Global Dialysis Perspective: Lebanon

Abstract

Lebanon is a 10,452 square kilometer Middle Eastern country that is known for its cedar trees, multireligious cohabitation, political turmoil, world highest ratio of refugee to native population, and lately one of the worst economic crises in the world history. Lebanon is divided into nine governorates that can be geographically reassembled into the following five major ones: Beirut, Mount Lebanon, North, South, and Beqaa (Figure 1). Owing to political reasons, Lebanon has not held a proper population census since 1932. According to the United Nations, Lebanon's population was estimated at 5,631,000 inhabitants in 2021 including Lebanese citizens and refugees. 1 However, the latest estimate of Lebanese citizens reported by the central administration statistics of the Lebanese council of ministers in 2020 was 4,842,000, 2 and the number of refugees reported by the United Nations High Commissioner for Refugees fact sheets was 1.5 million. 3 The Lebanese health care system is known to be complex and pluralistic. 4 Although 80% of hospitals in Lebanon are private, health care services are largely covered by public third-party payers. These public payers include the Lebanese Ministry of Public Health (MoPH), National Social Security Fund (NSSF), Civil Servants Cooperative, Army/Security institutions, and Municipalities. These public institutions only cover Lebanese patients, whereas refugees are supported by the United Nations High Commissioner for Refugees and Non-Governmental Organizations (NGOs). As a result, refugees and their data are not officially part of the Lebanese health care system. 3,5 The MoPH is the major contributor in the public sector, and it is the country's highest health authority, enforcing health regulations by releasing policies and decrees. From the year 2005 onward, a financial ceiling was set in contracts between hospitals and MoPH; this ceiling limited the number of hospitalizations and chronic dialysis patients covered by the MoPH in each hospital.