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French Version

Hospitals syndicate boss pushes for major healthcare reform (Daily Star)

Sleiman Haroun says numerous agencies ­ each governing a different part of the sector ­ have stalled all previous improvement efforts

Social security and insurance firms must realize that a fundamental rate change is needed if hospitals are to continue functioning properly, said Sleiman Haroun, head of the Syndicate of Lebanese Hospitals (SLH).

“The last raise was seven years ago,” Haroun said at a news conference at the SLH headquarters in Beirut Tuesday. “Since then, costs have skyrocketed due to new tariffs and taxes, inflation and increase in transportation and wages, not to mention investment in infrastructure and hi-tech equipment and spare parts, which are subject to annual raises.”

Haroun spoke in response to a memo by Walid Ammar, Health Ministry General Manager, titled The Health System and Reform in Lebanon. It said the social and political setting was “not opportune for a wide-ranging white paper that would oblige the government to implement fundamental changes in the sector.”

“Many before him have expressed the same opinion but never to such an extent,” said Haroun, noting that there are five public health insurance agencies in Lebanon ­ each under the supervision of a different ministry, in addition to two private companies, also supervised by different ministries. “Each plays its own tune without any master plan or coordination,” he said. “The numerous agencies, whose scope is limited to managing financial concerns, have brought reform efforts to nothing. The health sector is at the edge of an abyss.”

Haroun attributed the situation to several factors, detailed in the book Health: Realities and Solutions, by Bahij Arbid, who heads the Health Ministry’s planning department. These include the inability of politicians to enact and implement solutions, and a hidden health policy agenda that needs to be approached cautiously.

The book mentions resistance to any change by “beneficiaries” inside or outside the administration, and the total absence of control and punishment in the light of an inept policy and project-appraisal system.

Haroun said the Health Ministry’s accreditation system for monitoring medical and hospitalization standards was vital. The extra expenses incurred by hospital for maintaining such a system are justified by guarantees it offers the insurance sector. “Talk of an increase in the health bill, if it were true, cannot be blamed on hospitals,” said Haroun. “Hospitals have contributed to keeping health spending in check.”

Haroun said every penny hospitals spend is accounted for and scrutinized by management, medical committees and representatives from insurance firms.

Khalil Majid, former head of the National Social Security Fund, offered ample proof in his book, Health Risk Protection: A futuristic Look, that the average health bill has decreased.

Statistics show that the average daily bill in 1999 was LL298,000, down from LL332,000 in 1998. In 1997, it was estimated at LL380,000.

“These figures represent a paradox, as normally the annual health bill registers an increase,” said Haroun. “This proves hospitals are subjected to pressure to lower their rates without real justification.” Haroun said only 25 percent of the publicized $1.5 billion to $2 billion health bill is for inpatients. The remaining 75 percent is for outpatient services. “Either the numbers are incorrect and must be amended, or else out-of-hospital costs should be reduced as there are no reliable controls on them,” said Haroun. “Each must be held accountable for its actions.”

He said that in France, inpatients account for 45 percent, and outpatient services offered by French social security are far more advanced than Lebanon. “In 2002, France spent an average of $1,150 on each citizen as compared with about $150 Lebanon spent for each Lebanese,” said Haroun. “We have to use ‘about’ because the exact number of citizens in Lebanon is never published.”

According to Haroun, such a gap is huge, even in the light of differences in the French system. He said this proved that hospitalization in Lebanon is far below international norms, despite fanfare touting services provided here.

Haroun called for an end to campaigns that smear the reputation of private hospitals and conceded that while mistakes were sometimes made they do not warrant exaggeration.

Haroun asked whether the establishment of government-run Beirut University Hospital was an effort to promote health tourism or provide free treatment for poor Lebanese. “What is the use of building government hospitals when the government’s policy is privatization?” asked Haroun. “The crux of the problem remains the absence of a clear and unified global health plan that will be imposed on all equally. “And let us not forget a reliable mechanism for implementing, developing and controlling this plan.”

Beirut 28-07-2003
Ara Alain Arzoumanian
The Daily Star

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