Lebanon - What is GIS - World Health Organization

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Lebanon Role of contractual arrangements in improving health system performance input from contracted parties, the study was not designed for this purpose and therefore this was limited in scope. 4. Synthesis of data. Information from multiple sources was synthesized. In light of the breadth of contractual arrangements in Lebanon, several case studies were conducted, rather than focusing on one study, to examine the performance of different levels of the health sector in Lebanon. Reviewing several case studies jointly also allowed for identification of important opportunities for improving performance through strategies of coordination and integration. 5. Summary of findings and recommendations. Based on examination of current situation, a scorecard is developed to illustrate where contractual arrangements have succeeded and failed, and to identify future steps that can be taken to improve performance. A set of recommendations are provided. These build on identified strengths and weaknesses. They represent a point for discussion with different stakeholders in Lebanon. The checklist provided by the Regional Office for assessing the role of contractual arrangements was useful both in guiding in the actual research and in developing the report. However, it was not possible to answer all questions in the checklist meaningfully for all the different contractual arrangements in Lebanon. This is mostly due to the sheer number of these arrangements. FINDINGS Health sector in Lebanon Lebanon is a middle-income country of approximately 4 million inhabitants (80% urbanized) who live in 6 administrative regions, or mohafazat. The greater Beirut area houses more than 40% of the population. Around 45% of Lebanese are under the age of 21 years and 10% are over age 65. Lebanon has favourable health indicators compared with other countries of the Eastern Mediterranean Region: life expectancy is 72 years for females and 69 years for males; overall and infant mortality rates are 7 and 28 per 1000, respectively (regional health inequalities are notable). Lebanon has undergone an epidemiological transition, with over 80% of the current mortality burden due to noncommunicable diseases and 10% due to injuries. The morbidity profile, compiled in the context of a national burden of disease study, suggests a similar pattern. Health is an important component of economic activities, consuming 12%–13% of GDP. Most health spending, however, is out-of-pocket (around 70%–75%), more heavily shouldered by the poorer segments. Slightly more than 10% of all public expenditures go to health. The main public financers are: the Ministry of Public Heatlh (receives 4% of the total budget and 1% of GDP), NSSF, Civil Service Cooperative (CSC), Ministry of Defense, Ministry of the Interior
Lebanon Role of contractual arrangements in improving health system performance and local municipalities. Enrollees and beneficiaries of these financing schemes are discussed later. Due to past unregulated growth of the private sector, which dominates the provision of health services, and various malfunctions of the public sector, the health sector suffers from chronic inefficiency, poor mix of providers and waste. This is true for both ambulatory care as well as hospitalization. Over 160 hospitals are licensed, of which more than 85% are private. There is gross oversupply of small (less than 100 beds) hospitals (73%). Only 5 hospitals have more than 200 beds. Hospital beds are in oversupply, with 12 000, beds or around 26 per 1000 population. The low occupancy rates (45%–50%) further contribute to poor economies of scale. There is oversupply of high technology in Lebanon (please see section on CABG under Case studies) which humbles the limited availability of similar technologies in many industrialized countries. Correspondingly, there is oversupply of specialized physicians. Indeed, over 70% of physicians in Lebanon are specialists, the inverse of the ratio in the United Kingdom, where the specialist/generalist mix is 30/70. Over 11 000 physicians are currently registered in the two Orders of Physicians in Lebanon. The exact number of practising physicians is not known, but probably 15%–20% are practicing abroad. Medical practices are not commonly organized according to groups of either single or multiple specialties, thus increasing overhead and cost of care and reducing efficiency. Medical care is mostly fee-for-service or flat-rate based. There are no managed care or capitation plans in Lebanon. Non-physician clinicians are undersupplied in Lebanon. For example, the nursing rate per capita in Lebanon is among the lowest in the world. Health care utilization is relatively high in Lebanon. Because Lebanon is a small country, access to medical services is not a major problem, although some areas remain plagued with low health care access rates. Around 12% of the population is hospitalized per year. Because of multiple factors, including undersupply of public hospitals, perceived low quality and social stigma in a culture that is image-conscious, most hospitalization is in the private sector. Around 28% of Lebanese uses ambulatory care services per month; the average number of ambulatory care visits per year is 4. There is an abundance of public and nongovernmental organization ambulatory health centres, over 110 primary care centres and over 400 dispensaries. However, most ambulatory care takes place in the private sector where it is problem-oriented and specialist-provided. Emphasis on prevention and health promotion is severely lacking. There have been multiple attempts at health sector reform in Lebanon since the end of the civil war. This has included a large World Bank-funded project. Large ambitious reform packages have not received political support, despite their perceived urgency. In this climate, public agencies, especially the Ministry of Public Health, are trying to regain regulatory powers and improve their stewardship of the health sector. This has proved to be challenging considering the large and powerful private sector, the limited political support, lack of citizen engagement and limited capacities of the public sector.
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Lebanon - What is GIS - World Health Organization

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