Egypt's largest listed fintech is no longer just moving money — it's moving into medicine. Fawry has secured a third-party administrator license through its subsidiary Tre Med, placing the company between patients, hospitals, and insurers: processing claims, managing provider networks, and using data to detect fraud and leakage in a medical insurance market where costs are rising year on year. Our next guest was consulted on exactly this development. Dr. Islam Anan is the founder and CEO of Accsight, a health economics and policy consultancy working across the Middle East and Africa. Dr. Anan, welcome to the show.
Hello. Thank you for having me. My pleasure.
You have said that once you create an insurance model, the system sees overuse, misuse, and abuse — and that the TPA is accountable for keeping spending rational. From your work at Accsight, how much of Egypt's medical insurance spending is actually leaking to waste and fraud, and who is paying for it today?
To put it in context — ten years ago, 70% of health expenditure in Egypt came out of pocket and 30% from government. Today it is roughly 50/50. As private insurance expands alongside the government's universal health insurance, more coverage will reach more people. But historically, in every country where a new insurance system is introduced — Australia, Asia Pacific — you see significant moral hazard. People are paying premiums so they want to take maximum benefit. You also see adverse selection where people don't fully declare their health status beforehand. Globally, around 20% of insurance spending leaks to waste — in prescription drugs, for example, including gastrointestinal products, vitamins, and painkillers. Once you introduce a new system, the most important thing is governance. Egypt has been building toward this since the new insurance law in 2019 — universal health coverage, a separate service provider entity in the Egyptian Health Authority, and an accreditation board.
The chairman of existing TPA Tricare describes a pricing trap — administrators locked into fixed fee contracts while hospital fees nearly tripled mid-year. Fawry's model reportedly avoids this by keeping pricing risk with insurers. Is fee-based TPA the only economically viable model in Egypt right now?
TPAs typically take no risk — they operate on fixed service fees for one fiscal year. That becomes very tricky when service providers increase fees mid-year. If a consultation fee goes from 500 to 700 Egyptian pounds, the extra 200 falls on the TPA, not the insurer. Fawry's approach moves that risk from the TPA to the insurer by combining both roles in one entity. The deeper issue is that fee-for-service means paying for every service delivered — which creates an incentive for service providers to increase volume. The UK model uses performance fees, where payment is tied to clinical outcomes, not services rendered. That removes the incentive to over-claim. Options like capitation also exist. But fee-for-service is the right starting point for Egypt because the medical registry needed to support more sophisticated models simply does not exist yet.
You have made a striking projection — that universal health insurance will not shrink private insurance but expand it from roughly 10% to potentially 40% of the population buying private coverage. Walk us through that.
The fear in the market is that public insurance will replace private insurance entirely. That will not happen. The government's essential services list will not cover private rooms, dental services, or enhanced services. So Egyptians will still want complementary private insurance. If private coverage moves from 10% to 14% of the population, that already represents 13 billion Egyptian pounds in premiums. But the opportunity goes much further — with subsidised government insurance as a base, people from lower socioeconomic groups can now afford complementary private policies at 30 to 40% lower premiums than they paid before. The private insurance market has a genuine blue ocean in front of it.
Fawry is simultaneously building an insurance arm, a TPA, and a payments platform. One group could write the policy, administer the claim, and process the payment. How should investors price that governance question?
On the surface, it looks like a conflict of interest — writing the policy, claiming the money, and paying the money all under one roof. But they do have separate platforms for each service. The key component is having a proper governance body, financial audit, and data protection framework in place. Policy writing, claims, and reconciliation must be separated at the platform level, with those functions not able to see each other. The governance body must sit outside the operating entity and provide transparent audit reports to investors and the stock exchange. It is tricky — but it is feasible if they manage to maintain genuinely separate entities and separate platforms with no visibility between them.
Dr. Anan, we truly appreciate you coming on the show today. Thank you very much.
My pleasure. Thank you.
