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Lebanon is working to implement a sweeping overhaul of its health sector, aiming to upgrade the direct provision of services, put in place more cost-effective management practices and expand basic medical coverage to all members of society.

With one of the highest per-capita outlays for health services provision of any country in the region, Lebanon spends $820 per person annually. The most recent World Health Organisation figures put Lebanon’s total expenditure on health at 8.9% of GDP and 11.9% of total state outlays.

While expenditure may be high, many believe that Lebanon is not getting full value for its money, with the National Social Security Fund (NSSF) – the workplace-funded health scheme covering those in contracted employment – heavily in deficit, while state services are under pressure to meet demand.

Key to the reforms proposed by the health minister, Mohammad Jawad Khalifa, will be providing insurance to those people who do not have access to coverage through the NSSF or other insurance options.

Though people currently without coverage are given free treatment through the Health Ministry, there are concerns that this system does not provide adequate or equitable service. As proposed by Khalifa, the 58% of people not currently covered would be included in a public programme giving them the option to access both public and private health care facilities.

Payment for treatment would be through a mix of direct charges met by patients and contributions from health insurance premiums, with the state paying 40% of a beneficiary’s total health care costs.

The reforms will also see the introduction of electronic cards, national insurance numbers and a fully computerised database, which are all aimed at improving managerial services and speeding up the processing of patients.

Among the proposed improvements to direct service provision include an increase in the level of free preventative care, including scanning for cancer and mammograms.

“There is an emphasis on public health care with these reforms, though I want to encourage the private sector as well,” Khalifa said in an interview with international media in late August. “There is no reason why everyone should not have access to affordable health care and excellent hospital treatment wherever they go.”

The latest reforms are just part of a far broader process that the ministry has been working to put in place over the past few years. Earlier this year, the ministry mandated fixed rates for certain medical procedures and treatment, with more than half of all procedures having set tariffs.

Another step was taken in mid-October, with the ministry announcing it has chosen Accreditation Canada, an independent non-profit organisation that undertakes external reviews of health and social service providers, to conduct a six-month study of current Lebanese primary health care standards.

The project is seen as an important step in accomplishing the ministry’s goal of upgrading health facilities, including hospitals, primary health care centres, laboratories and other medical institutions.

According to Accreditation Canada’s president and CEO, Wendy Nicklin, one of the aims of the project is to share the organisation’s expertise in health care excellence through accreditation with Lebanon’s Ministry of Public Health.

“This initiative clearly demonstrates the ministry’s commitment to improve the health and wellbeing of the Lebanese people by providing them with the best quality health care services possible,” Nicklen said on October 19.

Of course, drafting a programme for broad-based reforms is one thing; implementing them is another. While Khalifa has held the office of health minister since 2005, long-running political uncertainty, combined with a new cabinet, will do little to help his efforts of pushing through such important reform.

Though it will probably be a challenge to advance the proposed reform package quickly, Khalifa does have a blueprint to work from for the future. Such a dramatic overhaul of the sector will surely be costly, but with some of the highest health costs in the region already, short-term spending pain may result in longer-term gain.