Pros and Cons of comprehensive health insurance Blog Image

Pros and Cons of comprehensive health insurance

14 March 2023

Who among us is not always looking for health insurance to cover his therapeutic and physical needs from a medical point of view, especially amid the price increase that occurs daily without stopping, and therefore we find many people wondering about the advantages and disadvantages of comprehensive health insurance and all its details at the present time.

Medical insurance is an insurance policy that is included between the two parties of the insured and the insured with the aim of protecting the insured from the material costs related to medical procedures and other coverage related to medical analyzes, examinations, and statements in cases of illness, whether chronic, emerging or emergency, whether for the benefit of the insurance owner or for his family, so let's learn more about the advantages and disadvantages of comprehensive health insurance.

What is comprehensive health insurance?

Knowing the advantages and disadvantages of comprehensive health insurance, we must know that comprehensive health insurance is a social system through which the state provides medical services to all segments of society without discrimination, and the state bears the burden of the material cost to the category of the unable in order to reduce disease rates and provide medical protection for all citizens.

What are the goals of comprehensive health insurance?

Comprehensive insurance is an insurance system that aims to reduce poverty and disease rates, by lowering or transferring the financial burden that occurs in the event of diseases from the citizen and full bearing to a strong integrated financial system that can control and control those burdens.

Comprehensive insurance also provides integrated medical protection for all family members in exchange for reduced monthly amounts for those who are able only, but in the case of those who are unable to do so, the state "public treasury" bears the material cost to cover the health burdens on behalf of those who are unable to do so.

In the end, if we follow this method, the state will help citizens to reduce enormous financial spending on the health of the individual and family, and improve a better standard of living.

What is the difference between current health insurance and comprehensive health insurance?

Many people wonder about the current health insurance system and the difference between it and comprehensive health insurance, which is summarized as follows:

  • Comprehensive health insurance aims to cover all citizens without exception from a medical point of view without discrimination, but in the case of current medical insurance, it covers only about 50% of citizens.

  • Comprehensive health insurance includes the entire family with children, wife, father, mother, and other family members, while the current insurance is the individual insurance coverage unit.

What are the conditions for benefiting from comprehensive health insurance services?

To benefit from the comprehensive health insurance system, it is not required to undergo large details, only the subscriber needs to:

  • He is obliged to pay the specified amount for health insurance and to pay the contributions required of him on time.

  • To be unable "with proof of that case", so the public treasury bears the burden of paying the subscription

  • In the event that the citizen does not participate or is late in paying the required contribution to benefit from the comprehensive health insurance services, he only needs to pay the late contributions in one payment or in installments, except in emergency cases.

Who is responsible for activating the comprehensive health insurance system?

comprehensive health insurance is achieved through the management of 3 public bodies, which are:

  • comprehensive health insurance Authority: It is based on managing and financing the purchase of health services provided to subscribers to the system.

  • Health Care Authority: The entity that includes hospitals, health units, care-providing centers, and public sector service providers.

  • Health Accreditation and Control Authority: It aims to ensure the quality of health services and is responsible for granting licenses to the entities involved in providing health services in hospitals.

Advantages and disadvantages of comprehensive health insurance

Talking about the advantages and disadvantages of comprehensive health insurance, we first mention to you a list of the most important advantages as follows:

  • comprehensive health insurance is characterized by the provision of comprehensive primary medical services, therapeutic and diagnostic services, pregnancy and reproductive care services, as well as emergency first aid.

  • The State shall pay the costs of treating individuals at a small deductible rate, in addition to paying the contributions of the unable and exempting them from material contributions to treatment.

  • The citizen's endurance in radiology and analysis reaches a maximum of 10%, equivalent to 750 at a time.

  • The percentage of the citizen's contribution to the operations procedures does not exceed 5%, not exceeding 400 pounds at a time.

  • The deductible for medicines and treatments does not exceed 10% with a maximum of EGP 1000 at a time.

  • In emergency cases, the citizen has the right to recover the material costs in the event of treatment outside the contracting parties.

  • People with tumors and chronic diseases do not bear any costs for treatment.

  • Until the implementation of the modern system of comprehensive health insurance, citizens are entitled to benefit from the current health insurance system that exists in the governorates now.

In addition to the above benefits, citizens and their families obtain additional benefits through comprehensive health insurance such as:

  • Benefit from a family doctor and general practitioner.

  • Specialist doctors include dentistry and surgery.

  • Treatment, hospitalization, surgeries, and other types of treatment.

  • Obtaining diagnostic imaging and laboratory tests.

  • Rehabilitation services and disbursement of prosthetic devices.

  • Dispensing medicines free of charge or with a deductible not exceeding 10%.

  • Home treatment if necessary.

  • Travel for treatment abroad (according to the relevant regulations).

  • Dispensing of oncology and chronic disease drugs is completely free of charge.

To continue talking about the advantages and disadvantages of comprehensive health insurance, here is a list of the most important disadvantages of comprehensive health insurance as follows:

  • Slow implementation of comprehensive insurance in all governorates of the Republic.

  • Poor application due to the small percentage applied to it, which reaches 2% of the total population.

  • Health insurance has become a business where patients take on financial burdens that they may not be able to afford.

  • Transforming government hospitals into a for-profit sector

  • In the event of failure to pay the monthly subscription for comprehensive health insurance, the children's health insurance will be forfeited.

  • The application is not comprehensive but optional.

  • Increasing the material burdens on citizens.

What health services are not covered by health insurance?

Under the name of the advantages and disadvantages of comprehensive health insurance, we find that one of the most prominent disadvantages of this type of insurance is that it does not include some public health services, which are:

  • Public health insurance.

  • Mental health.

  • Preventive health services.

  • Ambulatory services.

  • Family planning services.

  • Disaster and epidemic coverage services.

Similarly, the state has decided to cover the expenses of these previous health services completely free of charge for all citizens.

finally, after we have explained the most important advantages and disadvantages of comprehensive health insurance, we must clarify that this service is still under implementation under the supervision of the state, and it has been completed in 3 governorates, including Luxor and Port Said, and its employment is being completed in all other governorates, knowing that the implementation of this type of insurance may take more time than citizens expect.