Lebanon’s healthcare system is made up of several bodies and government organizations which cover the hospitalization of the Lebanese people. These include the National Social Security Fund, the Civil Servants Cooperative, the Ministry of Public Health and military forces hospitalization (Internal Security Forces, State Security, General Security, the army).

In addition, there are several different mutual fund programs such as the fund for judges and judges assistants, the fund for teachers of the Lebanese University, the fund for Members of Parliament and other civil servants.

In spite of all these organizations and the huge cost shouldered by the Treasury, over half of the Lebanese population does not receive any health coverage.
In a three-part study, Ii Monthly will examine the cost and number of beneficiaries of each of the different public administrations pertaining to hospitalization. This edition will begin with a look at medical care at the expense of the Ministry of Public Health.

Contracts between the Ministry of Public Health and private hospitals

The Ministry of Public Health enters into contracts with a number of private hospitals to provide care and medical treatment for Lebanese citizens who do not receive coverage by any other government organization. Beneficiaries of this arrangement are estimated to number approximately one million.

In the absence of a clear and defined health policy, this method has led to a considerable increase in the number of private hospitals over the last twenty years. In addition, critics contend that the Ministry’s hospital selection policy has been based on interests and political and religious considerations, rather than on medical needs.

First category hospitals (Medicine and Surgery)

The private hospitals that have entered into annual contracts with the Ministry of Public Health number 140 out of 157, while the number of private hospital beds in the first category (medical, surgery, maternity, pediatrics) has reached 2,020 out of a total of 12,000. These are distributed according to Table 1.

Hospitals for invalidity and paralysis cases

The Ministry also entered into contractual agreements with a number of institutions to treat paralysis, invalidity, chronic diseases and other cases, as shown in Table 2.

Private sector hospitalization fees

Due to the substantial number of private hospitals that negotiated contracts with the Ministry of Public Health and the growing number of utilized beds (reaching 6,530 in the year 2000), hospitalization fees increased from LL 80 billion ($53 million) in 1993 to LL 210 billion ($139 million) in 2002. The yearly evolution is shown in Table 3.

In addition to the figure of LL 1,592 billion (See Table 3), the overdue sums owed to private hospitals by the Ministry of Health are estimated at approximately LL 300 billion ($199 million). Therefore, the total amount to be paid by the Ministry reaches the huge sum of LL1,892 billion ($1.2 billion).

Soaring Costs

The causes leading to high hospitalization fees in private institutions entering into contractual agreements with the Ministry of Public Health include the following:

• The Ministry often enters into contracts with small hospitals, a policy which leads to an increase in fees because of both the higher costs in small institutions and the transfer of patients to bigger hospitals for additional treatment, incurring additional fees.

• Some hospitals reserve all their beds for the Ministry and with the lack of government control, many deliberately keep them occupied, even if they are not taken up for medical necessities.

• Inflated bills or fictitious treatments are another problem. Although control committees are in place and they have, in instances, reduced billed amounts by up to 50%, the Ministry of Public Health has not yet taken the proper measures of terminating contracts with such institutions.

• Unstructured access to care at the expense of the Ministry of Public Health has been cited as another cause of soaring costs. Prospective patients can easily obtain approval for hospitalization without being obliged to provide any evidence of poverty or need. The only required documents are a patient ID card and a certificate stating that the individual does not benefit from any other coverage.

• Despite the availability of state care, patients are still granted hospitalization in private institutions.

•  The Ministry of Public Health monitors private hospital activities through supervisory doctors, some of whom manage more than one hospital and several specializations at a time. In its 1996-1997 report, the Central Inspection Committee noted negligence on the part of some doctors, and reported a lack of experience, as well as complicity with hospital administrations in a number of instances.

•  In the absence of the necessary controls, some hospitals charge different rates for the same service, depending on the public sector organization or fund that is expected to pay.

Consequently, the rising expenses of the Ministry of Public Health, in terms of hospitalization, result from a lack of due consideration to a claimant’s financial situation, the manner in which contracts are carried out, the diversification of guaranteeing institutions, as well as the control exercised by private hospitals over contract terms and conditions, and lead to the imbalance between charged fees and real fees. In addition to hospitalization being funded by the Treasury, the government has set up mutual funds for civil servants in some administrations (these funds aim to cover the full cost of hospitalization and scholarships) and allocates funds for them.

The funds also have the right to collect fees to finance their costs. Table 4 lists those mutual funds and shows the direct contribution of the government to their expenses for the year 2002.

The Alternative

Finding solutions to this problem, ending the squandering of public funds and providing adequate hospitalization to the Lebanese public at the actual cost can only be accomplished by implementing a comprehensive health policy, which determines the role of the government and of the private hospitals.

This will create a system that ensures the good health and security of the individual, and the prosperity of the society.

In next month’s segment of our three-part series on the cost of health, we will explore the healthcare system at the expense of the National Social Security Fund.