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A prescription of order

Injecting hope into a virulent healthcare setting

by Executive Editors

When word broke earlier this year that physicians and pharmacists have been treated to new prescription forms by order of Health Minister Wael Abou Faour, the matter seemed pale — perhaps even byzantine — when compared with the minister’s flashier preoccupations. Who wants to bother with discussing some bureaucratic, procedural reform when there are so many daring indictments of food villains and patient-rejecting hospitals to drum up, replete with photo ops?

Even with the prospect that the new prescription regime might save citizens and the state some pretty pennies on drug expenditures — 30 percent ought to be possible, according to officials (see “Waiting for (re)forms“) — and at the same time stimulate local production of generic pharmaceuticals, almost everyone ignored examining the new measure and its significant, albeit not short term, implications.

Everyone except Executive, that is. Even more shocking than the malnourished attention given to pharmaceutical issues that each year represent, give or take, 5 percent of our painfully high total imports bill, is another healthcare cost problem. Lebanon may spend much more than it needs to on branded pills but as a society we spend far too little on health overall, it appears, whether on primary healthcare or on preventive medicine.

Data shows that Lebanon spent a mere 7.2 percent of its GDP on health in 2012. This sounds good when compared with an exorbitant expenditure of 12.4 percent of GDP back in 1998 but when compared with the average of 9.3 percent share of healthcare in the GDP of the developed nations in the Organization for Economic Cooperation and Development (OECD), this is far from enough. It means we and especially our younger generations may be sitting on a medical time bomb. 

This explosive potential has two components. The first is underfunding and under-investment. According to the Economist Intelligence Unit’s Healthcare outcomes index 2014, the Lebanese currently get good value on money spent on healthcare, as spending per individual amounts to $684 and ranks higher in outcomes than for spending.

[pullquote]The index unsurprisingly shows a correlation between healthcare expenditures and outcomes[/pullquote]

However, the index unsurprisingly shows a correlation between healthcare expenditures and outcomes. Maintaining a developed healthcare system typically requires total expenditures to hover around or above 10 percent of national GDP and countries that do so demonstrate advanced efficiency in health outcomes. Not investing sufficiently in the universal provision of advanced healthcare — and such underspending is implied by the sinking share in GDP — means that the national bill is in danger of blowing up from an eruption of accumulated health risks.

The second component of Lebanon’s health gamble is the combination of an aging population and a general increase in lifestyle diseases.

The evidence for this is as strong as it is shocking, even when examining just one massive lifestyle risk. More than one third of Lebanese adults smoke cigarettes, according to a 2008 survey. The survey cautions that “11.3 percent of the adult Lebanese population suffers from smoking-related heart disease [while] smokers with heart disease make up 6.6 percent of the total population.” 

Aging and correlated demographic change is also an established fact. A Lebanese male born between 2005 and 2010 can expect to live 76 years, while a female can expect to reach 80. While longer lifespans are not at all a bad thing, experience from developed economies such as Japan shows that population aging has massive implications for healthcare and state spending needs.

If the inevitable rise of lifestyle diseases and the increasing needs of an older populace come to a point of confluence with underfunded and underinvested health safety nets and woefully insufficient pension structures, the cost bomb could be mindblowing for a state that has made it a habit to exist on the financial edge. Conventional economic wisdom is that countries with debt issues — and boy do we have one — will be hit harder by increases in health and age related spending needs.

Making healthcare more efficient in Lebanon, as in the case of the prescription form reform, is a step in the right direction. The latest view is that the notorious fragmentation of Lebanon’s healthcare landscape could even be a positive for the sector by adding resilience. But the piecemeal reforms and small improvements that have been achieved in the past 20 years cannot and must not detract from the overriding need to address the future of Lebanese healthcare with what has been lacking in the past decades: political vigor and administrative rigor. 

[pullquote]Two urgent issues demand proper and immediate care: health investments and implementation of legal frameworks[/pullquote]

Thus far, healthcare reform packages had to be slipped onto the desks of incoming ministers with cautious hopes that one or another component — like the implementation of prescription forms — might find favor with the new politico in the building. This makes the historic pattern of healthcare restructuring and development in Lebanon into the most pathetic excuse for the lack of a national strategy that one can imagine.

Henceforth, thus, two urgent issues demand proper and immediate care: health investments and implementation of legal frameworks. In addition to reforming healthcare financing, the government must explore options to spur investment in health infrastructure. The only way to maintain and further improve the quality of Lebanon’s clinics and hospitals is through a consistent flow of investment injected into the medical system. Ways for achieving this, whether through state funding, public–private partnerships, or new and inventive methods have to be researched and discussed in inclusive dialogue. Neither behind closed doors nor in popularist political announcements and not even in reliance on generous donors can our health network leap into the 21st century.

One good news of the recently initiated reform of prescription processes for pharmaceuticals is that it adds a vital, and hitherto missing, component: data. The new process will allow authorities to track how doctors prescribe and pharmacies dispense medications — making clearer not just how one of the major components of Lebanon’s healthcare system works, but also allowing the identification of perpetrators of bad and wasteful practices in the medical field. This, in turn, will over time inform the contours of further financial and insurance reforms. And that is the genius hidden in the new prescription pad.

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Executive Editors

Executive Editors represents the voice of the magazine.

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