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Lebanon is one step away from universal health care


A law creating a new system of universal health care is waiting for final approval from Lebanon’s parliament. In the meantime, the Ministry of Health has started to implement certain measures of this law, using its existing budget.

Lebanon is just one step away from implementing universal health care. A bill to initiate the reform has already passed the necessary parliamentary committees and only needs a final vote of approval from members of parliament before it becomes law. How the new system will be paid for, however, is still unclear.

The bill itself is not new. Atef Majdalani, a former MP from the Future Movement (FM), introduced the legislation a few years ago as part of a slate of reforms. But the original text has been amended to accelerate the process of implementation, according to outgoing Minister of Health Ghassan Hasbani.

The legislation calls for the creation of a standardized health care card for all Lebanese citizens. “It gives all Lebanese citizens access to medical care, especially those without medical coverage,” Hasbani says.

There are two different parts to the new health care system put forward by the bill. The first is coverage for routine annual tests that people need regardless of what insurance they have. These tests would be tracked in a new system of biometric medical files. "This allows the attending physician to access this biometric file - with the patient's consent - and update it when necessary.” adds Hasbani.

The biometric files will reduce costs by eliminating duplicate medical examinations. At the same time, coverage for routine tests will allow for better preventative and early stage care. “Many chronic diseases, such as diabetes, hypercholesterolemia, triglycerides, high blood pressure, cardiovascular diseases... can be prevented, making it easier to avoid the complications that may arise,” Hasbani explains.

The second part of the new system addresses the needs of the roughly 1.8 million Lebanese who rely on the Ministry of Health for their health care coverage. In addition to the mandatory, routine examinations, it would cover 90 to 100 percent of the cost of hospital bills, depending on people’s needs, and 70 percent of the cost of outpatient medical examinations in government hospitals, which are not currently insured by the ministry, and treatment for chronic diseases. Daily medications will also be provided by the Ministry of Health, but through clinics run by civil society associations, such as the Young Women’s Christian Association (YWCA).

Complementing the NSSF

There have been some misunderstandings and rumors about how the new system will work in parallel with the existing National Social Security Fund (NSSF). The health care card will not interfere with the NSSF, according to Hasbani, but instead is intended to be a complimentary service. “The Ministry of Health can benefit from extending the scope of social groups to be covered by the NSSF because it will reduce the hospital bills paid for by the ministry,” he says.

A bill submitted in October by Yassine Jaber and Anouar el-Khalil, MPs from Nabih Berry’s parliamentary bloc, suggests amending certain sections of the new health care law regarding the NSSF to include employers as future beneficiaries. This would allow the Ministry of Health, which currently covers these patients, to save money.

As far as costs for individual Lebanese are concerned, the health care card would only require a symbolic 10,000 LL payment to open a biometric medical file. But how the system will be paid for overall is still an unanswered questions and was the subject of controversy during discussions over the bill in the finance and budget committees. Several potential financing options were eventually proposed, including an 8 percent excise tax levied on mobile phone bills. "This symbolic contribution should be able to ensure a source of income and support the current health budget,” Hasbani notes.

Adopting the new system is important, especially as health care costs in Lebanon continue to rise. Better early detection of disease and a higher degree of health consciousness are leading people to spend more money on health care, according to Hasbani. At the same time, drugs are becoming increasingly expensive, especially those used to treat chronic diseases such as cancer. The Ministry of Health conducted a study to see the effect of the proposed system on these rising costs. “It shows that, in the long term, the health card will save between 30 percent and 40 percent on the health bill,” Hasbani says.

Working ahead of time

But there are still obstacles to the new system being put into place. Until Lebanon’s new government is formed, the bill cannot be adopted into law, and the question of funding has not been fully answered.

Despite these roadblocks, the Ministry of Health has already started to implement some of the measures in the bill that it already has a budget for, such as covering outpatient medical examinations. The price of these examinations has already been included in the budget allocated to every government hospital.

Also, the biometric medical record system is being developed with support from the World Bank’s Health System Resilience Project in Lebanon, which was approved in June 2017. The $150 million, five-year project focuses on strengthening the infrastructure of government hospital and providing primary health care centers across the country with equipment. “A first phase will seek to create biometric records for some 300,000 people registered at the Ministry of Social Affairs and who are considered the poorest patients,” Hasbani says. "We have already started on certain measures referred to in the bill on the health card. But a law remains necessary to ensure the sustainability of the project”.

Ultimately, the Ministry of Health, which is already struggling with insufficient funds, will need a bigger budget to sustain the new system. Five years from now, when the World Bank project end, "there should be a budget for the card in the annual budget law," Hasbani concludes.

(This article was originally published in French in L'Orient-Le Jour the 17th of December 2018)

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