HEALTH & BALANCE

Lebanon 2013 | HEALTH & EDUCATION | REVIEW: HEALTH

While Lebanon's healthcare sector has much to be proud of, the public-private balance needs to be better aligned to ensure universal care.

Equipped with some of the best technology and well-educated doctors, Lebanon's hospitals are the envy of the region. However, government after government has been slow to reshape healthcare programs that frustrate domestic hospitals and compromise health services, especially in the public sector.

MEDICAL TOURISM

Lebanon's hospitals have elite status in the region and medical tourism is common in Beirut. Known for its affordable cosmetic surgery, the country is also praised for its cardiology and oncology specialties. Today, some 85% of foreigners who come to Lebanon for medical treatment are doing so for something other than cosmetic surgery. In 2012, the Medical Travel Quality Alliance ranked the Clemenceau Medical Center in Beirut as one of the world's top-10 medical destinations, making it the only hospital on the list heralding from the MENA region. However, regional instability often threatens such efforts. The Agency for Investment Development in Lebanon estimated 30% growth in medical tourism from 2009 to 2011, but recent safety concerns have turned the tide. According to The Daily Star, compared to the same period in 2012, the total number of tourists in Lebanon fell by 10% in the first eight months of 2013. The most marked drop was among Arabs, the number of which fell 18.8%. Tourists from the UAE saw the biggest decline at 70.3%, while those from Saudi Arabia fell 49.4%, from Kuwait by 34.3%, and from Jordan by 14.3%.

On top of safety concerns, the lack of a supervising agency to hold hospitals accountable for their practices has also raised concern. A study led by healthcare payment services company GlobeMed found that a “medical outcome," which is a negative shift in one's health status post clinical intervention, occurred in 5% of patients between 2005 and 2010, although the percentage is thought to be much higher. A lack of reporting of these matters prevents positive change from taking place.

Even so, the trek for accessing healthcare services has not overshadowed this glitch, as the domestic population faces an uphill battle to be treated in the first place.

UNDER-COVERED

The National Social Security Fund (NSSF), referred to as daman, is the country's largest insurance provider and covers some 30% of the Lebanese population. The fund takes 21.5% of employees' salaries from their employers—6% funneled to family allowances, 7% to the health indemnity fund, and 8.8% to the end-of-service fund. Employees front the outstanding 2% for health coverage. In effect, the NSSF takes on 90% of hospitalization costs and 80% of medication and examination costs. At least that is what the fund is designed to do. The NSSF has caused a stir due to its chokehold in the healthcare sector despite its evident limitations. The rate of input to any of its three funds is based on fixed monthly salaries and is capped at LBP1.5 million for family allowances and the health indemnity fund and at LBP30,000 for employee health coverage. This method does not take into consideration rising standards of living, inflation, climbing salaries, increasing equipment costs, and other factors that affect hospital budgets. The funds themselves run large debts. The NSSF also determines the amount of money that private hospitals can charge patients covered by the fund, which is often well below hospital targets and is further leaching money from a sector desperate for cash flow.

PUBLIC-PRIVATE SPLIT

According to a 2012 report released via a joint effort among Université Saint-Joseph, the World Health Organization (WHO), and the Ministry of Public Health analyzing the healthcare system of 2011, Lebanon was home to 164 hospitals and nearly 15,500 beds, some 82% of which were private. The role of the private sector continues to grow, mostly on account of the government's incapacity to fully fund and manage public hospitals. Many have shut down over the years, and the Ministry of Public Health has attempted to push public patients to private institutions.

Ismael Sukkareye, a member of a parliamentary committee that worked for the WHO on the Lebanon-focused “Right to Healthcare" report in 2007, told IRIN News that from 1971 to 2000, private hospitals with contracts with the Ministry to treat patients under public healthcare rose from 14 to 134. This so-called “transfer" system soon turned unappealing to private hospitals, as the government was unable to fund the remaining 90% of patients' bills that it was required to do so as part of the NSSF. This has left public healthcare patients on the curb and hospitals struggling to fill the gap in expenses.

GlobeMed General Manager Walid Hallassou echoes worries about the consequences of financial setbacks. Hallassou told TBY, “Lebanon has a firm economy, but is not growing sufficiently because of the political climate, security issues, and regional events. Essentially, economic growth is not tracing the cost of healthcare." Private hospitals are still reliant on public insurance and are in perpetual fear of an unbalanced private-public healthcare patient ratio putting them at the mercy of the government.