Egypt’s Path to Universal Health Coverage: The Case for Automatic UHIS Enrollment

A recent policy note released in 2025 by the World Bank’s Health, Nutrition and Population Global Practice in collaboration with the International Food Policy Research Institute (IFPRI), the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO), and the Japan Policy and Human Resources Development Fund (PHRD), highlights a persistent challenge in Egypt’s journey toward Universal Health Coverage (UHC): the low enrollment rate of vulnerable individuals in the Universal Health Insurance System (UHIS), despite legal and financial provisions. Despite nearly a million people qualifying for fully subsidized health coverage across four governorates, only 56 percent were enrolled by mid-2024. This shortfall, according to the report, can be remedied through automatic enrollment mechanisms that rely on digital integration and streamlined administration, policies already proven successful in countries such as the United States, Thailand, and Turkey.

Bureaucratic Complexity Keeps Vulnerable Groups Uninsured

Egypt’s health insurance framework, codified under a 2017 law, envisions a phased national rollout of UHIS, with formal sector employees, pensioners, unemployed individuals eligible for unemployment benefits, informal workers, and underprivileged groups all categorized for enrollment. The latter group, whose contributions are subsidized by the Ministry of Finance, is the most underserved. Their eligibility is typically tied to participation in one of six public benefit programs, most notably the Takaful and Karama Program (TKP), which serves about 20 million citizens. Others include programs for orphans, persons with disabilities, people in disaster-struck regions, and poor individuals who don't qualify for TKP.

However, even individuals who are deemed eligible for these public assistance programs face considerable obstacles in securing UHIS coverage. Enrollment requires in-person visits, multiple interviews, and the collection of extensive documentation. A particularly striking example is seen in Category 6 (the ultra-poor not covered by TKP), where only 104 out of 232 applicants were approved over a four-year span, revealing how burdensome the eligibility determination process has become. The lack of real-time eligibility verification and the absence of coordinated data systems between agencies such as UHIA, MOSS, and NOSI further discourages applicants. As a result, many drop out of the process altogether, sliding into uninsurance despite being legally entitled to care.

Lessons from Global Front-Runners

The policy note draws valuable insights from global best practices. In the United States, initiatives like Express Lane Eligibility (ELE) and presumptive eligibility have helped streamline the enrollment process for low-income groups by using existing data from other government programs. ELE allows health insurers to rely on verified data from welfare programs, bypassing the need for redundant documentation. In Thailand and Turkey, the use of national ID numbers facilitates data sharing between agencies, eliminating duplicate entries and helping streamline citizen services. A compelling case comes from Massachusetts, where the suspension of automatic enrollment led to a 33 percent drop in coverage, but its reinstatement resulted in a 48 percent increase, clearly underlining the effectiveness of simplified, default-based mechanisms.

Digital campaigns and simplified forms also played a crucial role in these countries. Governments invested in accessible online platforms and real-time eligibility checks that could deliver results within 24 hours. These systems helped reduce paperwork for both applicants and agency staff while improving enrollment accuracy and targeting. Egypt, the report argues, could adopt similar reforms by leveraging its existing national ID system and Unified National Registry (UNR).

The Cost of Coverage: Far Less Than Fuel Subsidies

From a financial perspective, the note asserts that expanding subsidized UHIS enrollment is both affordable and justifiable. In 2024, Egypt spent only 0.014 percent of its GDP on subsidized UHIS enrollment, a tiny figure compared to the 0.8 percent it spent on fuel subsidies in 2021/22. Increasing coverage to all eligible individuals in the four UHIS governorates would cost just 0.025 percent of GDP. Scaling up to 30 percent of the national population by 2028/29 would require 0.4 percent of GDP, equivalent to only 2 percent of projected government expenditures.

The report urges Egypt to recalibrate how it determines UHIS subsidies. Currently pegged at five percent of the monthly minimum wage, the amount does not reflect the actual cost of delivering the health benefits package. Instead, the system should base its financial planning on a clearly defined package of health services, as done in Thailand, which aligns resources with healthcare needs and service use trends.

Streamlining Systems for Seamless Enrollment

The key to improving enrollment is the integration of digital and administrative systems. The report proposes three interlinked reforms: simplifying the administrative process, digitally integrating agencies, and establishing a medium-term budget plan. Standardized application and renewal forms, unified databases, and a shared digital interface between MOSS, NOSI, UHIA, and health providers would allow for real-time eligibility determination and automatic enrollment. The introduction of a unified benefits card that combines social protection and health insurance identification would further ease the process for applicants.

Additionally, the report emphasizes the need to reform agency culture and performance management. Enrollment targets should be tracked, and staff incentivized for higher coverage rates. Quarterly public reporting and qualitative research, such as focus groups and policy impact studies, could help policymakers understand where the system is failing and how to address gaps in access.

A Vision for Equitable Health Access

The policy note concludes that Egypt is uniquely positioned to achieve near-universal health insurance coverage for its most vulnerable citizens through automatic enrollment. With strong political leadership, a robust national ID system, and a legal mandate already in place, the country has the foundational tools to implement this reform. Automatic enrollment would eliminate queues, reduce the administrative burden on both applicants and agency workers, and ensure that individuals do not fall through the cracks during transitions in family status, health, or income.

This transformation will require investments in digital infrastructure, streamlined procedures, and coordinated policy planning. But the reward, a healthier, more secure population with equitable access to care, is well within reach. By aligning its systems and subsidies to serve those most in need, Egypt can fulfill the promise of Universal Health Coverage and set a precedent for the region.