Salam Rayes is the chief executive officer of the Ashrafieh-based St. George Hospital, one of Beirut’s oldest healthcare institutions. Executive sat down with Rayes for a frank discussion on the ailing state of healthcare in Lebanon.
E in last year’s Facts & Forecasts issue, Executive looked into how the National Social Security Fund and insurance were the biggest obstacles to the healthcare industry in Lebanon.
Has anything changed?
Basically, there is no change — the problems are the same. The main problem is that the healthcare sector is fragmental and there is no policy or guidance to the sector. The private sector works on its own and the public sector works on its own. And the public sector is [really] public sectors — social security, the Ministry of Public Health, the armed forces. Each one has its own healthcare program and health coverage. And then again you have the insurance companies. Reimbursement is the main problem; it’s still a serious problem that is… jeopardizing the delivery of healthcare.
E In Lebanon, private hospitals are said to be much preferred over public hospitals — is this the case?
You’d be surprised. There are good government hospitals on the periphery, depending on the management. If you have good managers you have good hospitals. I can name two or three that are excellent hospitals on the periphery and people go to them. But in general what you are saying is correct [the majority of people go to private hospitals], but I hope that the government hospitals that are providing [good] healthcare to people are increasing.
E What other problems are facing the healthcare sector in Lebanon?
Most universities graduate medical students who go abroad and never come back because of the way of life here. They have better opportunities [abroad] in whatever they specialize.
The human resources are not being attended to very well. There is a shortage of nurses, which has increased this past year because the nursing schools did not take the number that they usually enroll — most of them went below 50 percent [of normal enrollment]. And there are no schools for paramedics.
If you look at the financing as a problem, the human resources as another problem, updating your equipment is a third problem. And nobody gives a damn: if you don’t have the ‘X’ piece of equipment you’re not a good hospital and people stop at that.
E Do you see any solutions to these problems?
I don’t think so. These problems have been accumulating over the past 100 years. Same problems, same mentality, same attitude. Solutions are all individually taken care of, not collectively: not as hospitals, not as [the] healthcare [sector], not as anything. Everybody solves his own problems and the one who solves them better is surviving better. It’s as simple as that.
I’ve been in the healthcare sector since 1965 and the same problems repeat themselves: reimbursement problems with the government, equipment, staffing, human resources, financing. Nothing has changed. Of course, the magnitude is different. I mean, we were worrying about $5 million and now we are worrying about $20 million or $25 million.
Yet, the situation is not pessimistic because of individual efforts. You have doctors who go abroad and specialize and come back and keep on going back and forth to gain more experience and knowledge. They come and treat patients better simply because they want to do that. And communication is easier now so they can browse and find more information about modalities of treatments and so on.
So if you look at it and take it at face value, everything is fine.
E Is it difficult staying competitive with so many hospitals and clinics popping up in Lebanon today?
We have good healthcare delivery — not in all hospitals but in quite a number of them. The practice of medicine has changed over the years. First of all, hospitals are divided into two main categories —either university-owned or church-owned as one main category and owned by individual doctors as another category. The majority of hospitals are small hospitals owned by individual doctors.
My competitor is no longer Hotel Dieu or AUH — it is the small hospital that has specialized in ‘X’ specialty. They have specialized in ophthalmology and they have good doctors there. So ‘X’ hospital is my competitor in ophthalmology, ‘Y’ hospital is my competitor in orthopedics. It’s not one place —it’s different hospitals now because there are good doctors practicing in small hospitals all over the place. So you cannot rank hospitals anymore —you can rank specialties if you want. Do we have a good specialist in neurosurgery in brain surgery, in spine surgery? They’re all over the country — in small hospitals not necessarily in big hospitals.
The disadvantage that they have in small hospitals is that they don’t treat the patient in totality — they treat him only for that specialty. If someone comes in for a spine problem and is diabetic and has a heart problem, they cannot treat him in that center, they have to get the specialist from other places. It’s only the big hospitals — the university hospitals — that have a general treatment of the patient in its totality.
E In this setup, is it difficult for your hospital to attract specialists?
This is of course a major challenge. You see we have 200 doctors — they have seven. They have to worry about finding seven — I have to worry about finding 200 and about replacing the 200, so the magnitude is different.
E Is the Ministry of Public Health responsive at all to the needs of the public or private healthcare sectors?
Yes and no. They are doing their best with the resources they have. I think that this minister is doing a lot better than previous ministers — after all he is a physician. The ones who were before him were just politicians. He’s definitely much better than what we had.
E What do you believe the healthcare sector will start looking like in the near future?
More of the same — no major changes unless you get a Minister of Health who is willing to impose changes that will shape up the whole system.