The potentials for corporatization of public hospitals: The case of Egypt

With changing health landscape across the globe, increasing burden of chronic diseases, increasing citizens expectations that accompanied by cost limitations, health reform becomes inevitable for Egyptian health system to maximize benefits and overcome challenges. Reform might include healthcare service provision, health policies, workforce planning or public health programs strategies. New Public Management concepts and principles represent the basis for many of reform plans since its emerging in the early 1990s. Many countries have used New Public Management guiding principles to shape its health reform program. Egypt is undergoing a reform plan across the whole sectors through Egypt 2030 plan announced by Ministry of Planning and Administrative reform. The reform plan has identified a set of goals for the health sector to achieve and another set of indicators to measure the progress and level of achievement. This paper presents corporatization of public hospital as a tool that can fit into the new reform program. With the execution of universal health coverage, the autonomy of hospitals will help to achieve the targeted level of performance, efficiency, and quality of services. The main challenge facing implementation is the high percentage of poverty in Egypt and their dependency on the government hospitals to get healthcare services. Transforming these hospitals into revenue generating organization will affect accessibility except there is a social insurance scheme that can protect poor against the commercialization of healthcare services. Research question: is corporatization improving performance, increasing accessibility and enhancing the quality of healthcare services? Methodology: qualitative research where semi-structured interviews were conducted with healthcare professional and system experts locally and globally to get their views on the feasibility of implementation of such reform in Egypt. Conclusion: corporatization of public hospitals in Egypt represents a fair organizational reform strategy for Egyptian health system to increase efficiency and satisfaction. Yet, a rigorous readiness assessment of the system components (regulations, providers, payers, and beneficiaries) should be executed to measure the readiness for implementation

Clinico-Pathological Features and Immunohistochemical Comparison of p16, p53, and Ki-67 Expression in Muscle-Invasive and Non-Muscle-Invasive Conventional Urothelial Bladder Carcinoma

Introduction: The identification of bladder detrusor muscle invasion in urothelial cancer is essential for prognosis and management. We studied the clinical, histological, and immunohistochemical expression of p16, p53, and Ki-67 in urothelial detrusor muscle-invasive bladder cancer (MIBC) and urothelial non-detrusor muscle-invasive bladder cancer (NMIBC) in Egyptian patients. Methods: Sixty-two bladder urothelial cancer cases obtained through TURBT were included and divided into two groups: (MIBC, stage T2) and NMIBC (T1). Tissue blocks were recut and re-examined microscopically; then, the immunostaining of p16, p53, and Ki-67 was performed to compare both groups and evaluate the 13% cut-off for Ki-67, 20% for p53, and p16 intensity in various conditions aided by telepathology technology. Results and conclusion: Hematuria was the main clinical first presentation, with no significant difference between either group. The mean age was 61.6 years, with male predominance (52 males and 10 females). The absence of papillary histological pattern was associated with a higher stage, including detrusor muscle invasion (p = 0.000). The overall average percent of p53 immunostaining was 12.9%, revealing no significant difference between MIBC and NMIBC when a cut-off of 20% was implicated. The Ki-67 expression was correlated with higher grade and muscle invasion; however, no association was found with the other two markers’ expression. The negative immunostaining of p16 was associated with low grade and NMIBC in the case of the preservation of the papillary pattern. We recommend further studies on the cut-off of widely used markers and more immunohistochemical and genetic studies on the p16(INK4A), taking into consideration the histological pattern of conventional carcinomas