Reform follows failure: II. Pressure for change in the Lebanese health sector

Lerberghe, Wim Van; Ammar, Walid; Rashidi, R El; Awar, M; Sales, Alessandra Santos; Mechbal, A

doi:10.1093/heapol/12.4.312

Cited by 9 publications

(3 citation statements)

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“…This created a strong financial incentive for hospitals to invest in sophisticated equipment and complex services without rational planning, resulting in increased overall hospitalization cost [ 7 ]. Such an unregulated environment resulted in major inefficiencies, especially within the context of the 1974–1990 internal conflict [ 8 ]. However the MoPH strategy has since progressed on cautious experimentation and seizing windows of opportunity as they arise [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems

Ammar

Khalife

El‐Jardali

et al. 2013

BMC Health Serv Res

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BackgroundResource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate.MethodsOur study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion.ResultsHospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies.ConclusionsOur results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in addition to accreditation in hospital contracting. Proxies developed may be used to detect miss-use and provider adverse behavior. Research using ICD-derived case mix is limited and our findings may be useful to inform similar initiatives and other limited-setting countries in the region.

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Section: Introductionmentioning

confidence: 99%

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems

Ammar

Khalife

El‐Jardali

et al. 2013

BMC Health Serv Res

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“…3 Lebanon is an example of a developing nation where such data are lacking despite a shift toward more rational, better quality, and cost-controlled primary health care. 4 Although the Lebanese healthcare system is based on fee for service, the government subsidizes a few programs aimed at assisting indigent patients. For example, the chronic drug program provides health centers with medicines to be distributed free of charge to individuals holding valid prescriptions from licensed physicians.…”

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confidence: 99%

Common Prescriptions in Ambulatory Care in Lebanon

et al. 2001

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The low rate of generic and essential drug prescribing, as well as the frequency of prescribing in respiratory infections, highlight the need for initiatives to help rationalize prescribing in primary care in Lebanon. Together with the diagnostic categories incurring high cost per person, these issues can be part of physician education or treatment guideline development. These measures may aid the government in its subsidy of primary health care centers.

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“…The central Ministry of Health (MOH) has an important role in resource allocation among areas and programmes; it must set norms and regulate. 176,177 MOH should develop policies on manpower and training, on health care financing, on pharmaceutical supply and quality control, &c. Outside assistance may be necessary, but there is then also a higher risk of non-appropriate solutions, with a dominance of the technical dimension over the social one.…”

Section: Managerial and Financial Sustainabilitymentioning

confidence: 99%

Medical Assistance to Self‐settled Refugees: Guinea 1990‐1996

Damme¹

1999

Disaster Prevention and Management: An International Journal

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* Carrying capacity is defined here as the population that can sustain themselves on the agricultural resources of the area. 19-21 country. There were no telephone services, nor was television reaching the area. The only possible connection between N'Zérékoré and the capital Conakry was by road, a trip which, under favourable climatic conditions, took 18 hours. There were many wooden bridges and a ferry on the main axis between Macenta and N'Zérékoré. Many villages could not be reached by car, and during the rainy season, mud or broken bridges often limited access even further. Even the main roads could be impracticable for several days, except for 4-wheel drive vehicles. On the other hand, N'Zérékoré was only at some 300 km tarmac road from Monrovia. Before the war broke out in Liberia in 1990, this road was in excellent condition. A trip between N'Zérékoré and Monrovia took only 5 hours. Supplies thus reached the Forest Region more easily through Liberia than from Conakry. Economically, the Forest Region of Guinea was more integrated with Liberia, and partly Côte d'Ivoire, than with the rest of Guinea. From the mid-1980s onwards foreign donors started investing in the Forest Region. In the Diecké area, host to large numbers of refugees since January 1990, the Société guinéenne de Palmiers et Hévéa improved the exploitation of the agricultural resources. The valley swamps were used for rice cultivation, and the use of water control measures improved considerably their yield. In the flood plains, palmtree and rubber plantations were created, employing many workers. These interventions attracted migrants to Diecké and created a monetarised economy in the project area. In Guéckédou, host to the largest concentration of refugees from 1991 onwards, the Projet Agricole de Guéckédou also introduced swamp farming. It is in this poorly developed region-even by Guinean standards-that some 500,000 refugees from Liberia and Sierra Leone would arrive between 1990 and 1995. * The only official private health facilities in Guinea were two mine hospitals, one mission hospital, a few mission dispensaries, and some rare private practises in the capital, Conakry. The informal private sector, however, was well developed.

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Reform follows failure: II. Pressure for change in the Lebanese health sector

Cited by 9 publications

References 0 publications

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems

Common Prescriptions in Ambulatory Care in Lebanon

Medical Assistance to Self‐settled Refugees: Guinea 1990‐1996

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