RESUMEN
Abstract-Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an "insurer of last resort," the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.
RESUMEN
Lebanon has a highly fragmented health care system. The Lebanese population receives its health care services through a system dominated by the private sector that is dependent to a large extent on public sector financing. Lebanon spends about 83% of its Gross Domestic Product (GDP) on health. This study consists of observations on the utilization of the Ministry of Public Health (MOH) program of hospital care provision. The study population included all patients admitted for hospitalization in any of the 126 hospitals contracted with the MOH, between August 2008 and July 2009 (one full year). This review is limited to medical admissions only. The surgical admissions have been excluded since they are covered under a 'flat fee' reimbursement. Findings reveal that a significant proportion of the hospital admissions under this program are for conditions that may not need hospitalization. Moreover, most of these admissions receive care in relatively small and peripheral hospitals. The findings ought to lead to a further scrutiny of the ministry program of support to the hospitalization of its nationals. Measures may be indicated to improve the efficiency and effectiveness of hospital utilization, avoid waste and possibly fraud, and reconsider the role of small and peripheral hospitals within the health care system of the country.
