In response to EIPR lawsuit: The Administrative Court restores the right of the student Hanin, and obliges "health insurance authority" to offer her free treatment


15 February 2022

In response to the lawsuit filed by EIPR against the General Authority for Health Insurance (Case No. 8245 for the year 76, urgent section - Tenth Circuit Administrative Judiciary), the Administrative Court of Justice issued an important judgment on January 24, 2022 obligating the General Authority to fully cover the costs of treating the child Hanin, until her full recovery.

Hanin is a ten-year-old schoolgirl. The doctors diagnosed her with congenital left extremity venous hematoma since she was born in 2012. Physicians from the General Authority for Health Insurance determined the appropriate treatment for her condition with "several sessions using interventional radiology." Since she is a student and beneficiary of health insurance and pays tuition fees and subscription fees in health insurance, she obtained letters of transfer from the General Authority for Health Insurance to the International Medical Center, being the body that has this type of treatment. Despite her right to health service, her family bears half of the cost of the treatment as well as the expenses of moving the girl from her home in Cairo to the International Medical Center on Ismailia Road, which constitutes a great burden on the girl’s family and causes severe harm to the family and its resources.

In November 2021, the student’s father filed a lawsuit before the administrative court, demanding to stop and cancel the decision to refrain from treating his child for free until her recovery, because she is a student and is entitled to health care and has a health insurance card. The lawsuit came after the commission partially repudiated its obligation to offer Hanin free treatment, which deprived her of enjoying the right to health, and forced the family of the ill student to bear the rest of the high cost to enable her to receive the treatment that she would not have received if her family was not able to manage to provide for these expenses. It is noteworthy that the student’s father bears the cost of the medical examination, which is 300 pounds, as well as about 4000 pounds per month, which represents half the cost of interventional radiology, which amounts to 8000 pounds at the International Medical Center.

At the court session of 15 November 2021 , the EIPR lawyer, entrusted by the girl’s father, demanded to stop the implementation and cancel the negative management decision to refrain from treating his daughter for free. The demand was based on the violation by the General Authority for Health Insurance of what successive constitutions settled on considering the right to health as a right of every citizen, and what was approved by the law of comprehensive health insurance, and, before it, the Student Health Insurance Law, according to which preventive, curative and rehabilitative health services are provided to students benefiting from the health insurance system until their recovery (Article 6 of the law). the Authority violated also the Minister of Health’s decision No. 321 of 1992 regarding the identification of chronic diseases for students benefiting from the insurance system including “malignant tumors of all kinds and their complications.”

Presently, the administrative court ruling obligating the General Authority for Health Insurance to bear the full costs of Hanin's treatment, is a victory for her inherent right to health, health coverage and protection from the catastrophic impact of the disease on her family. The ruling also represents an enactment of the constitution and the laws that already exist, which guarantee citizens' right to health and their protection from falling into financial crises due to the financial cost of the health service.

In this regard, the State Commissioner’s report in the Hanin case said that “the failure of the General Authority for Health Insurance in this way is contrary to the constitutional and legal duty, especially if the patient’s condition does not bear the routine and bureaucratic slowness in administrative procedures, and since it is proven that the General Authority for Health Insurance has refrained regarding the provision of the necessary and prescribed treatment for the diseased condition - the administrative authority did not deny negate this claim - , and therefore its conduct in this regard is a negative decision in violation of the law, which calls for the cancellation of the negative decision contested by the General Authority for Health Insurance refraining from dispensing the prescribed treatment and medication to treat the plaintiff's daughter’s condition (which is) an injection procedure using interventional radiology for free.”

The commissioners' report recommended accepting the case in form, and on the matter annulling the negative administrative body's decision to refrain from providing the treatment and medication prescribed for the treatment of the plaintiff's daughter's illness.

Still, this case raises an important question: Do citizens have to sue state agencies to obtain their rights?

This story is recurring and the vast majority of citizens are unable to take the same measures that Hanin’s family took to secure their rights. There are certainly many cases similar to the case of the Hanin, and it is not logical for each of them to resort to the administrative judiciary, and wait for months, that the health condition may not allow for, to obtain the right to appropriate treatment.

The fact that patients and their families are forced to spend from their pockets to obtain their right to health is inseparable from the decline in the health sector’s ranking in government spending priorities, as it ranks fifth among these priorities in the current year’s budget. Despite the increase in its allocations by about 15 billion pounds over the previous year, it still does not exceed half of what the constitution specified, contrary to government assurances about its commitment to the targeted percentage. (For more, you can read the EIPR’s report on the 2021/2022 budget).

Therefore, Egypt is one of the countries where the percentage of out-of-pocket payments borne by individuals out of the total current spending on health is 62.1% (as in the case of the student whose family had to cover the cost of the absence of health protection).

The health out-of-pocket index is an important indicator for tracking the level of protection against financial risks regarding health. Relatively small payments may have severe financial consequences, especially among individuals who are already close to the poverty line. In conclusion, the percentage of families and individuals who may fall into poverty because of their direct spending on health from their pockets will increase, in light of weak government spending on health, and without protection for individuals from financial risks.

The attached figure - its source is the Human Development Report issued by the United Nations Development Program - shows Egypt's position from this angle compared to global averages.

Percentage of direct out-of-pocket spending by individuals in relation to total health expenditure in Egypt and a number of medium income countries. (2018 data)