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

Lebanon
could be a first step towards ending the fragmentation of health financing. This step will entail
some challenge in terms of consolidation of administrative structures of different agencies, but
would be well worth the effort.
Identified problems with current contractual arrangements, whether they concern the
Ministry of Public Health or other public financing agencies, mostly reflect two key factors.
• Lack of political support. A wide range of reforms are urgently needed in the health sector.
These include, most urgently, ending the current fragmentation of health care financing. Use
of contractual arrangements as a tool for reform requires political support as contracted
parties, whether hospitals or physicians or other providers, have large powers and can exert
them very effectively over the public sector. This is compounded by their dominance of
health service delivery. The difficult economic conditions of over-supplied provider groups
in the midst of ongoing economic difficulties in Lebanon further complicates the situation.
Nevertheless, visionary public health policies and stewardship and more pressures from
beneficiaries can bring on profound changes.
• Lack of adequate capacities. It is commonly indicated that current capacities in the different
public health agencies are not adequate to oversee and monitor a different scope of
contracting arrangements that emphasize quality of care and which are outcome based. For
example, most agencies do not have the needed number of highly qualified supervisory
physicians. A different and new set-up is needed for contractual arrangements with different
focus. This includes a health informatics system, interlinked financing agencies and
providers and enhanced transfers of data and payment.
CONTRACTUAL ARRANGEMENTS: A SCORECARD
Table 5 summarizes strengths and weaknesses of contracting arrangements according to
financing agency. It might be also useful here to provide a general overview of what contracting
arrangements can and cannot do. Contractual arrangements provide important contributions to
the performance of the health care system in Lebanon. These arrangements:
Provide the legal and organizational framework for public–private interactions to provide health
care and health-related services to large segments of the Lebanese population (both the
insured and uninsured).
Cover uninsured portions of the Lebanese population, thereby contributing to improving equity.
This is especially important with regards to coverage of hospitalization and acute care
services. Coverage of primary care services is gradually improving.
Support selected nongovernmental organizations which provide basic social services beyond health
care.
Improve the capacity of the Government of Lebanon to monitor performance of contracted health
care institutions.
Can lead to upgrading standards and performance of contracted parties.
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