Field notes · The economics

Egyptian prices are high. It is not fraud. It is economics.

By Dr Hossam Elkholy, physician and former hospital medical director on Egypt's Red Sea coast · Updated June 2026

The wrong diagnosis

When a European desk sees a Red Sea invoice at several times the German price for the same care, the reflex is moral: someone is cheating. The reflex is wrong, and it leads to the wrong treatment. Accusations produce defensive paperwork, hardened positions and unpaid hotels of correspondence. The bill survives.

The truth is less dramatic and more useful: the prices are mostly rational. They are what an economy under severe currency pressure charges the only customers who pay in hard currency.

The touristic fee, layer by layer

A foreign patient on the Red Sea is not priced as a patient. He is priced as a tourist, by every single layer that touches his case:

• The building. Clinic premises in resort towns pay resort rents, and the owner of the walls prices the foreign wing accordingly.
• The doctors. A specialist called to a tourist at 2 a.m. bills a tourist visit, not a local consultation. So does the anaesthetist, the radiologist, and the consultant who signs the discharge.
• The equipment and consumables. Egypt imports most of its medical devices, implants and reagents, and imports are paid in dollars. When the pound falls, these lines reprice within weeks.
• The staff premium. Nurses and technicians who work the international wing cost more, in an economy where wages chase inflation.
• The margin itself. A business whose costs inflate by a third each year does not plan with a ten percent margin. It cannot.

The macro picture, in two charts

Put the two together and the invoice you received stops being mysterious. A hospital whose dollar costs doubled while its home currency lost two thirds of its value will price its hard-currency customers, foreign payers, to carry the difference. The tourist premium is not a deception. It is the business model of an entire coastline under monetary stress.

Rational for them is not payable for you

Here is the line that matters: understanding the premium does not oblige you to fund it. Your policy insures medical care, not a hospital's currency hedge, not resort rent, and not an economy's inflation pass-through. The work of containment is therefore not an accusation of dishonesty. It is a separation exercise: which part of this invoice is the care the policy covers, and which part is geography, priced into the bill because the payer historically accepted it?

Nobody confesses to economics, and nobody needs to. A clinical record can be read, line by line, without anyone being called a cheat.

Why this framing wins settlements

When the challenge is moral, the hospital defends its honour. When the challenge is clinical and economic, "the record supports four nights, and these consumables appear twice", the hospital defends a spreadsheet, and spreadsheets concede. I review invoices in exactly this spirit: physician to physician, on the record, without accusation, separating what the care required from what the geography added. The bills fall because they can fall without anyone losing face.