCPUR KPPAO KCSY KTBT KCIS KNEP KFRDCVISCMGTCASCKOCIASECPHUMSMIGEG KNNB KGCC KINR KPOP KMFO KENV KNAR KVIR KDRG KDMR KFCE KNAO KDEN KGCN KICA KIMMITT KMCC KLFU KMSG KSEC KUM KCUL KMNP KSMT KCOM KOMCSG KSPR KPMI KRAD KIND KCRP KAUST KWAWC KTER KCHG KRDP KPAS KITA KTSC KPAOPREL KWGB KIRP KJUST KMIG KLAB KTFR KSEI KSTT KAPO KSTS KLSO KWNN KPOA KHSA KNPP KPAONZ KBTS KWWW KY KJRE KPAOKMDRKE KCRCM KSCS KWMNCI KESO KWUN KPLS KIIP KEDEM KPAOY KRIF KGICKS KREF KTRD KFRDSOCIRO KTAO KJU KWMNPHUMPRELKPAOZW KEN KO KNEI KEMR KKIV KEAI KWAC KRCIM KWCI KFIU KWIC KCORR KOMS KNNO KPAI KBWG KTTB KTBD KTIALG KILS KFEM KTDM KESS KNUC KPA KOMCCO KCEM KRCS KWBGSY KNPPIS KNNPMNUC KWN KERG KLTN KALM KCCP KSUMPHUM KREL KGH KLIP KTLA KAWK KWMM KVRP KVRC KAID KSLG KDEMK KX KIF KNPR KCFC KFTFN KTFM KPDD KCERS KMOC KDEMAF KMEPI KEMS KDRM KEPREL KBTR KEDU KNP KIRL KNNR KMPT KISLPINR KTPN KA KJUSTH KPIN KDEV KTDD KAKA KFRP KWNM KTSD KINL KJUSKUNR KWWMN KECF KWBC KPRO KVBL KOM KFRDKIRFCVISCMGTKOCIASECPHUMSMIGEG KEDM KFLD KLPM KRGY KNNF KICR KIFR KM KWMNCS KAWS KLAP KPAK KDDG KCGC KID KNSD KMPF KPFO KDP KCMR KRMS KNPT KNNNP KTIAPARM KDTB KNUP KPGOV KNAP KNNC KUK KSRE KREISLER KIVP KQ KTIAEUN KPALAOIS KRM KISLAO KWM KFLOA
PHUM PINR PTER PGOV PREL PREF PL PM PHSA PE PARM PINS PK PUNE PO PALESTINIAN PU PBTS PROP PTBS POL POLI PA PGOVZI POLMIL POLITICAL PARTIES POLM PD POLITICS POLICY PAS PMIL PINT PNAT PV PKO PPOL PERSONS PING PBIO PH PETR PARMS PRES PCON PETERS PRELBR PT PLAB PP PAK PDEM PKPA PSOCI PF PLO PTERM PJUS PSOE PELOSI PROPERTY PGOVPREL PARP PRL PNIR PHUMKPAL PG PREZ PGIC PBOV PAO PKK PROV PHSAK PHUMPREL PROTECTION PGOVBL PSI PRELPK PGOVENRG PUM PRELKPKO PATTY PSOC PRIVATIZATION PRELSP PGOVEAIDUKNOSWGMHUCANLLHFRSPITNZ PMIG PREC PAIGH PROG PSHA PARK PETER POG PHUS PPREL PS PTERPREL PRELPGOV POV PKPO PGOVECON POUS PGOVPRELPHUMPREFSMIGELABEAIDKCRMKWMN PWBG PMAR PREM PAR PNR PRELPGOVEAIDECONEINVBEXPSCULOIIPBTIO PARMIR PGOVGM PHUH PARTM PN PRE PTE PY POLUN PPEL PDOV PGOVSOCI PIRF PGOVPM PBST PRELEVU PGOR PBTSRU PRM PRELKPAOIZ PGVO PERL PGOC PAGR PMIN PHUMR PVIP PPD PGV PRAM PINL PKPAL PTERE PGOF PINO PHAS PODC PRHUM PHUMA PREO PPA PEPFAR PGO PRGOV PAC PRESL PORG PKFK PEPR PRELP PREFA PNG PGOVPHUMKPAO PRELECON PINOCHET PFOR PGOVLO PHUMBA PRELC PREK PHUME PHJM POLINT PGOVPZ PGOVKCRM PGOVE PHALANAGE PARTY PECON PEACE PROCESS PLN PRELSW PAHO PEDRO PRELA PASS PPAO PGPV PNUM PCUL PGGV PSA PGOVSMIGKCRMKWMNPHUMCVISKFRDCA PGIV PRFE POGOV PEL PBT PAMQ PINF PSEPC POSTS PHUMPGOV PVOV PHSAPREL PROLIFERATION PENA PRELTBIOBA PIN PRELL PGOVPTER PHAM PHYTRP PTEL PTERPGOV PHARM PROTESTS PRELAF PKBL PRELKPAO PKNP PARMP PHUML PFOV PERM PUOS PRELGOV PHUMPTER PARAGRAPH PERURENA PBTSEWWT PCI PETROL PINSO PINSCE PQL PEREZ PBS

Browse by classification

Community resources

courage is contagious

Viewing cable 09CAIRO2320, THE MYSTERIES OF EGYPT'S HEALTH CARE REFORM

If you are new to these pages, please read an introduction on the structure of a cable as well as how to discuss them with others. See also the FAQs

Understanding cables
Every cable message consists of three parts:
  • The top box shows each cables unique reference number, when and by whom it originally was sent, and what its initial classification was.
  • The middle box contains the header information that is associated with the cable. It includes information about the receiver(s) as well as a general subject.
  • The bottom box presents the body of the cable. The opening can contain a more specific subject, references to other cables (browse by origin to find them) or additional comment. This is followed by the main contents of the cable: a summary, a collection of specific topics and a comment section.
To understand the justification used for the classification of each cable, please use this WikiSource article as reference.

Discussing cables
If you find meaningful or important information in a cable, please link directly to its unique reference number. Linking to a specific paragraph in the body of a cable is also possible by copying the appropriate link (to be found at theparagraph symbol). Please mark messages for social networking services like Twitter with the hash tags #cablegate and a hash containing the reference ID e.g. #09CAIRO2320.
Reference ID Created Released Classification Origin
09CAIRO2320 2009-12-17 15:59 2011-02-16 21:00 CONFIDENTIAL Embassy Cairo
VZCZCXRO9320
PP RUEHDH RUEHHM RUEHPB RUEHSL RUEHTM RUEHTRO
DE RUEHEG #2320/01 3511559
ZNY CCCCC ZZH
P 171559Z DEC 09
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 4483
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
C O N F I D E N T I A L SECTION 01 OF 02 CAIRO 002320 
 
SIPDIS 
 
DEPT FOR NEA/ELA 
 
E.O. 12958: DECL: 12/16/2019 
TAGS: PREL PGOV EAID ECON SOCI EG
SUBJECT: THE MYSTERIES OF EGYPT'S HEALTH CARE REFORM 
 
REF: CAIRO 2209 
 
Classified By: Minister-Counselor for Economic and Political Affairs Donald A. Blome for Reason 1.4 (b)
1.Key Points --The Ministry of Health (MoH) is spearheading a series of national health care reform programs, including connecting private clinics and hospitals to public heath care programs, upgrading the infrastructure at health care facilities, improving medical training, and most importantly, expanding health insurance for poor Egyptians. --Two years into implementing a pilot program that incorporates these programs in the Delta governorate of Suez, progress is difficult to measure yet MoH still plans to introduce similar programs to the Upper Egypt governorate Sohag in 2010 and Alexandria in 2011. --Egyptian government (GoE) officials intend to introduce legislation to expand government-provided health insurance to 25 million of Egypt's poorest citizens in the next Parliament session. --(C) The GoE has neither explained how it will fund its programs nor offered any evaluation of the effectiveness or demand for its new programs. Opposition critics have begun mounting protests and legal challenges aimed at these and other aspects of the proposed reforms. -------------------- New Reform Structure -------------------- 2.(SBU) The centerpiece of MoH's reform policies is a new national health insurance bill, designed to meet President Mubarak's 2005 call for universal health care. The culmination of nearly 15 years of MoH health care planning, the legislation's main goal is to provide insurance for Egyptians without any form of coverage. Approximately 54% of the population is currently covered by the Health Insurance Organization (HIO), the GoE's government insurance provider, with most of those individuals government employees. Under the new legislation, MoH estimates 85-90% of the population would receive coverage in the next 10-15 years; 25 million individuals without any insurance (approximately 30% of the population and identified as among the country,s poorest citizens) will be brought in the new system via financial support from the government.

3.(SBU) While the expansion of coverage is the Ministry's primary goal, it is also seeking to overhaul other elements of its health care services. MoH seeks to enroll primary health care plan participants in a family health model, which essentially would allow them to pay family rather than individual rates. Decentralization is another key goal: state-owned hospitals would become independent entities, operating loosely under MoH direction instead of following strict management and economic direction. ---------------------- Out of Pocket Concerns ----------------------

4.(SBU) The GoE hopes that these improvements will lower the out-of-pocket health costs borne overwhelmingly by its poor and uninsured. Currently 62% of all health care spending is paid by individuals. The Ministry of Finance (MoF) projects that without reform, this figure will rise to above 70% in the next decade. ---------------------- Ground Zero for Reform ----------------------

5.(C) Even though it has yet to introduce health reform legislation in Parliament, MoH has used Suez governorate as the testing ground over the last two years for its reform programs. MoH chose Suez due to its close proximity to Cairo, stable employment, and low poverty levels. Health Minister Hatem El-Gabaly has failed to disclose any results - ranging from increase in insurance enrollment to improvement in primary health care. Despite this, MoH intends to extend its new system to Sohag next year and to Alexandria in 2011. According to Dr. Alaa Hamed, senior health specialist at the World Bank, Sohag was selected as the next governorate because MoH needed to prove it could operate in a more "difficult environment" and not just bring services to more "prosperous areas." Sohag, one of the poorest governorates, has both high unemployment and poor insurance coverage. CAIRO 00002320 002 OF 002 Hamed said both Sohag and Alexandria were selected for "political reasons" as the GoE looks towards elections in 2010 and 2011. ----------------------- Looming Challenge Ahead -----------------------

6.(C) What ultimately may determine the success of health care reform is program financing. Other than estimating in an October speech that MoH would require LE 7-17 billion (USD 1.3 to 3.15 billion) to provide medical care Egyptians can "look forward to," El-Gabaly has ceded responsibility on the issue to the Ministry of Finance (MoF). Dr. Mohammed Maait, Deputy Finance Minister for Social Insurance, told Econoff that MoF has not identified a funding source for MoH's reforms. Maait further explained MoF is considering several options ) including increasing taxes on employee salaries (and concurrently lowering the amount employers pay into the health insurance system) and raising the cigarette tax potentially as much as fivefold. Maait mused that shisha ) a popular flavored tobacco smoked in water pipes in cafes across the country ) is not taxed but quickly noted that this was not currently an option. While it is unclear which if any of these proposals will be included in the health care bill, Maait emphasized that the GoE plans to address these questions in the current Parliament session.

7.(SBU) Sporadic protests against the proposed legislation have already begun in Cairo. On December 6, a 500 person demonstration at Parliament demanded that Speaker Fathi Sorour oppose the law. On the same day, El Badri Forgharty, the head of a loosely organized group of pensioners, complained to several newspapers that MoH was planning to "privatize" health care. On December 10th, the State Council - one of Egypt's highest judicial bodies responsible for reviewing legislation - returned the bill to the government with multiple objections, explaining that the law failed to explain what new health care services Egyptian would receive and what costs they would have to bear.

8.(C) Comment: Since launching what El-Gabaly has labeled the "Suez Model," there is no mechanism to evaluate the overall effectiveness of the reforms. More importantly, MoH has repeatedly failed to discuss whether or not the services it is offering match the health needs of Suez,s citizens. Questions over how these reforms programs will be financed and sustained, coupled with the difficulty in convincing an increasingly skeptical public, have failed to deter MoH from continuing plans to expand the new system in two more governorates and eventually to the rest of the country. NDP political pressure, notably from Gamal Mubarak (Ref A) - labeled the "driving force" in the NDP on health care reform by a member of the Party's Policy Committee - continues to drive the new legislation presumably, in hopes of bolstering the party's slim record of accomplishment as 2010 elections approach. Scobey