Universal Health Coverage is achieved while increasing efficiency and quality of services provided

Offer affordable and quality health services to all citizens and residents

People Centered, Efficient and Affordable Services

1.Universal health coverage (UHC) means that all people and communities have access to equal minimum promotive, preventive, curative, rehabilitative and palliative health services of sufficient quality to be effective, while ensuring that such use does not expose the user to financial hardship

2.Health is a basic human right, and the provision of basic health care coverage by Governments is essential to human development, social stability, and poverty reduction

3.Of the two main categories (public and private) of sources of funds for health coverage, “public” refers to health expenditure by all government agencies including donor (external) funding. “Private sources” refers to households who spend directly (out-of-pocket) when buying health services or make indirect prepayments through insurance or assistance by NGOs

4.For Lebanon, a universal health coverage policy is central to renewing the social contract between the citizen and the Lebanese state

1.Total Health Expenditure (THE) % of GDP

2.% of OOP expenses out of THE

3.% of population who has health coverage (public and private)

4.Number of people not admitted to ER

5.Infant mortality rate (0.8%)

6.Life expectancy (80.0 yrs)

7.WHO National Health Accounts

1.In 2018-9, 44% of the population did not have any type of health insurance: Elderly people who have lost their health coverage after retirement; self-employed individuals; employers; workers in the informal sectors; the unemployed; the poor

2.To receive care, the latter rely on the Ministry of Public Health (MoPH) which acts as the provider of last resort for services such as hospitalization and medicines for chronic and incurable diseases expenses, regardless of income and coverage status (upon minister’s approval)

3.Total Health Expenditure (THE) (average 8.3% of GDP in 2018) is high compared to the region (Jordan 7.7%, KSA 6.3%, Kuwait 5%, Iraq 4.2% , UAE 4.1%)

4.Out -of-Pocket (OOP) health expenses represent a high percentage of household expenditures, that become even higher for lower income families

5.Since the compounded financial, economic and social crises, a large majority of people can no longer afford health care expenses, and more people are losing their health insurance coverage (private or public) as they become unemployed

6.There is also a large disparity between coverage, depending of the insurance provider:

• Several public insuring bodies: the National Social Security Fund (NSSF); the army health fund; and the Civil Servants Cooperative. These bodies have different funding mechanisms, regulations, and most importantly tariffs, for health services and hospitalization
• On the private side, private insurance companies have their own health plans, services, and tariffs for health services and hospitalization, and are regulated by the Ministry of Economy and Trade (MOET)

7.Inefficient use of resources and capacity problems, especially in remote areas

8.Escalating price of drugs

1.1/3 of the health care bills are born directly by patients as Out of Pocket (OOP) payments (double world average). 1/3 by the government from tax revenues, 1/3 by private insurance and other public contribution-based schemes (NSSF, etc.)

2.Disproportionate allocation of resources favors expensive curative (75% of THE on hospitalization) over cheaper preventative care (8% of THE for PHC)

3.Existence of a universal coverage for tertiary care and sophisticated treatments such as open heart and joint replacement surgeries and expensive cancer patent drugs, whereas, paradoxically, prevention and PHC services are not universally covered

4.Growing ageing population, yet, those above 64 are not covered

5.Some hospitals are turning down patients covered by MoPH due to the ministry failing to meet its financial obligations

6.NSSF has been recording deficits for years, and is at risk of loosing its funds that were invested in treasury bills

7.Insurance providers also are at the risk of bankruptcy following the financial crisis

1.MOPH is the policy maker, regulator, and sometimes provider for health services and medications.  It also is responsible for (and funds) some public health services: vaccination and immunization campaigns programs for school health, reproductive health, and oral health, as well as epidemiological surveillance

2.MOPH submitted several UHC plans

• 2010 - Draft project with an overall budget of USD 1.053B
• 2012 - Draft project with an overall budget of USD 1.32B
• 2014 – Publication of UHC strategy on MOPH website

3.MOPH plan includes partial citizen contribution such as enrollment fees in Primary Health Care (PHC) centers and yearly health card fees (except for the poorest identified by MOSA)

4.MOPH plan includes a voluntary enrollment system in PHC centers and government hospitals. PHC centers are the first point in a 3 level referral system, and receive funding from MOPH on enrollment heads

Policy Action

1.Complete health map (all providers, number of people, analysis of supply and demand)

2.Secure universal health insurance coverage by introducing a mandatory Healthcare Card, that qualifies every card holder to receive the same package of basic preventive and health treatment services

3.Prepare a draft law to make UHC mandatory for all citizens, (with government providers (NSSF, COOP, Army, security forces, and customs) and private providers roles and contracts to be reformed accordingly)

4.Define the minimal UHC coverage basket after doing an actuary study to determine exact costs on treasury and citizens. At a minimum, the basket should include: PHC, hospitalization (including long stay and chronic diseases), out-patient services, diagnosis services, medicine, physiotherapy and artificial limbs, modern diseases (psychiatry, drugs, etc.)

5.A fee must be paid by employers with a minimal contribution from the employee. Nevertheless, the vulnerable (unemployed and/or without income) are exempted from this payment

6.The Ministry of Social Affairs (MoSA) will cover the contribution fees for those below the nationally agreed poverty or extreme poverty levels

7.Secure sources of UHC funding from MOPH budget by lobbying MPS, COM, MOF, donors, etc.

8.Survey the capacity of MOPH and prepare the organigram of human resources needed to manage the UHC. The appointment of an independent medical council, etc. will be needed

9.Include private sector in UHC implementation. The private sector can provide 3rd party administration i.e. processing applications, health card management, accredited operator of health care institutions such as PHC centers, etc.

10.Strengthen compliance and homogeneity of the PHC network and accreditation system, as primary care and prevention are essential in reducing the overall healthcare bill