Health equity in Lebanon: a microeconomic analysis

Abstract

BackgroundThe health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.MethodsWe use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.ResultsWe find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.ConclusionsThe lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.

The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

“…The probability of catastrophic expenditure was then 4.4 times higher among households having incurred expenses for treating chronically ill persons in Georgia, and up to 7.8 times higher in Burkina-Faso [17,56]. Similar results were found in West Bengal (India), in Lebanon and in China [15,40,57,58]. Up to 11.6% of households in Western and Central China were pushed under the US$ 1.08 poverty line after incurring outpatient expenses associated with chronic diseases [42].…”

The health, financial and distributional consequences of increases in the tobacco excise tax among smokers in Lebanon

“…The health system savings on hospitalization costs are calculated for each quintile by multiplying the deaths averted by the average cost of a smoking-related hospitalization and the utilization rates by quintile and by disease. Subsequently, we derive the savings in OOP health expenditures using the share of healthcare costs paid out of pocket by expenditure quintile, reported in Table 1 (Salti et al., 2010). OOP health expenditures averted are calculated keeping in mind that insurance plans cover acute health expenditures associated with hospitalizations due to tobacco-related illnesses, and patients without insurance coverage pay out of pocket.…”

Lebanon's essential health care benefit package: A gateway for universal health coverage

“…The multiplicity and ambiguity shrouding the health insurance schemes in Lebanon, in addition to the relatively high OOP health expenditures, and lack of coverage of outpatient services generated a sense of public dissatisfaction with the current state of the health care system . The health care system in Lebanon also adversely affected the most low‐income population; in that, the lowest quintiles had lower rates of insurance coverage and had to pay more frequent catastrophic payments, increasing their vulnerability . Over the past 10 years, almost every minister of health and several parliamentarians have attempted to pass laws to merge the health insurance schemes, create a single funding pool, and standardize the package of services, but none of these laws were passed due to conflicting stakeholder interests .…”