web_vol47 4.pdf - International Hospital Federation

Policy: Egypt
Public policy and medical tourism:
Ethical implications for the Egyptian
health care system
ROB HALEY
ASSISTANT PROFESSOR, PUBLIC HEALTH DEPARTMENT,
UNIVERSITY OF NORTH FLORIDA, USA
ABSTRACT: Egypt’s medical tourism industry has been experiencing tremendous growth. However, Egypt continues to lack
the necessary investment in its public health system to effectively care for its population. Current policy and the
emergence of medical tourism have led to unequal health care access, resulting in high a prevalence of infectious
diseases and lack of resources for its most vulnerable populations. As a new Egyptian government emerges, it is important
for policymakers to understand the critical issues and ethical concerns of existing health policy. This understanding may
be used to propose new policy that more effectively allocates resources to care for Egypt’s population.
In January 2011, Egyptians began demonstrating in Cairo’s Tahrir
Square as part of a much broader movement called the “Arab
Spring.” This movement served to communicate the
population’s growing economic and political discontent and is
resulting in unprecedented political change in the Middle East (The
Economist 2011). Egyptians were particularly steadfast in
demanding change despite the fact that Egypt’s economy had
been experiencing tremendous growth over the past several
decades. However, it continued to lack the necessary investment
in its public health system to effectively care for its population
(Haley and Bég 2010). This lack of priority and funding is best
illustrated by Egypt’s overall spending on health care of just 3.7
percent of GDP; far lower than the17.6 percent spent by the
United States (Auerback and Kellermann 2011). More importantly,
of this 3.7 percent, less than 43 percent was attributed to Egypt’s
public health system while more than 57 percent was allocated to
the relatively more affluent private health care sector (Fouad 2005).
Egypt’s public policy tended to favor the private sector, particularly
the sectors that supported its tourism industry and its emerging
medical tourism market. This inequity is of significant concern
because Egypt’s health indicators are among the lowest in the
region (WHO 2004).
In February 2011, Egyptian President Hosni Mubarak resigned
and a new government will likely face an extraordinary and
persistent demand for fair and equitable public policies. Policymakers
will likely experience significant challenges as it attempts
to create a new government and rebuild its tourism industry and
medical tourism market. This article aims to inform Egyptian
policymakers of the importance of identifying policy that results in
an equitable and adequately resourced public health system. It
also identifies ethical issues and concerns regarding current
Egyptian public policy and identifies solutions for policymakers to
consider when developing new public health policy.
Egypt’s tourism industry and public health
Egypt’s tourism industry produces approximately $4 billion per
year and accounts for over 11 percent of its gross domestic
product (GDP) (County Guide to Egypt 2011). Increasingly, public
policy was developed that often favored the disproportionate
investment and reallocation of health care resources away from
the public health sector in order to fund policies that more directly
supported Egypt’s tourism industry. These policies often had
significant financial and ethical implications that negatively
impacted the equity and distribution of Egypt’s public health
resources. For example, health care services in Egypt’s urban and
tourism dominant areas are far more accessible and more modern
relative to the health care systems in Egypt’s lower income and
rural regions. Egypt’s lower income and rural areas are typically
non-tourism regions. These regions often have the highest
prevalence of infectious disease and a significant lack of access
and financing for its public health system (El Hadadi 2004).
Furthermore, these areas typically lack the most basic public
health services such as health care centers, family planning units,
and hospitals (Handoussa 2008). In addition, studies indicate that
more than 81 percent of Egypt’s total physician hours are provided
within urban areas although they only represent less than half of
Egypt’s total population (El Hadidi 2004).
While Egypt is typically known as a tourist destination, it has also
positioned itself as an emerging medical tourism destination
particularly for cosmetic surgery. The global economic recession
and the exponential increase in medical costs in many developed
countries have resulted in a growing number of patients from
these countries trying to identify affordable health care options for
their elective and acute procedures. Therefore, an increasing
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