The role of contractual arrangements in improving health sector ...

Lebanon
at their disposal for regulating health care services and improving quality of care, while
controlling health care costs. Contractual arrangements are among the main tools that these
agencies have for carrying out these tasks. The main objective of this report, therefore, is to
evaluate how well this is done given the available opportunities.
The specific aims that correspond to this objective include:
1. Describe current contractual arrangements in which the main public agencies are involved.
Focus on contractual arrangements of the MOPH.
Examine case studies of hospitalization and ambulatory care.
2. Evaluate contractual arrangements in terms of their ability to meet the stated needs in terms
of:
Responding to demands of financing agencies.
Fulfilling essential public health functions, especially public health protection.
3. Address the questions posed in the study questionnaire distributed by the WHO Regional
Office for the Eastern Mediterranean..
Contractual arrangements are but one tool in the hands of health policy-makers to enhance
performance of the health sector. Therefore, evaluation of contractual arrangements must
consider other tools and mechanisms. Nevertheless, in a country like Lebanon, where
nongovernmental parties dominate the health sector, the contractual arrangements by themselves
merit evaluation as a key tool for regulating performance of the different functions of health care
delivery. This is the main rationale for this effort.
APPROACH AND METHODS
Conceptual framework and approach
The first aim of the report is to provide a technical overview of contracting arrangements in
Lebanon. The report attempts to synthesize data from multiple resources to understand, and when
possible assess, the contribution and performance of contractual arrangements in the health
sector. The report utilizes commonly available indicators, such as those of process indicators,
utilization patterns and expenditures, to achieve this purpose.
The report also aims to review contractual arrangements in light of broader health care
sector and health system issues in Lebanon. To this end, the report evaluates contractual
arrangements in relation to two overarching concerns, social protection and equity.
Consequently, the report attempts to look beyond cost and technical and administrative efficiency
into how contracting arrangements are able to serve foremost those most in need. Many of the
available indicators, however, do not tell the whole story of the ability of the contracting
arrangements, or for that matter the health sector, to contribute to social protection and to
improving equity. Other indicators, e.g. those exposing inequalities, are needed but are
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