First published in ITIJ 103, August 2009
As a popular tourist destination for visitors from all over the world, Egypt has been refining its medical offerings for international patients for some time. Dianne Glon assesses the quality of, and access to, care available today and examines the country’s booming facilities for medical tourism
Egypt has long been an attractive destination for tourists from around the world for both historical and cultural reasons. The country is home to some of the world’s most ancient wonders, beautiful resorts and beaches, as well as unique oases tucked away within the country’s vast expanses of desert land. However, in recent years, Egypt has become a destination of other sorts – namely, medical. The Red Sea runs along its eastern border and the country is also host to mineral-infused, curative muds and a temperate climate, all of which are ingredients for climatotherapy and the treatment of chronic conditions such as psoriasis and arthritis – ailments that have typically been treated in Egypt’s Dead Sea. Thus, the country’s high levels of annual tourism, combined with an increasing number of foreigners who venture to the home of the Great Pyramids seeking medical treatment, has steadily transformed the nature of medical care available in Egypt, resulting in a wider offering that is higher in quality and, comparatively, quite affordable.
A healthy infrastructure
The Egyptian government is planning for a general influx of tourists, and it is estimated that over 14 million foreigners will visit Egypt by 2014. Accordingly, available medical services to cater to these foreigners will increase too. Private tourist clinics have sprouted at an incredible rate over recent years following the continuing rise in tourist numbers, and are seen as a profitable enterprise. These tourist clinics more often than not tend to resemble something closer to a retreat or spa, focusing on helping patrons ‘get away’ from the hustle and bustle of everyday life and relax; but others, such as the El Salam Hospital Arabia Beach in Hurghada and El Gouna Hospital in El Gouna, situated on the Red Sea coast several hours south of Cairo, provide more conventional medical treatment, including general surgery.
There are a range of local and international assistance companies operating in Egypt, and they are best placed to direct patients to the most appropriate medical facility for the treatment they need. Such assistance companies include Connex Assistance Middle East, General Assistance, Middle East Assistance, Ramsis Assistance, and Kahil Assistance, based in Cairo, as well as foreign-owned assistance companies such as Mapfre Assistancia, International SOS, and Remed.
hospitals in tourist areas are well equipped to deal with 95 per cent of the cases that pass through them
Assistance companies send patients to a variety of different facilities. Dar Al Fouad Hospital, a private medical facility based in Egypt’s capital, Cairo, provides emergency care for trauma and accident-related injuries, cardiac-related issues, and provides foreign patients requiring surgery with emergency care at an international standard. It boasts a trauma team, provides vascular surgery, orthopedic services, intensive care, and has all the necessary equipment and trained medical staff to operate laboratories, a radiology department, administer CT scans and MRIs in order to support emergency services, as well as provide normal day-to-day medical care.
According to its representatives, Darl El Fouad Hospital has several years’ experience working with insurance companies, both in Egypt and abroad, including Bupa, AXA, Mondial Assistance, and Alico, and works with several of the approximately eight assistance companies that are fully operational in the Middle East. Among these is Connex, which provides foreigners travelling in Egypt with solutions to their medical needs according to the contracts they have with their insurance companies, and maintains close working relationships with Mondial Assistance, Europ Assistance, SOS International, Filo Diretto, AIG, Eurocross, and several other international companies.
Orthopedic cases are generally referred to El Salam International Hospital in Cairo, a private facility. Hematology cases are sent specifically to the Nasser Institute, also in Cairo, and cancer cases are referred to the Cairo-based National Cancer Institute, both of which are public hospitals. Other hospitals across Egypt that provide specialised medical care include the private Luxor International Hospital for cardiac catheterisation and dialysis, Sharm International Hospital, a government facility, for trauma and emergencies, Alexandria University, Mostafa Kamel Miltary Hospital in Alexandria, and the private Alexandria International Hospital. El Salam International Hospital, the Nasser Institute and the National Cancer Institute are accredited by the International Organisation for Standardisation (ISO), and are among the most reputable and well-known in the country. Dar El Fouad Hospital, on the other hand, has been accredited by Joint Commission International (JCI) twice in its 10 years of operation, has received ISO accreditation, and has collaborated with Cleveland Clinic (USA) and Care International. It is, in fact, the first hospital in Africa and Egypt to be accredited by JCI. In this capacity, foreigners can feel reassured about receiving treatment – emergency or otherwise – in internationally accredited facilities in Egypt.
most private hospitals in touristic areas have a long history working with international patients, and also have a history of dealing and cooperating with insurance companies
For cases that require treatment in more remote parts of Egypt, Connex, for example, works with a network of 1,200 medical facilities across the country and sends cases to the most reputable and internationally accredited of these. Helmy Tanahy, chairman of the company’s Middle East division, maintains that hospitals in tourist areas are well equipped to deal with 95 per cent of the cases that pass through them. These include El Salama Hospital in Alexandria, Sharm El Dawly Hospital in Sharm El Sheikh, Luxor International Hospital in Luxor City, Mubarak Military Hospital in Aswan, and El Salam Hospital in Hurghada, all of which have trauma and emergency units. These hospitals are located across Egypt, so no matter where one is travelling inside Egypt, high quality medical attention is never far away.
Doing the sums
As we have seen, high quality medical care is available across Egypt for foreigners and at a fraction of the cost of the same treatment in other countries. For example, hip replacements may cost up to $100,000 abroad, but only $25,000 in Egypt. Knee replacements can cost up to $60,000 abroad but only $15,000 in Egypt. Open heart surgery and valve replacement in Egypt can run just 20 to 25 per cent of the cost in the US, while patients receiving cosmetic surgery in Egypt, on the other hand, can pay as little as 15 per cent of the cost for the same cosmetic procedure in western countries.
However, costs in the country are sometimes inflated through the over treatment of leisure and medical tourists, especially within smaller clinics. This is a persisting problem, with some medical providers seeing foreigners as a potential source of revenue. Established assistance companies help to mitigate this problem and have experience dealing with fraudulent invoices on behalf of medical facilities.
Generally, though, as has been shown, medical services are far cheaper in Egypt when compared to the same treatment in countries like the UK or the US. Medical attention in less touristy areas might be a bit more costly compared to medical facilities in Cairo, for example, but Tanahy maintains that, most of time, procedures cost less than half of what they would for a foreigner back home. One only needs to make certain that various courses of treatment and medical attention can be covered by their insurance, which can be facilitated by an assistance company.
[Cairo] is quite large and on a typical work day in the middle of the week, traffic is an undeniable factor that seriously impacts transport time, specifically with regards to emergency transportation and ambulance services.
Facilities like Dar Al Fouad and others such as Nasser Institute, Luxor International Hospital, Sharm International Hospital, Kasr El Ainy International Hospital, El Salam International Hurghada, El Salam International Hospital and most private hospitals in touristic areas have a long history working with international patients, and also have a history of dealing and cooperating with insurance companies thanks to Egypt’s prominent standing as an attractive tourist destination. Thus, the processes involved post-care is perhaps easier than what can be found in other developing countries.
The issue for foreigners who visit Egypt – whether for medical purposes or as a tourist who then requires medical attention – is to discern between reliable and imposter medical facilities and medical providers. Egypt does have its share of phony clinics and physicians with little or no training and falsified degrees. These clinics and individuals are mushrooming around the country and are hard to regulate, so the role of assistance companies is again important to ensure that foreigners in the country are matched with qualified and well trained professionals in established and reputable institutions.
Pharmacies in Egypt can be found on virtually any street. Pharmacists often speak English and are very well informed about the various medications that can be taken if a person’s medical need does not necessitate the attention of a doctor. Medicine in the country is fairly cheap, and often does not require a prescription. However, foreigners should take care to read the leaflets inside boxes of medicine to ensure that it is exactly what they are seeking, as pharmacists might try to sell something slightly more expensive that may not exactly address one’s medical needs.
Ms Omayma El Husseiny, media coordinator at the Ministry of Tourism in Egypt, reiterates the nature of the country’s position in the field of medical tourism and the overall medical care it affords foreigners: “Egypt’s competitive advantage stems from its position as an attractive and popular tourist destination … Other advantages include a relatively reasonable cost of living, proximity to the European market, and ideal weather for recuperating and [general] health restoration.” She notes that the country’s potential to become a primary destination for medical tourism, like India or Brazil, has been recognized by Egypt’s government and planned for accordingly. “A general budget has been developed, giving a total development cost of US$19.5 million over the next 12 years,” says El Husseiny. Currently, those who travel to Egypt specifically for medical purposes seek treatment in government hospitals like the Nasser Institute, Ain Shams University Hospital and New Kasr El Ainy French Hospital, as well as in private hospitals like Dar Al Fouad Hospital or El Salam Hurghada Hospital.
But what of the healthcare available to Egypt’s indigenous citizens? The government currently provides primary care and medication free of charge for its citizens – including those in rural areas – in government hospitals and clinics. It also provides universal ‘subsidised healthcare’ in specialist, state-owned hospitals at very low prices, but this is predominantly used by those who need it the most, as there are long waiting lists for treatment. There is also ‘economic healthcare’, however, which is provided by both military and government hospitals and is cheaper than treatment at a private hospital, and includes a variety of general medical treatment. Although subsidised healthcare is cheaper, there are shorter waiting lists for economic healthcare. In addition, government-sponsored medical treatment is available to chronically and critically ill patients who apply to the government for a grant to cover their treatment costs in private, governmental or military hospitals. There is generally a very short waiting list for treatment for patients with a government grant. For certain illnesses, such as chronic renal failure, where a patient needs regular, structured treatment, the patient is best off getting such sponsorship from the government. State sponsored treatment is also better in the case of time sensitive critical illnesses that require operations, such as open heart surgery, cardiac catheterization and liver or kidney transplants. Grants are given out by the General Medical Council at the Ministry of Health.
While anyone who pays into the national health insurance service is entitled to state health insurance, some decide not to participate in it because of the hassle of long waiting lists and unavailability of beds in state hospitals. Despite this, the existence of private medical insurance is still widely underdeveloped within the country. Tanahy claims that only 20 to 25 per cent of the population has private health insurance, reflecting the fact that only a minority of Egyptians have the financial resources with which to purchase high-end medical insurance or be treated in private hospitals.
In terms of quality of medical care and facilities, university hospitals, reputable private hospitals, and military hospitals are roughly all equivalent in terms of quality of care. The quality of care in state hospitals is generally lower because overheads are very high: expenditure for general hygiene and the volume of services provided are too much for the government budget. Private hospitals tend to be exceptional in terms of hygiene and the personal attention afforded to patients, and they are void of long waiting lists.
There is a wide network of public primary healthcare clinics and hospitals all around the country, though the Ministry of Health was unavailable to comment on an exact estimate. However, the US Embassy in Cairo can provide visitors with a list of all available hospitals in the country, and a list of hospitals in each of Egypt’s governorates can be found when visiting the Ministry of Health’s website online.
It is worth noting, however, that the metropolis of Cairo is one of the world’s most densely populated cities. The city is quite large and on a typical work day in the middle of the week, traffic is an undeniable factor that seriously impacts transport time, specifically with regards to emergency transportation and ambulance services. Still, despite the traffic that plagues city dwellers and foreigners alike, representatives of Dar El Fouad Hospital insist that ambulances – provided by the government – have become far more advanced and have improved dramatically over recent years. Consequently, at any given time, one can dial 1-2-3 and a government ambulance will be sent and arrive to a patient in anywhere between five and 15 minutes, say the representatives. However, there is speculation among the country’s residents as to just how efficient, timely, and responsible these ambulances actually are.
In any case, ambulances are typically provided at no cost to a patient in the case of emergencies, but ambulance crews often demand payment whenever the patient has medical insurance, whether local or international. Still, many medical facilities, including the Dar Al Fouad Hospital, maintain their own road ambulance services.
When it comes to air ambulance provision, the government does maintain such an evacuation programme, but it is not very well organised or run. No private air ambulance companies currently operate have bases in the country, although this is something that Connex is looking at providing.
the country’s potential to become a primary destination for medical tourism, like India or Brazil, has been recognized by Egypt’s government and planned for accordingly
While well equipped facilities with modern technology and well-trained staff – including staff that have overseas training – are available in Egypt, Tanahy maintains that more hospitals accredited by organisations such as JCI are needed in the country for it to become a more sought after destination for medical tourism, and to guarantee visiting foreigners that it can adequately address their medical concerns and needs. He believes the country has all the ingredients necessary to reach these two goals, however: “We have the hospitals, the resources, expertise, personnel, and equipment. Hospitals in touristic areas are now well aware of this and … [generally] meet international standards.” Besides accreditation, he also stresses that hospitals need to strengthen their relationships with insurance, travel, and assistance companies around the world in order to provide a more rounded offering to international patients.