Algeria

Multiple social security funds, National Health Insurance Fund for Salaried Workers and their Dependents (Caisse Nationale des Assurances Sociales des Travailleurs Salariés, CNAS); and National Health Insurance Fund for Non-Salaried Workers and their Dependents (Caisse Nationale des Assurances Sociales des Non-salariés, CASNOS)

   

Fragmentation

Bahrain

Single Social Health Insurance Fund Authority responsible for implementing the National Social Health Insurance Program (SEHATI)

Creating a new pooling agency

2018

To be fully implemented mid-2020, so impact is unknown

Djibouti

Single National Social Security Fund (Caisse National de la Sécurité Sociale, CNSS), which segments population groups

     

Egypt

Universal Health Insurance Authority merging different pools previously under the Health Insurance Organization

Creating a new pooling agency

2018

Considerable defragmentation

Parallel to ongoing old system: Health Insurance Organization has separate fund pools for their different population groups

 

Earlier years

Fragmentation due to options and linking entitlements by income. Inefficiencies. High out-of-pocket spending

Existing system still fragmented

Iraq

Efforts to create health insurance in Kurdistan government

     

Jordan

Multiple pools (Civil Insurance Program via Ministry of Health, Royal Medical Services, Social Security Corporation, private insurance). Populations segmented by socioeconomic group

   

No reform: likely double coverage of citizens

Fragmentation

Kuwait

Single pool via DAHMAN segments population in two schemes: Afya for retired nationals management by DAHMAN (private entity) and funded by the government

Creating a new pooling agency

2016

Further fragmentation

Lebanon

Multiple social insurance funds (National Social Security Fund, civil service, army, security forces) and Ministry of Public Health as “insurer” for the uninsured

     

Morocco

Multiple social security agencies for different population segments: Health Insurance Fund for Civil Servants (Caisse Nationale des Organismes de Prévoyance Sociale, CNOPS); Health Insurance Fund for Formal Sector Salaried Workers (Caisse Nationale de Sécurité Sociale, CNSS); and subsidized Social Health Insurance Program (Régime d’Assistance Médicale, RAMED), with phased expansion to the poor nationally since 2012

     

Oman

Multiple pools: Ministry of Health’s Dhamani health insurance scheme

Planned: Unified Health Insurance Policy for private sector employees

Social health insurance

2019

Further fragmentation

Qatar

Multiple competitive private pools

 

2015

Further fragmentation

Saudi Arabia

Multiple pools

Compulsory Employment-based Health Insurance

Creating a new pooling agency

2006

Fragmentation

Sudan

Multiple funds: National Health Insurance Fund (NHIF), HIKS

Several other pools at state level, armed forces, police, and Ministry of Interior

Centralizing formally decentralized pools (but reform is pending)

2016

New NHIF mandates coverage to all including coverage of vulnerable groups (pensioners, poor), and is subsidized by public funds. In 2019, first medical coverage of Sudanese returnees launched under the NHIF

Boards of various state branches were abolished in order to unify all pools

Tunisia

Creation of National Health Insurance Fund (Caisse Nationale d’Assurance Maladie, CNAM) as a merger of CNSS and CNRPS

Within CNAM, segmented public sector, family doctor, reimbursement

Assistance Médicale Gratuite (AMG) 1 and AMG 2 being expanded

Creating a new pooling agency

2004

Considerable defragmentation

United Arab Emirates

Abu Dhabi

Single quasi-publicly run fund (DAMAN) segments population into three insurance schemes: Thiqa cover, available only for Emirati nationals; Basic cover, mainly for unskilled laborers and lower-paid employees; and Enhanced cover, mainly for higher-skilled expatriate workers

Creating a new pooling agency

2007

Equity concerns.

Fragmentation

Dubai

Multiple private pools

Mandatory private insurance

2014

Inequity/overutilization.

Fragmentation