Health Insurance Systems and Pathways to Sustainability with Application on the Egyptian Health Insurance System

The quest for Universal Health Coverage (UHC)-ensuring all people access to quality health services without suffering financial hardship-is a central target of the United Nations Sustainable Development Goals (SDGs) (WHO, 2021). The architecture of a country's health financing system, particularly its health insurance mechanism, is the primary engine for achieving this aim. Well-designed systems promote equity, efficiency, and resilience; poorly designed ones exacerbate inequality, foster inefficiency, and are vulnerable to collapse.

Globally, successful health insurance architectures, whether based on social health insurance (e.g., Germany), single-payer models (e.g., United Kingdom), or hybrid systems (e.g., Canada), share common foundational pillars. These include mandatory universal coverage, pre-pooled financing, strong regulation, and strategic purchasing. Conversely, systems that fail to institutionalize these pillars, such as the historically fragmented model in the United States, struggle with uninsurance, underinsurance, and the world’s highest health expenditures despite suboptimal outcomes.