Critics say move to put heart stents on insurance off-beat

At the time when Health Minister Adel al-Adawy announced last month the inclusion of stents as part of the health insurance, a number of doctors criticized the decision.
Doctor Mohamed Hassan Khalil, coordinator of the National Right to Health Committee (NRHC) considered the decision a first step for the privatization of the health sector. Doctor Mohamed Aziz, Dean of the National Heart Institute, agreed with Khalil, stressing that health insurance is not a perfect solution to the stents' crisis in Egypt.
Al-Masry Al-Youm met with the heart patients at the National Heart Institute in Imbaba and Nasser Institute for Research and Treatment.
To the right of the banner of outpatient clinics for heart diseases, patients could be seen scattered at the examination room, some reserving to carry out catheter operations and CT scan, and others on the wrought-iron benches waiting for their turn in medical examination. Their dialects varried, but they all suffered from heart diseases.
Mostafa Kamel, 43, was destined to stay on a wheelchair since childhood due to polio. Kamel suffered two coronary thrombosis two months ago, after which he kept moving between Nasser and the Heart institutes. Officials since then kept sending Kamel from office to another to receive the approval of the Ministry of Health on a catheter operation at Nasser Institute.
Samia, 61, has been suffering from diabetes for 30 years, and recently started to suffer from heart problems. She carried out a catheter operation at Nasser Institute after suffering two coronary thromboses in March. The doctor told her she needed to install heart stents at her own expense. Samia came out of the hospital, struggling day after day until she became one of those whose names would be put with hundres of others on a waiting list to replace the stents in an open heart surgery.
The suffering of low-income heart patients is not limited to seeking stents or open-heart surgeries, but extends to affording for the Plavix, which costs up to LE205 per pack, and should be used for not less than six months following the surgery.
The problem does not stop at the Health Ministry's failure to provide stents, forcing patients to resort to a more difficult solution, an open-heart surgery, and being placed on long waiting lists. Patients receive low-quality stents that clog in record times, as happened to Ne'ma Grace, 63. Grace has been suffering from heart pain for three months after the stents she received were clogged in 20 days.
Consultant at Nasser Institute Mohamed al-Sherief says the Institute's outpatient clinics receive 15 patients a day that need catheterization and stents. Among the 15 there are at least two patients who need stents.
There is not much difference between the Nasser Institute and Heart Institute in Imbaba.
On a wooden bench Bakhita Hassan, 55, sits silently. She looks from time to time to the electrocardiogram chamber. The brown skinned elderly who suffers from coronary thrombosis held a plastic bag where she kept the permission of treatment at the expense of the state and a number of tests and X-rays. Hassan performed a catheter operation and should install a stent in her heart, she said.
Hassan is currently on a waiting list and lives on the Plavix pills. She said she could barely afford for the pills and did not know how she would provide LE7,000 to install the stent.
The scene is totally different on the sixth floor of a private hospital in Mohandiseen where patients meet accountants with a wide smile and talk quietly about the prices of stents, the price of which could reach LE28,000.
Doctor Aziz believes that the inclusion of stents as part of the health insurance would not solve the crisis.
"Modern medicine dispensed with regular stents with a rate up to 80 percent… The health minister's decision to include stents in health insurance is not the optimal solution for the treatment of poor patients, because the health insurance bears only LE4,000 of the stent's price which costs LE8,000 at the institute," said Aziz.
Doctor Khalil considered the health minister's decision a first step toward the privatization of the health sector. The patients' contribution to their own treatment will be the first step toward bearing the rest of their treatment expenses, Khalil added.
"The Ministry of Health is trying to bring us back to the plans of Mubarak's Health Minister Hatem al-Gebaly who tried desperately to privatize the health sector. The new health insurance bill is an evidence as one of its articles states that the citizen would bear part of the expense of their treatment," Khalil said.
Khalil doubted the accuracy of the Health Ministry's budget, saying it will cost at least 3 percent of the GDP instead of 1.6 percent.
Edited translation from Al-Masry Al-Youm

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