Spending of the Ministry of Public Health

According to the public budget bill for the year 2012, the budget assigned to the Ministry of Public Health stood at LBP 554.48 billion (around USD 368 million), which accounts for a scanty 2.6% of the total public spending. The largest share of the Ministry’s budget is usually allocated for the hospitalization of the uninsured Lebanese in private hospitals and amounts to LBP 340 billion or approximately 61.3% of the total expenses. The provision of drugs ranks second on the Ministry’s agenda, with LBP 120 billion or 21% spent on medication. Together, the above items make up 83% of the Ministry’s total spending, equaling around LBP 460 billion.

In addition, the Lebanese, the uninsured particularly, can benefit from a number of contributions of which we mention:

• LBP 13 billion allocated to public hospitals
• LBP 10 billion allocated to joint programs with the UNICEF aimed at providing vaccines and medication
• LBP 4.349 billion for the Lebanese Red Cross
• LBP 4.875 billion for the Young Men’s Christian Association to provide medication for chronic diseases
• LBP 200 million for the National AIDS Control Program
• LBP 500 million for Caritas
• LBP 500 million for the Imam As-Sadr’s associations
• LBP 900 million for the Lebanese Union for the Physically Handicapped
• LBP 100 million for the Association of the Martyr
• LBP 300 million for the United Nations Population Fund (UNFPA)
• LBP 85 million for the National Eye Bank Center
• LBP 500 million for the National Organization for Organ and Tissue Donation and Transplantation
• LBP 700 million assigned for joint programs with the Directorate General of Technical and Vocational Education and the Lebanese University.
• LBP 160 million in support of the National Nursing Development Program
• LBP 450 million for the Thalassemia Center
• LBP 250 million for the Social Welfare Institutions/ Dar al-Aytam al-Islamiya
• LBP 135 million for the Social Movement Association
• LBP 220 million for the Mohammad Khaled Social Foundations
• LBP 145 million for the Lebanese College for the Handicapped- Beit Shabab
• LBP 70 million for the Greek Orthodox Nursing Home
• LBP 55 million for Dar As-Sadaqa in Zahle
• LBP 145 million for the National Center for Development and Rehabilitation
• LBP 70 million for the Saint George Medical Center
• LBP 55 million for the Tal-Chiha Nursing Home
• LBP 200 million for the Childhood Protection and Care Association
• LBP 2.450 billion for vaccination programs
• LBP 2.750 billion for the primary healthcare program (Dispensaries)
• LBP 550 million for the Medical Awareness Program

A portion of the Ministry’s expenditure goes to:

• Office supplies: LBP 110 million
• Administrative supplies: LBP 810 million
• Liquid fuels: LBP 200 million
• Laboratory supplies: LBP 250 million
• Pesticides: LBP 400 million
• Communication: LBP 500 million
• Electricity and water: LBP 475 million
• Office rent and maintenance: LBP 1.217 billion
• Advertising and publications: LBP 807 million
• Services and cleaning: LBP 250 million
• Salaries and wages: LBP 26.957 billion
• Expenses of the inoperative central laboratory: LBP 1.055 billion
• Technical equipment: LBP 2.1 billion
• IT equipment: LBP 1.5 billion

The beneficiaries of the Ministry’s donations are estimated at approximately 1.9 million Lebanese, which brings the share of each individual to no more than LBP 242,000 annually, a meager portion compared to the high cost of hospitalization in Lebanon.

National Social Security Fund

The number of the Lebanese covered by the NSSF amounts to 1,335,505 people distributed as follows:

• The insured: 593,508 members
• The beneficiaries or dependants: 728,944 members
• The optional subscribers: 12,756 members

The medical services of the NSSF reached LBP 626.1 billion in 2011 and were distributed as follows:

• Services to the insured members: LBP 460.685 billion
• Services to taxi drivers: LBP 75.438 billion
• Services to specific segments: LBP 18.630 billion
• Services to optional subscribers: LBP 26.315 billion
• Administrative expenses: LBP 45.03 billion

Military Healthcare

The military health insurance covers members of the Lebanese armed forces, their dependants, which total approximately 500,000 people, and the prisoners detained by the military forces. The healthcare costs of the above amount to LBP 379.625 billion annually and break down as illustrated in Table 1.

Source: 2012 draft budget law

Ministry of Social Affairs

An amount of LBP 193.7 billion is earmarked annually by the Ministry of Social Affairs to assist non-governmental organizations. The share of health care is estimated at approximately LBP 65 billion, assigned mainly to provide medication and to cover tests and check-ups at the Ministry’s centers or at the centers of those organizations engaging in contracts with the Ministry.

The beneficiaries of this type of assistance are those who lack health insurance and seek coverage at the expense of the Ministry of Social Affairs. The health and hospitalization costs borne by the Ministry are detailed as follows:

• Joint social and healthcare projects with NGOs: LBP 9 billion
• Allocations to development services centers: LBP 18 billion
• Contribution to Caritas Lebanon: LBP 400 million
• National Substance Abuse Prevention Program: LBP 100 million

Solidarity Funds

The 2012 draft budget law also allocated LBP 53.7 billion for the solidarity funds set up by the government to assist in hospitalization and education. It is known that the members of these funds contribute to their expenses, noting that around 30,000 people benefit from their contributions. These funds are:

• MPs Solidarity Fund: LBP 13 billion
• Solidarity Fund for the Parliament Staff: LBP 1.6 billion
• Solidarity Fund for the Lebanese University Teachers: LBP 23 billion
• Judges Solidarity Fund: LBP 10.5 billion
• Solidarity Fund for the Judges of Islamic Religious Courts: LBP 5 billion
• Solidarity Fund for Judicial Assistants: LBP 600 million

State Employees Coop

The State Employees Coop offers health and education coverage to both serving and retired public employees and teachers. The system of benefits covers around 400,000 people and the Coop’s spending on health alone amounts to LBP 175 billion.

Conclusion

The Lebanese state spends, along with the contributions of the private sector to the social security fund, an approximate LBP 1823 billion on healthcare and hospitalization as detailed in Table 2.

Source: 2012 draft budget law

Problem and Solution

While the Lebanese state spends approximately USD 1.2 billion annually on healthcare, 51% of the Lebanese people have only access to the coverage of the ministries of public health and social affairs with a negligible individual share not exceeding LBP 300,000. This requires a reconsideration of the entire healthcare system by unifying medical offerings and services, standardizing medical tariffs and limiting the coverage services within the jurisdiction of one health provider in order to reduce costs. If costs are to be kept at their present rates, full coverage for all the Lebanese, whether hospitalized or not, is the least to be expected in return.

Distribution of Funds to Private Hospitals in Contract with the Ministry of Public Health

According to the 2013 draft budget law, the Ministry of Public Health set the financial ceiling for the admissions it subsidizes to both private and public hospitals at LBP 420 billion (USD 280 million) distributed as follows:

1- Private Hospitals: LBP: 225.7 billion (USD 150 million)

Source: Decree no. 10033 dated 6-3-2013

2-Public Hospitals: LBP 94 billion

Source: Decree no. 10033 dated 6-3-2013

3- Chronic illness medical centers and institutes: LBP 14.559 billion

4- Centers for irreversible paralysis and disabilities: LBP 728.4 million

5- Centers for cerebral palsy and chest diseases: LBP 1.294 billion

6- Centers for reversible paralysis and disabilities: LBP 4.490 billion

7- Coma treatment centers: LBP 2.8 billion

8- Mental disorders’ centers: LBP 12.655 billion

9- Hearing and speech centers: LBP 680 million

10- Prostheses centers: LBP 805 million

11- Centers providing hearing devices and aids: LBP 205 million

The total funds distributed to the above centers (from 3 to 11) amount to LBP 38.2 billion