This study aimed to analyze the impact of fiscal reform policies on public expenditure efficiency in Egypt during the period (1991–2023), through the construction of a composite index for public expenditure efficiency, The hypothesis of a positive relationship between fiscal reform and expenditure efficiency was tested, and the results provided partial support for this hypothesis. Specifically, a significant positive relationship was found between tax revenues as a percentage of GDP and expenditure efficiency. Conversely, the findings revealed a negative relationship between the size of public expenditure and efficiency, due to weak allocation and lack of oversight, reflecting the Egyptian economy's reality, where current spending and untargeted subsidies have been prioritized at the expense of productive and social expenditures. A relative improvement in expenditure efficiency was observed during reform periods, particularly between 2005 and 2010, despite persistent structural and institutional problems such as weak transparency and the absence of program-based and performance budgeting. Additionally, macroeconomic factors, including exchange rate instability, negatively affected expenditure efficiency, while the impact on social spending was limited. Based on these findings, the study recommends adopting program and performance budgeting, restructuring public expenditure to enhance investment and human development allocations, improving public debt management, strengthening financial transparency and oversight, controlling inflation, and achieving macroeconomic stability. It also emphasizes the use of periodic composite indicators to measure expenditure efficiency and evaluate fiscal policies.